VIP

What it is

A 28-amino-acid neuropeptide discovered in 1970 that functions as a vasodilator, bronchodilator, immunomodulator, and neurotransmitter. VIP is widely distributed across the central and peripheral nervous systems and the gastrointestinal tract. The synthetic form, aviptadil, received FDA Orphan Drug Designation for ARDS and Fast Track Designation for COVID-19-associated respiratory failure, though the pivotal TESICO trial was stopped for futility. In the CIRS (Chronic Inflammatory Response Syndrome) and mold illness recovery community, intranasal VIP is the final step (Step 12) of the Shoemaker protocol, discussed in the context of neuroinflammation, grey matter restoration, and immune marker normalization. Independent RCT validation of the CIRS application is lacking.

Community-reported ranges

Intranasal dosing from published Shoemaker protocol documentation (50 mcg 4x daily starting, escalating to 100-150 mcg 4x daily). IV dosing from TESICO trial protocol (50-150 pmol/kg/hr). Not dosing guidance.

Frequently discussed alongside

Based on community forum discussions. Not a recommendation to combine compounds.

Published research

VIP occupies an unusual position: strong mechanistic rationale across multiple disease areas (PAH, CIRS, neuroinflammation, ARDS) but failure to achieve FDA approval for any indication. The TESICO trial's futility stop was a significant setback for the aviptadil program. In the CIRS community, VIP remains the protocol endpoint peptide prescribed by Shoemaker-trained physicians, with over 10,000 patients reportedly treated, but evidence quality is limited to open-label practitioner-reported data and small prospective studies (e.g., grey matter volume restoration on NeuroQuant MRI). The 2-minute IV half-life effectively restricts meaningful systemic use to continuous infusion, while the Shoemaker intranasal protocol leverages local mucosal delivery. The FDA's 2019 move to restrict VIP compounding adds regulatory uncertainty for CIRS practitioners.

Reported side effects

From community self-reports. Not from controlled studies.

IV aviptadil (clinical trials): hypotension is the most significant dose-limiting effect; the TESICO trial showed significant MAP drops and increased vasopressor requirements. Diarrhea (VIP stimulates intestinal water and electrolyte secretion — VIPomas cause classic watery diarrhea syndrome) and flushing are also reported. Intranasal (Shoemaker protocol): reported as generally well-tolerated across thousands of practitioner-managed patients, though independent safety monitoring data is lacking. Lipase elevation and pancreatitis are monitored risks; if lipase rises at the first in-office dose, VIP is discontinued per protocol.

Regulatory status