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Intravenous Angiotensin 2

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Intravenous Angiotensin 2, Intravenous Angiotensin II, Giapreza

  • See Also
  1. Vasopressor
  2. Angiotensin
  • Indications
  1. Septic Shock or other Distributive Shock
    1. Adjunct to other management (Intravenous Fluids, Vasopressors)
  • Pharmacology
  1. See Angiotensin for mechanism
  2. Angiotensin 2 increases Blood Pressure
  3. Half-Life: <1 minute
  4. Peak Effect: 5 minutes
  5. Metabolized by aminopeptidase A and Angiotensin Converting Enzyme 2 and 3
  • Dosing
  • Adults
  1. Initial
    1. Start 20 ng/kg/min
    2. Titrate in 5 to 15 ng/kg/min increments every 5 min for Blood Pressure response
    3. Maximum: 80 ng/kg/min in first 3 hours of management
  2. Maintenance
    1. Titrate in 5 to 15 ng/kg/min increments down every 5 to 15 min
    2. Maximum: 40 ng/kg/min
    3. Lowest effective dose: 1.25 ng/kg/min
  • Adverse Effects
  1. Venous Thromboembolism (e.g. DVT, PE)
    1. Most common adverse effect (>10% Incidence)
  2. Thrombocytopenia
  3. Tachycardia
  4. Fungal infection
  5. Delirium
  6. Acidosis
  7. Hyperglycemia
  8. Peripheral ischemia
  • Drug Interactions
  1. ACE Inhibitors
    1. Increase response to Angiotensin 2
  2. Angiotensin Receptor Blockers (ARB)
    1. Decrease response to Angiotensin 2
  • References
  1. LoVecchio (2018) Crit Dec Emerg Med 32(7): 28
  2. LoVecchio (2022) Crit Dec Emerg Med 36(7): 32