Synthetic version of human angiotensin II. Used in the ICU to raise blood pressure in septic or distributive shock that does not respond to other vasopressors.
Regulatory status
Approved (FDA / EMA)
Family
Peptide vasopressor (renin-angiotensin system)
Scientific evidence
Moderate
Number of findings
1
Where it acts
Heart and blood
Also known as
angiotensin II, Giapreza, LJPC-501
Regulatory status
FDA (US): Approved (2017, Giapreza) to raise blood pressure in adults with septic shock or other distributive shock.
EMA (EU): Approved (2019, Giapreza) for refractory hypotension in adults with septic shock or other distributive shock despite fluids and vasopressors.
Dose
Continuous intravenous infusion via a central line: 20 ng/kg/min at the start, adjusting every 5 minutes; not exceeding 80 ng/kg/min in the first 3 hours or 40 ng/kg/min for maintenance (FDA Giapreza label). ICU only.
Safety
More arterial and venous thrombosis than with placebo (13% vs 5%), so antithrombotic prophylaxis is recommended. Also decreased platelets, tachycardia, delirium, hyperglycemia, and fungal infections.
Interactions
ACE inhibitors may increase its effect; ARBs may reduce it.
Differences between women and men
The FDA label found no relevant pharmacokinetic differences between men and women.
Effect by goal · level of evidence
Blood pressure rise in refractory shock
improvesModerateRCT (AA)in people
70% vs 23% response
ATHOS-3 trial with 321 adults: 70% reached the target blood pressure at 3 hours versus 23% with placebo. 28-day mortality of 46% versus 54%, a non-significant difference (data from the FDA label).
Angiotensin II is a natural hormone that constricts blood vessels by binding to the AT1 receptor. It also stimulates the release of aldosterone and vasopressin. This raises blood pressure and allows lower doses of other vasopressors.
What the evidence says
In people
Blood pressure rise in refractory shock. ATHOS-3 trial with 321 adults: 70% reached the target blood pressure at 3 hours versus 23% with placebo. 28-day mortality was 46% versus 54%, a nonsignificant difference (data from the FDA prescribing information). PubMed 28528561