Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 2.5mg/mL
- 5mg/2mL
Shock
Indicated to increase blood pressure in adults with septic or other distributive shock
Initial: 20 ng/kg/minute IV by continuous infusion
Titration: Monitor blood pressure response and titrate q5min by increments of up to 15 ng/kg/min prn to achieve or maintain target blood pressure; not to exceed 80 ng/kg/min during the first 3 hr of treatment
Maintenance: Should not exceed 40 ng/kg/min; doses as low as 1.25 ng/kg/min may be used
Once the underlying shock has sufficiently improved, titrate downward q5-15min by increments of up to 15 ng/kg/min based on blood pressure
Administration via central venous line is recommended
Dosage Modifications
Renal or hepatic impairment
- Clearance of angiotensin II is not dependent on renal or hepatic function; therefore, the pharmacokinetics are not expected to be influenced by impairment
Safety and efficacy not established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (0)
Monitor Closely (20)
- azilsartan
azilsartan decreases effects of synthetic human angiotensin II by pharmacodynamic antagonism. Use Caution/Monitor.
- benazepril
benazepril increases effects of synthetic human angiotensin II by unspecified interaction mechanism. Use Caution/Monitor.
- candesartan
candesartan decreases effects of synthetic human angiotensin II by pharmacodynamic antagonism. Use Caution/Monitor.
- captopril
captopril increases effects of synthetic human angiotensin II by unspecified interaction mechanism. Use Caution/Monitor.
- enalapril
enalapril increases effects of synthetic human angiotensin II by unspecified interaction mechanism. Use Caution/Monitor.
- eprosartan
eprosartan decreases effects of synthetic human angiotensin II by pharmacodynamic antagonism. Use Caution/Monitor.
- finerenone
synthetic human angiotensin II and finerenone both increase serum potassium. Modify Therapy/Monitor Closely. Finerenone dose adjustment based on current serum potassium concentration. Monitor serum potassium and adjust finerenone dose as described in the prescribing information as necessary.
- fosinopril
fosinopril increases effects of synthetic human angiotensin II by unspecified interaction mechanism. Use Caution/Monitor.
- irbesartan
irbesartan decreases effects of synthetic human angiotensin II by pharmacodynamic antagonism. Use Caution/Monitor.
- lisinopril
lisinopril increases effects of synthetic human angiotensin II by unspecified interaction mechanism. Use Caution/Monitor.
- losartan
losartan decreases effects of synthetic human angiotensin II by pharmacodynamic antagonism. Use Caution/Monitor.
- moexipril
moexipril increases effects of synthetic human angiotensin II by unspecified interaction mechanism. Use Caution/Monitor.
- olmesartan
olmesartan decreases effects of synthetic human angiotensin II by pharmacodynamic antagonism. Use Caution/Monitor.
- perindopril
perindopril increases effects of synthetic human angiotensin II by unspecified interaction mechanism. Use Caution/Monitor.
- quinapril
quinapril increases effects of synthetic human angiotensin II by unspecified interaction mechanism. Use Caution/Monitor.
- ramipril
ramipril increases effects of synthetic human angiotensin II by unspecified interaction mechanism. Use Caution/Monitor.
- sacubitril/valsartan
sacubitril/valsartan decreases effects of synthetic human angiotensin II by pharmacodynamic antagonism. Use Caution/Monitor.
- telmisartan
telmisartan decreases effects of synthetic human angiotensin II by pharmacodynamic antagonism. Use Caution/Monitor.
- trandolapril
trandolapril increases effects of synthetic human angiotensin II by unspecified interaction mechanism. Use Caution/Monitor.
- valsartan
valsartan decreases effects of synthetic human angiotensin II by pharmacodynamic antagonism. Use Caution/Monitor.
Minor (0)
Adverse Effects
>10%
Thromboembolic events (12.9%)
1-10%
Thrombocytopenia (9.8%)
Tachycardia (8.6%)
Fungal infection (6.1%)
Delirium (5.5%)
Acidosis (5.5%)
Deep vein thrombosis (4.3%)
Hyperglycemia (4.3%)
Peripheral ischemia (4.3%)
Warnings
Contraindications
None
Cautions
Risk of thromboembolism observed in clinical trials; use concurrent venous thromboembolism prophylaxis
Drug interaction overview
- Coadministration with angiotensin-converting enzyme (ACE inhibitors) may increase response to angiotensin II
- Coadministration with angiotensin II blockers may decrease response to angiotensin II
Pregnancy
Pregnancy
Data are insufficient in pregnant women to determine risk of adverse developmental outcomes
Animal reproduction studies have not been conducted
Clinical considerations: Septic or other distributive shock is a medical emergency that can be fatal if left untreated; delaying treatment in pregnant women with hypotension associated with septic or other distributive shock is likely to increase the risk of maternal and fetal morbidity and mortality
Lactation
Unknown if distributed in human breast milk
Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for the drug, and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal condition
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Angiotensin II, the major bioactive component of the renin-angiotensin-aldosterone system (RAAS), serves as one of the body’s central regulators of blood pressure
It raises blood pressure by vasoconstriction and increased aldosterone release; direct action of angiotensin II on the vessel wall is mediated by binding to the G-protein-coupled angiotensin II receptor type 1 on vascular smooth muscle cells, which stimulates Ca2+/calmodulin-dependent phosphorylation of myosin and causes smooth muscle contraction
Absorption
Serum levels are similar at baseline and at 3 hr; after 3 hr, however, the serum level of angiotensin I (precursor of angiotensin II) is reduced ~40%
Metabolism
Metabolized by aminopeptidase A and angiotensin-converting enzyme 2 to angiotensin-(2-8) [angiotensin III] and angiotensin-(1-7), respectively in plasma, erythrocytes, and many of the major organs (ie, intestine, kidney, liver, lung)
Elimination
Half-life: <1 min
Administration
IV Compatibilities
0.9% NaCl
IV Preparation
Inspect solution for particulate matter and discoloration; solution should appear clear
Solution must be diluted before use with 0.9% NaCl to a final concentration of 5,000 or 10,000 ng/mL
Diluted solution concentrations
Not fluid restricted
- 2.5-mg/mL vial in 500 mL 0.9% NaCl = 5,000 ng/mL
Fluid restricted
- 2.5-mg/mL vial in 250 mL 0.9% NaCl = 10,000 ng/mL
- 5-mg/2 mL vial in 500 mL 0.9% NaCl = 10,000 ng/mL
IV Administration
Administer by continuous IV infusion via central venous line
Storage
Unopened vials
- Refrigerate at 36-46°F (2-8°C)
Diluted solution
- May store refrigerated or at room temperature
- Discard prepared solution after 24 hr
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Giapreza intravenous - | 0.5 mg/mL vial |  | |
| Giapreza intravenous - | 2.5 mg/mL vial |  |
Copyright © 2010 First DataBank, Inc.
Formulary
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