VIP

What it is

Vasoactive intestinal peptide (VIP) is a 28-amino-acid peptide your body makes naturally in the gut, brain, lungs and immune system. It relaxes smooth muscle and blood vessels, and it dials down inflammatory signalling.

The pharmaceutical form is called aviptadil. It has been used as an injected treatment for erectile dysfunction, combined with phentolamine, in a few countries. Outside that, VIP has been studied in lung conditions and in COVID-19 respiratory failure, where trial results did not lead to approval.

In the research peptide world, VIP is mainly associated with the chronic inflammatory response syndrome (CIRS) community. A US doctor, Ritchie Shoemaker, proposed a protocol that includes nasal VIP for people with mould illness-type CIRS. CIRS as a diagnosis is contested in mainstream medicine, and the evidence for that protocol is limited. Read this as a description, not an endorsement.

History

VIP was discovered in 1970 by Sami Said and Viktor Mutt, who isolated it from the gut and found it dilated blood vessels. It has been studied in lung disease, erectile dysfunction, pulmonary hypertension and sarcoidosis over the decades. Roughly 55 years old as a known molecule. The nasal use in CIRS dates from Shoemaker's work in the 2000s and 2010s.

How it works

VIP binds VPAC1 and VPAC2 receptors found on many cell types. It relaxes blood vessels and airway muscle, and signals immune cells to reduce production of inflammatory molecules. In the CIRS theory, low VIP is part of the problem, and replacing it is meant to help regulate inflammation and the brain-body signalling that goes wrong. That theory is not broadly accepted.

Dosage

• Shoemaker-style CIRS protocols use a nasal dose of around 50 mcg per spray, several times a day, as a prescription compounded product. Check the source protocol rather than relying on a summary, and note that this is prescribed within that practitioner community.
• Injectable doses reported in the community are small, tens to low hundreds of micrograms. They are extrapolations rather than trial doses.
• Because the half-life is so short, effects are brief and dosing is frequent.

How it is taken

• Nasal: reconstituted VIP is placed in a clean nasal spray bottle. Compounded nasal preparations from a pharmacy are made under sterile conditions. A homemade spray is less controlled, so contamination is a worry.
• Subcutaneous: a 29-31G insulin syringe into belly fat, though injection is less typical than nasal.
• Rotate sites if injecting. Keep nasal bottles clean and discard if cloudy.

How to reconstitute

• For a 10 mg vial, adding 5 ml of bacteriostatic water gives 2 mg/ml. On a 1 ml (100-unit) insulin syringe, 5 units (0.05 ml) is 100 mcg and 2.5 units is about 50 mcg.
• Those small unit numbers are awkward to measure accurately. For small doses, many people dilute further, for example adding the 10 mg to 10 ml gives 1 mg/ml where 5 units is 50 mcg and 10 units is 100 mcg (only if your vial can hold 10 ml).
• Add water slowly down the vial wall, swirl gently and do not shake. VIP is more fragile in solution than many peptides, so mix only what you will use within a short time.

How it should arrive

A sealed glass vial with a small white lyophilised cake. Ideally shipped cold or with cold packs.

How it should look once reconstituted

A clear, colourless solution. Any cloudiness or particles mean do not use it.

What to expect, and when

• Vascular effects such as flushing and lower blood pressure can occur within minutes of a dose.
• In the CIRS community, people report assessing symptoms and lab markers over weeks to a few months. This is anecdote and practitioner reports, not controlled trials.
• If nothing changes after a reasonable trial, it is probably not helping.

Side effects

• Nasal: nasal irritation, runny nose, congestion, nosebleeds.
• Flushing, warm sensation and headache, from blood vessel dilation.
• Lower blood pressure, dizziness or lightheadedness.
• Diarrhoea, since VIP affects the gut. In high amounts it causes watery diarrhoea.
• Increased heart rate in some people.

Risks

• Evidence for the CIRS protocol is limited and the underlying diagnosis is disputed in mainstream medicine. Chronic fatigue and brain fog have many treatable causes that should be checked first.
• Low blood pressure can be a problem, especially if you already take blood pressure medicine.
• A home-prepared nasal spray raises contamination risk. Compounded pharmacy versions are safer.
• VIP is not approved for general use in the UK, and what is sold online is unregulated.
• Because VIP is a signalling molecule with many roles, effects across the body over long-term use have not been fully studied.
• Quality varies, and a fragile peptide like VIP is more likely to degrade in transit.

Potential gains

• Licensed use: aviptadil combined with phentolamine for erectile dysfunction in some countries (given by injection into the penis).
• Small trials in lung conditions suggested some benefit, but the COVID-19 trials did not lead to approval.
• CIRS community reports of improved energy, cognition and symptoms. These are not backed by large, independent controlled trials.
• Anti-inflammatory and vasodilating effects are well established as pharmacology, but that does not mean they translate into a useful treatment for any given condition.

Other useful information

If you are thinking about VIP for chronic fatigue, brain fog or suspected mould illness, the sensible first step is a proper medical work-up. If you do go down this road, a compounded nasal product from a pharmacy is a lower-risk route than home-made sprays, and a clinician who knows your history is far better than going alone.