Synthetic human angiotensin II
Indications
Synthetic human angiotensin II is used for:
Indicated to increase blood pressure in adults with, septic shock, other distributive shock
Adult Dose
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
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
Child Dose
Renal Dose
Renal impairment
Clearance of angiotensin II is not dependent on renal or hepatic function; therefore, the pharmacokinetics are not expected to be influenced by impairment
Administration
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
IV Administration
Administer by continuous IV infusion via central venous line
Contra Indications
Precautions
Risk of thromboembolism observed in clinical trials; use concurrent venous thromboembolism prophylaxis
Pregnancy-Lactation
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
Interactions
Coadministration with angiotensin-converting enzyme (ACE inhibitors) may increase response to angiotensin II
Coadministration with angiotensin II blockers may decrease response to angiotensin II
Adverse Effects
Side effects of Synthetic human angiotensin II :
>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%)
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