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Vasopressor (Angiotensin II Receptor Agonist) Pregnancy: Published data in pregnant women are insufficient to determine a drug-associated risk of adverse developmental outcomes; animal reproduction studies have not been conducted. Septic or other distributive shock is a medical emergency that can be fatal if untreated, and delaying treatment in pregnant women is likely to increase maternal and fetal morbidity and mortality.

Angiotensin II (Human)

Brand names: Giapreza

Angiotensin II (human) is a vasoconstrictor used as an intravenous infusion to raise blood pressure in adults with refractory hypotension due to septic or other distributive shock.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Starting dosage 20 nanograms (ng)/kg/min by continuous intravenous infusion; titrate as frequently as every 5 minutes by increments of up to 15 ng/kg/min as needed to achieve or maintain target blood pressure
Route: Continuous intravenous infusion only — must be diluted in 0.9% sodium chloride before use; administration through a central venous line is recommended
Frequency: Continuous infusion, titrated every 5 minutes against blood pressure response
Max: Do not exceed 80 ng/kg/min during the first 3 hours of treatment; maintenance doses 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, down-titrate every 5 to 15 minutes by increments of up to 15 ng/kg/min based on blood pressure. Dilute the contents of one vial (2.5 mg/mL) in 0.9% sodium chloride to a final concentration of 5,000 ng/mL (1 mL into a 500 mL bag) or, if fluid restricted, 10,000 ng/mL (1 mL into a 250 mL bag). Diluted solution may be stored at room temperature or refrigerated and must be discarded after 24 hours. Use concurrent venous thromboembolism (VTE) prophylaxis because of the thrombotic risk. THIS DOSE IS FROM THE US LABEL; no UK SPC posology was available in this bundle — verify against UK labelling before use.

Dose auto-extracted from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • None stated (US label section 4: 'None')

Side effects

  • Thromboembolic events (most common, >10%; 12.9% vs 5.1% with placebo in ATHOS-3)
  • Deep vein thrombosis (4.3% vs 0% with placebo)
  • Thrombocytopenia (9.8% vs 7.0% with placebo)
  • Tachycardia (8.6% vs 5.7% with placebo)
  • Fungal infection (listed among reactions occurring in >=4% of treated patients; entry truncated in the fetched label text)

Interactions

  • ACE inhibitors — concomitant use may increase the response to angiotensin II
  • Angiotensin II receptor blockers (ARBs) — concomitant use may decrease the response to angiotensin II

Clinical monograph

How it works

It is a synthetic form of the endogenous peptide hormone angiotensin II that acts on vascular angiotensin type 1 receptors to cause vasoconstriction and increase systemic vascular resistance.

Prescribing in practice

  • There is an increased risk of arterial and venous thromboembolic events, so concurrent venous thromboembolism prophylaxis is recommended unless contraindicated.
  • It is intended as add-on therapy alongside conventional vasopressors and should be administered in a critical care setting with continuous haemodynamic monitoring.
  • Titrate to the target blood pressure response, reducing the rate as the patient stabilises, in line with the SPC.

Monitoring

Use continuous blood pressure and haemodynamic monitoring during the infusion and watch for thromboembolic complications.

Counselling the patient

  • This is a critical care medicine used to support your blood pressure during severe illness.
  • It is given through a drip and your blood pressure is monitored continuously.
  • Measures to prevent blood clots are usually given alongside it.

Evidence & guidelines

The ATHOS-3 trial demonstrated that angiotensin II raised blood pressure in catecholamine-resistant distributive shock, supporting its use as an adjunctive vasopressor.

Reference: NICE TA553 (Angiotensin II for treating refractory distributive shock, 2019); ATHOS-3 trial (NEJM 2017); Surviving Sepsis Campaign Guidelines (2021); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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