Immune · 28-aa neuropeptide · Compounded 503A
VIP: vasoactive intestinal peptide for immune balance.
VIP (vasoactive intestinal peptide) is a 28-amino-acid neuropeptide with profound anti-inflammatory, vasodilatory, and immunomodulatory activity. It has gained clinical attention through Dr. Ritchie Shoemaker's CIRS (chronic inflammatory response syndrome) protocol, where it is the capstone treatment for restoring immune and hormonal balance.
What VIP (Vasoactive Intestinal Peptide) is
VIP is a 28-amino-acid peptide produced throughout the central and peripheral nervous system, gut, and immune cells. It is part of the secretin/glucagon peptide superfamily and signals through the VPAC1 and VPAC2 receptors.
Endogenously, VIP regulates vasodilation, smooth muscle relaxation, intestinal secretion, and circadian rhythm — but in clinical practice it is best known for its immunomodulatory effects.
Therapeutic compounded VIP nasal spray has been popularized by the Shoemaker CIRS protocol as the final step after biotoxin exposure mitigation — used to restore hormonal axis function and resolve residual inflammation.
How it works
VIP binds VPAC1 and VPAC2 receptors on immune cells, neurons, and epithelial cells. This shifts the immune balance toward Th2 and regulatory T cell responses while suppressing Th1 inflammation — particularly relevant in chronic dysregulated immune states.
VIP stabilizes mast cells and reduces histamine release — relevant for mast cell activation syndrome (MCAS) and chronic histamine-driven symptoms.
In the brain, VIP modulates microglial activation and supports circadian rhythm function through the suprachiasmatic nucleus — relevant for sleep, mood, and neuroinflammatory states.
What patients use it for
CIRS recovery
The signature clinical use — restoring hormonal axis function and resolving residual inflammation in patients who have completed the biotoxin-exposure mitigation steps of the Shoemaker protocol.
Mast cell modulation
Stabilizes mast cells and reduces histamine release — relevant for MCAS, chronic urticaria, and histamine intolerance.
Neuroinflammation
Modulates microglial activation and supports brain immune balance — relevant in post-infectious cognitive and neuroinflammatory states.
Pulmonary support
VIP's vasodilatory and anti-inflammatory activity has been investigated in pulmonary hypertension and inflammatory pulmonary conditions.
Evidence summary
Delgado M, Ganea D (Amino Acids, 2013) reviewed VIP's immunomodulatory mechanism — including Th1 suppression, Treg promotion, and anti-inflammatory cytokine modulation.
Shoemaker RC et al. (Health & Environmental Research Online, 2013) described the VIP component of the CIRS protocol and reported clinical and laboratory recovery in mold biotoxin-illness patients.
Petkov V et al. (J Clin Invest, 2003) demonstrated efficacy of inhaled VIP in pulmonary hypertension — an early clinical proof of concept for therapeutic VIP.
Honest framing: VIP has well-characterized anti-inflammatory pharmacology and an established niche use in CIRS practice; broader RCT data is limited.
Dosing and clinical context
General clinical context only. Kindr Health physicians determine the appropriate dose and protocol for each patient based on history and labs. This is not a prescription or dosing recommendation.
Most commonly intranasal spray — typical Shoemaker-protocol regimens are 50 mcg per spray, 1–4 times daily, with periodic reassessment of laboratory markers.
Best used as the capstone of a comprehensive CIRS protocol — not as a standalone intervention. Pretesting and lab monitoring are central to safe use.
Compounded VIP nasal spray from licensed 503A pharmacies is the typical U.S. dispensing pathway. Not FDA-approved.
Safety and contraindications
Generally well-tolerated when used per protocol. The most common reported issue is mild nasal irritation.
Specific to CIRS protocols: VIP should only be started after biotoxin exposure is removed and prerequisite labs are in range — otherwise it can trigger pancreatitis or symptom flare. This is the central safety teaching of the Shoemaker protocol.
Contraindications: ongoing biotoxin exposure, pancreatitis history, pregnancy, lactation. Use under physician supervision familiar with the protocol.
Who it's typically considered for
- Patients completing a structured CIRS protocol under specialist supervision
- Patients with MCAS or chronic histamine-driven symptoms
- Adults with post-infectious neuroinflammatory presentations under specialist guidance
- Patients with chronic inflammatory states unresponsive to first-line therapy
Frequently asked questions
Is VIP FDA-approved?
No. VIP is investigational; compounded preparations are dispensed by licensed 503A pharmacies under physician prescription for off-label use.
What is the CIRS protocol?
CIRS (chronic inflammatory response syndrome) is a clinical framework developed by Dr. Ritchie Shoemaker for chronic illness triggered by biotoxin exposure (mold, post-Lyme, post-Babesia). VIP nasal spray is the capstone step.
Can I use VIP if I'm still exposed to mold?
No. The protocol is explicit: VIP should not be started until exposure is removed and prerequisite labs are in range. Using VIP before that point can trigger pancreatitis or symptom flare.
Will VIP help my mast cell symptoms?
VIP's mast cell-stabilizing mechanism is well-aligned with MCAS support. Many MCAS specialists incorporate VIP nasal spray into multi-modal protocols.
VIP vs KPV — which?
Different size, different scope. KPV is a small tripeptide best for gut and skin inflammation. VIP is a larger neuropeptide with broader systemic and CNS effects. They address overlapping but distinct conditions.
How long are typical VIP courses?
VIP is often used for extended periods (months) under the Shoemaker protocol with periodic lab reassessment — but always with specialist supervision.
Does VIP affect sleep?
VIP modulates the suprachiasmatic nucleus and circadian rhythm. Some patients report sleep improvements; others report timing-dependent effects. Discuss timing with your physician.
Sources
- Delgado M, Ganea D. Vasoactive intestinal peptide: a neuropeptide with pleiotropic immune functions. Amino Acids (2013). — pubmed.ncbi.nlm.nih.gov/22139413
- Shoemaker RC et al. Structural brain abnormalities in patients with inflammatory illness acquired following exposure to water-damaged buildings. Health and Environmental Research Online (2014). — pubmed.ncbi.nlm.nih.gov/24560070
- Petkov V et al. Vasoactive intestinal peptide as a new drug for treatment of primary pulmonary hypertension. J Clin Invest (2003). — pubmed.ncbi.nlm.nih.gov/14523040
- Gomariz RP et al. VIP-PACAP system in immunity: new insights for multitarget therapy. Annals of the NY Academy of Sciences (2006). — pubmed.ncbi.nlm.nih.gov/16831909
Considering VIP (Vasoactive Intestinal Peptide)?
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Medically reviewed by Dr. Ana Lisa Carr, MD, MBA
Board-Certified Family Medicine Physician · Lead Provider / Medical Reviewer
NPI 1689841744 · Last reviewed: May 10, 2026
Last reviewed May 10, 2026. Compounded medications are prepared by FDA-registered 503A pharmacies and are not FDA-approved drug products. Prescriptions require a clinical evaluation; a Kindr Health physician determines eligibility. Not for use in pregnancy. This page provides educational information and is not medical advice.