Angiotensin II

Class: Renin-Angiotensin-Aldosterone System (RAAS)
Chemical Name: L-aspartyl-L-arginyl-L-valyl-L-tyrosyl-L-isoleucyl-L-histidyl-L-prolyl-L-phenylalanine acetate salt
Molecular Formula: C₅₀H₇₁N₁₃O₁₂•(C₂H₄O₂)
CAS Number: 68521-88-0
Brands: Giapreza

Medically reviewed by Drugs.com on Oct 25, 2021. Written by ASHP.

Introduction

Vasoconstrictor; synthetic form of endogenous angiotensin II, a peptide hormone of the renin-angiotensin-aldosterone system (RAAS).

Uses for Angiotensin II

Shock

Used to increase BP in patients with septic or other distributive shock.

Substantially and rapidly increases mean arterial pressure (MAP) in patients who remain hypotensive despite fluid and vasopressor therapy.

May have a catecholamine-sparing effect, but effects on mortality not established.

Angiotensin II Dosage and Administration

General

• Individualize dosage based on BP response.

• Monitor BP and titrate dosage as frequently as every 5 minutes to achieve or maintain target BP.

Administration

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Administer by continuous IV infusion; manufacturer recommends administration via central venous line.

Dilution

Must dilute commercially available injection concentrate prior to infusion.

Dilute with 0.9% sodium chloride injection to final concentration of 5000 or 10,000 ng/mL depending on patient's fluid status. For patients who are not fluid restricted, prepare concentration of 5000 ng/mL by adding 1 mL (2.5 mg) of the injection concentrate to an infusion bag containing 500 mL of 0.9% sodium chloride injection. For fluid-restricted patients, prepare concentration of 10,000 ng/mL by adding 1 mL (2.5 mg) of the injection concentrate to an infusion bag containing 250 mL of 0.9% sodium chloride injection.

Rate of Administration

Individualize rate of IV infusion based on BP response without exceeding maximum recommended rates. (See Prescribing Limits under Dosage and Administration.)

Dosage

Available as angiotensin II acetate; dosage expressed in terms of angiotensin II.

Adults

Septic or Other Distributive Shock

IV

Initially, 20 ng/kg per minute by continuous IV infusion. Titrate based on BP response. May increase infusion rate by increments of up to 15 ng/kg per minute as frequently as every 5 minutes as needed to achieve or maintain target BP. Do not exceed maximum dosage of 80 ng/kg per minute during the first 3 hours of treatment.

When underlying shock has improved, titrate dosage downward by decrements of up to 15 ng/kg per minute every 5 to 15 minutes as tolerated to maintain target BP. Do not exceed maximum dosage of 40 ng/kg per minute during maintenance therapy.

Prescribing Limits

Adults

Septic or Other Distributive Shock

IV

First 3 hours of infusion: Maximum 80 ng/kg per minute.

Maintenance period: Maximum 40 ng/kg per minute.

Special Populat...