ARA-290 (Cibinetide) protocol

Standard

Week 1 (ramp)

25u

2 mg · Daily SubQ

Common community start, assess tolerance before the full dose.

Weeks 2–4 (target)

50u

4 mg · Daily SubQ

The trial dose. Phase 2 tested 1–8 mg/day; 4 mg was the therapeutic target and 8 mg gave no extra benefit, do not chase a higher dose.

Off

After 28 days

Trials ran a single 28-day course. Reassess before repeating; no long-term dosing data exists.

Phase	How often	Dose	Units	Notes
Week 1 (ramp)	Daily SubQ	2 mg	25u	Common community start, assess tolerance before the full dose.
Weeks 2–4 (target)	Daily SubQ	4 mg	50u	The trial dose. Phase 2 tested 1–8 mg/day; 4 mg was the therapeutic target and 8 mg gave no extra benefit, do not chase a higher dose.
Off	After 28 days	–	–	Trials ran a single 28-day course. Reassess before repeating; no long-term dosing data exists.

Cycle & timing

Cycle: A 28-day daily course (what the trials actually did), then reassess. Community practice repeats courses with a break rather than dosing continuously.

Timing: Daily SubQ, anytime; consistency matters more than time of day.

Where: SubQ abdomen or thigh. Rotate. Bioavailability >85% SubQ.

What to expect

Neuropathic pain and symptom scores improved over the 28-day course; structural nerve regrowth (corneal nerve fiber density) measurable by day 28. Serum half-life is only minutes, the effect comes from receptor signalling, not blood levels, so don’t chase frequency.

How much to buy

For at the 4 mg/day target. At 2 mg/day, halve it.:

4 days/vial (7 vials per 28-day course)

× 16mg vials

2.5 days/vial (~11 vials)

× 10mg vials

Men & women

Unisex, the IRR repair pathway is not sex-specific and trials enrolled both men and women at the same 4 mg dose; no cycle effect. Avoid in pregnancy (no data).

Dilution calculator

Set to the guide's typical mix for ARA-290 (Cibinetide). Change anything to see where to draw.

Vial size

BAC water added

Dose you want

Draw to

50u

Volume

0.50 mL

Strength

8 mg/mL

Doses per vial

2

Assumes a U-100 insulin syringe (100 units = 1 mL). Double-check against the compound's page before you draw.

Recommended mixes

Vial	Water	Strength
10 mg	1.25 mL	8 mg/mL
16 mg	2 mL	8 mg/mL

10 mg: 1 unit = 0.08 mg (4 mg = 50u)

Storage

PowderFreeze-dried: -4°F.
MixedReconstituted: 36–46°F, use within 4 weeks; protect from light.

Don't use if: Active malignancy, theoretical, via EPO-receptor pathway biology · Concurrent erythropoietin / ESA therapy · Pregnancy and lactation (no data)

Stop if you notice

Rising hematocrit or hemoglobin (unexpected, evaluate)
New or worsening cardiovascular symptoms
Persistent injection-site reaction beyond 7 days

Side effects

Well tolerated in trials. Occasional mild injection-site reaction. No rise in hemoglobin, hematocrit, reticulocytes, or blood pressure at 4 mg/day × 28 days; the key difference from EPO.

Drug interactions

Erythropoietin / ESAs (epoetin, darbepoetin): overlapping receptor pathway; do not combine. Immunosuppressants / biologics: ARA-290’s anti-inflammatory effect may confound response markers, coordinate monitoring, don’t replace prescribed therapy. No known interaction with the other peptides in this guide.

Labs

Compound-specific: CBC at baseline + end (confirm hematocrit/hemoglobin are unchanged, they should be). CMP baseline. Out of range? A rising hematocrit is NOT expected on ARA-290, investigate another cause.

What these labs mean →

Warnings

Not FDA-approved. Holds orphan-drug designation for sarcoidosis-associated small-fiber neuropathy, but was never submitted for approval; development stalled after 2020 when the sponsor wound down. All human data is Phase 2, single-institution (Netherlands), n ranging from under 40 to 64; no Phase 3 replication. Longest human exposure studied is 28 days, long-term safety is unknown. Interacts with EPO-receptor complexes and vascular endothelium, caution with pre-existing cardiovascular disease. Vial quality varies, request a COA for each lot.

Patient education

This treats nerve symptoms, not the underlying disease causing them; keep treating the root cause. Give it the full 28 days; nerve regrowth is slow and the trial endpoints were measured at day 28. More is not better: 8 mg/day performed no better than 4 mg in trials. Aseptic technique: swab the septum and site, single-use sterile needle every injection, never share vials. Mark the date of first puncture; inspect for cloudiness or particulates before each use. Sharps disposal in an FDA-cleared container.

These apply on top of the universal safety rules.

Pairs well with

BPC-157

broader tissue repair

BPC-157

KPV

additive anti-inflammatory

KPV

Alpha-lipoic acid / B12

standard neuropathy support

Vitamin B12

Avoid with

Active malignancy

EPO-receptor biology, theoretical

Erythropoietin / ESA therapy

overlapping receptor pathway

Pregnancy, lactation

Can ARA-290 (Cibinetide) + BPC-157 share a syringe?

Can share a syringe. Both are water-based. Combine them if you dose on the same schedule and site.

What it does

11-amino-acid peptide from the helix-B domain of erythropoietin. Selectively activates the Innate Repair Receptor (IRR), the EPOR/CD131 (β-common) heterodimer, not the classic EPO receptor. Drives tissue protection, small-nerve-fiber regeneration, and resolution of inflammation, without stimulating erythropoiesis.

Evidence

Phase 2 human RCT data (sarcoidosis small-fiber neuropathy), unusually strong for this catalog, but single-institution and no Phase 3.

Approved drug

Four drugs are FDA-approved for nerve pain: pregabalin (Lyrica), duloxetine (Cymbalta), tapentadol ER (Nucynta) and the 8% capsaicin patch (Qutenza). Proven and prescribable, reasonable to try first.

References

NCT02039687 (Phase 2b)IOVS, corneal nerve fiber PubMed IRR mechanism FSR webinar

From the guide, page 18.