angiotensin II


an-jee-oh-ten-sin too

Trade Name(s)

  • Giapreza

Ther. Class.

Pharm. Class.


Increases blood pressure in septic or other distributive shock.


Causes vasoconstriction and release of aldosterone, which lead to an increase in blood pressure.

Therapeutic Effect(s):

Increase in mean arterial pressure.


Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism and Excretion: 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 major organs.

Half-life: <1 min.

TIME/ACTION PROFILE (increase in mean arterial pressure)

IVminutes5 minminutes


Contraindicated in:

  • None.

Use Cautiously in:

  • OB:  Use only if potential maternal benefit outweighs potential fetal risk
  • Lactation: Safety not established;
  • Pedi:  Safety and effectiveness in children not established.

Adverse Reactions/Side Effects

CNS: delirium

CV: THROMBOEMBOLIC EVENTS, peripheral ischemia, tachycardia

Endo: hyperglycemia

Hemat: thrombocytopenia

Misc: fungal infection

* CAPITALS indicate life-threatening.
Underline indicate most frequent.



  • Concurrent use with  ACE inhibitors  may ↑ vasopressor effects.
  • Concurrent use with  angiotensin receptor blockers  may ↓ vasopressor effects.


IV (Adults): 20 ng/kg/min continuous infusion; may be titrated every 5 min of up to 15 ng/kg/min to achieve or maintain target mean arterial pressure. Do not exceed dose of 80 ng/kg/min during first 3 hr. During maintenance therapy, do not exceed dose of 40 ng/kg/min. Once shock has adequately improved, titrate down by 15 ng/kg/min every 5–15 min based on mean arterial pressure.


Solution for IV infusion (must be diluted): 2.5 mg/mL


  • Monitor blood pressure continuously or frequently during therapy.
  • Monitor for deep venous thromboses. Use concurrent venous thromboembolism (VTE) prophylaxis (TED stockings, hydration) during therapy.

Potential Diagnoses


  • Rate: Administer based on rate in Route/Dosage. After sufficient improvement in underlying shock, down-titrate every 5–15 min by increments of up to 15 ng/kg/min based on blood pressure.

IV Administration

Continuous Infusion:   Diluent:  Dilute vial of angiotensin II in 250 ml for fluid restriction or 500 ml of 0.9% NaCl. Concentration: 5,000 ng/mL or 10,000 ng/mL.Store at room temperature or refrigerated for up to 24 hrs. Discard unused portion of vial or diluted solution after 24 hrs. Administer through central line.

Patient/Family Teaching

  • Educate patient on purpose of angiotensin II.
  • Advise female patient to notify health care profession if pregnant.

Evaluation/Desired Outcomes

Increase in mean arterial pressure.

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Anesthesia Central is an all-in-one web and mobile solution for treating patients before, during, and after surgery. This collection of drug, procedures and test information is derived from Davis’s Drug, MGH Clinical Anesthesia Procedures, Pocket Guide to Diagnostic Tests, and MEDLINE Journals. .