synthetic human angiotensin II (Rx)

Brand and Other Names:Giapreza
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Dosing & Uses

AdultPediatric

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

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Interactions

Interaction Checker

and synthetic human angiotensin II

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            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%)

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            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
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            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.

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            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

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            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
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            Formulary

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.