Evidence Grade A — Regulatory approved. 104 published studies. 10 registered clinical trials.
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Sincalide (sold as Kinevac) is not a treatment — it is a diagnostic tool. It is a synthetic version of the active portion of cholecystokinin (CCK), a gut hormone that makes the gallbladder contract. Doctors use it during imaging scans (HIDA scans) to measure how well the gallbladder empties — helping diagnose gallbladder dysfunction in patients with symptoms but no gallstones.
Sincalide is also known by these brand and alternate names:
104 published studies: 83 human, 12 animal, 5 in-vitro, 13 reviews
Sincalide is marketed as Kinevac (Bracco Diagnostics, approved approximately 1976). Its primary use is during hepatobiliary scintigraphy (HIDA scans) to assess gallbladder function. It is also used to stimulate pancreatic secretion for collection during diagnostic testing and to accelerate barium transit during small bowel imaging.
Sincalide is one of the longest-established peptide compounds in clinical use and one of the few used purely for diagnostic purposes. Its role in gallbladder ejection fraction testing is well-established, though debate continues about the clinical significance of a low ejection fraction and whether it reliably predicts symptom improvement after gallbladder removal.
After a meal, the gut releases cholecystokinin to signal the gallbladder to contract and release bile into the intestine for fat digestion. Sincalide mimics this signal by activating CCK receptors on the gallbladder muscle, producing a controlled contraction. During a HIDA scan, this allows radiologists to calculate the gallbladder ejection fraction — essentially how much bile the gallbladder can push out. A low ejection fraction (below 35–40%) suggests gallbladder dysfunction and may support a decision for surgery.
Sincalide's role in the gallbladder ejection fraction test during HIDA scans is well established. A low ejection fraction (below 35-40%) suggests the gallbladder is not functioning properly and may support a decision for surgical removal. However, there is ongoing debate about how reliable this test is at predicting which patients will actually feel better after gallbladder surgery — the clinical significance of a low ejection fraction in the absence of gallstones remains contested. No significant research programmes exist for sincalide itself. The broader CCK receptor field remains active in research, with CCK-1 receptor activation explored for appetite control and weight management, though no therapeutics have reached approval through this pathway.
PeptideTrace tracks 10 registered clinical trials for Sincalide sourced from ClinicalTrials.gov.
Mechanisms and Targeted Therapy of Airway Basal Cell Dysfunction in Bronchiolitis Obliterans Syndrome
POTS-FLOW: Interplay Between Gut Hormones and Autonomic Postprandial Blood Flow Regulation in Patients With POTS
Study to Assess the Way the Body Absorbs, Distributes, Breaks Down and Eliminates Radioactive BMS-986278 in Healthy Male Participants
A Study Evaluating the Effect of Albiglutide on Gallbladder Emptying in Healthy Subjects
Impact of Two Genetic Variants of OATP1B3 or MRP2 or Rifampin on Systemic Disposition and Biological Efficacy of CCK-8
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Sincalide is the synthetic C-terminal octapeptide (8 amino acids) of cholecystokinin (CCK), retaining the biologically active portion of the native 33-amino-acid hormone. It is used exclusively as a diagnostic agent.
Sincalide activates cholecystokinin-A (CCK₁) receptors on gallbladder smooth muscle cells, producing gallbladder contraction and bile ejection into the duodenum. It also stimulates pancreatic enzyme and bicarbonate secretion via CCK₁ receptors on pancreatic acinar and duct cells. There are no therapeutic applications—it is a pharmacological provocation test agent.
Sincalide is marketed as Kinevac (Bracco Diagnostics, originally approved approximately 1976). Diagnostic indications: (1) gallbladder contraction for hepatobiliary scintigraphy (HIDA scan)—gallbladder ejection fraction (GBEF) calculation, where normal is ≥35–40%; (2) stimulation of pancreatic secretion for collection and analysis; (3) acceleration of barium transit in small bowel follow-through imaging. Administered IV over 30–60 seconds for HIDA scans.
Linaclotide is marketed as Linzess (approved August 2012). It is taken as a daily oral capsule on an empty stomach, at least 30 minutes before the first meal. The recommended dose is 290 mcg for IBS-C and 72 or 145 mcg for chronic constipation. In clinical trials, approximately 34% of IBS-C patients met the composite improvement endpoint compared to 17% on placebo. Diarrhoea is the most common side effect (approximately 20%) and the leading reason for discontinuation. Linaclotide has a boxed warning against use in children under 6 years due to deaths in young mice, though no such events have been reported in humans. It competes with plecanatide (which targets the same pathway) and other IBS-C treatments.
Elamipretide (Forzinity) was approved by the FDA for Barth syndrome based on the TAZPOWER trial. The randomised crossover phase (12 patients) did not meet its primary endpoints, but the open-label extension (168 weeks) demonstrated durable improvements in walking distance and muscle strength that formed the basis for approval. Barth syndrome affects approximately 1 in 300,000–400,000 births. A larger Phase III trial in primary mitochondrial myopathy (218 patients, MMPOWER-3) did not meet its primary endpoint, and the drug was not approved for that broader indication. Elamipretide remains approved exclusively for Barth syndrome. See also SS-31 (#158) for the research compound context.
Glucagon has been available as an emergency injection since the 1960s and remains the standard rescue treatment for severe hypoglycaemia. Recent innovation has focused on making it easier to administer in emergencies. Baqsimi, approved in 2019, was the first needle-free option as a nasal powder. Gvoke, also approved in 2019, eliminated the need to mix and reconstitute the medication before injection — a significant advance since severe hypoglycaemia often impairs the ability to follow complex preparation steps. Dasiglucagon (Zegalogue), a next-generation stable liquid glucagon approved in 2021, further improved on the convenience of rescue administration. Beyond emergency rescue, glucagon's receptor is now a major research target — dual and triple agonists combining glucagon receptor activity with GLP-1 (such as survodutide and retatrutide) are in advanced clinical trials for obesity and metabolic disease.
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