Angiotensin II

Summary

Angiotensin II (Giapreza) is a synthetic human angiotensin II approved for vasodilatory shock. It acts on AT1 receptors to produce potent vasoconstriction, raising mean arterial pressure in catecholamine-refractory septic or other distributive shock states.

Mechanism of Action

Endogenous octapeptide that binds AT1 and AT2 receptors. AT1 receptor activation causes vasoconstriction, aldosterone secretion, sodium retention, and increased blood pressure. Also stimulates ADH release and sympathetic nervous system activity.

Routes of Administration

Goals & Uses

• Hepatorenal Syndrome (investigational)Renal/HepaticLow
• Mean Arterial Pressure IncreaseHemodynamic SupportHigh
• Septic Shock Rescue TherapyCritical CareHigh
• Catecholamine-Sparing EffectSupportive CareModerate
• Vasodilatory/Distributive Shock ManagementHemodynamic SupportHigh

Contraindications

• Hypersensitivity to angiotensin II or excipientsAllergyHigh
• Concurrent use of ACE inhibitors in certain contextsDrug InteractionModerate

Adverse Effects

• Peripheral ischemiaVascularUncommon
• Fungal infectionInfectiousUncommon
• TachycardiaCardiovascularCommonAbnormally fast heart rate
• Thromboembolic events (DVT, arterial thrombosis)CardiovascularCommon
• Delirium / agitationNeuropsychiatricUncommon
• Hypertension / excessive blood pressure elevationCardiovascularCommon

Drug Interactions

• Norepinephrine / CatecholaminesModerate
• Angiotensin Receptor Blockers (ARBs)Moderate
• VasopressinModerate
• ACE Inhibitors (e.g., enalapril, lisinopril)Moderate

Population Constraints

• PregnancyReproductive SafetyRelative
• Pediatric patientsAgeRelative
• Patients with pre-existing thromboembolic disordersHematologicRelative
• Severe coronary artery diseaseCardiovascularRelative

Regulatory Status

• European UnionApprovedApproved: Refractory vasodilatory shock in adultsEMA approved October 2019 under brand name Giapreza; marketed by PAION.
• United StatesApprovedApproved: Vasodilatory shock (to increase blood pressure in adults with septic or other distributive shock)FDA approved December 21, 2017 under brand name Giapreza (La Jolla Pharmaceutical). Orphan Drug designation granted.
• United KingdomApprovedApproved: Vasodilatory shock in adultsApproved by MHRA following EMA approval; post-Brexit maintained authorization.

FDA-approved in December 2017 (Giapreza, La Jolla Pharmaceutical) for vasodilatory shock. EMA approved in 2019. Indicated as a vasopressor to increase blood pressure in adults with septic or other distributive shock.

Evidence & Sources

No sources recorded yet.