angiotensin II at a glance
Medicine class
Vasopressor and cardiac stimulant.
Licensed use
Refractory hypotension in adults with septic or other distributive shock.
Administration
Diluted continuous intravenous infusion in an acute hospital setting; central venous administration is recommended.
Key monitoring
Blood pressure, haemodynamics, organ perfusion and signs of thrombosis or peripheral ischaemia.
What is angiotensin II used for?
It is licensed for refractory hypotension in adults with:
Septic shock despite adequate fluid replacement and catecholamines or other available vasopressors.
Other distributive shock under the same circumstances.
How does angiotensin II work?
Angiotensin II binds mainly to type 1 angiotensin receptors on vascular smooth muscle. This narrows blood vessels, increasing vascular resistance and blood pressure, and promotes aldosterone release. Its plasma half-life is less than one minute.
angiotensin II preparations and strengths
Solution for infusion
Route: Intravenous
Strengths: 2.5 mg/mL
How to take angiotensin II
Angiotensin II is prepared and administered by trained hospital staff, not taken by the patient.
The concentrate is diluted before intravenous infusion.
Continuous haemodynamic and end-organ perfusion monitoring is required.
A central venous line is recommended.
The infusion is reduced gradually when stopping, as abrupt withdrawal can cause hypotension or worsening shock.
angiotensin II side effects
Common or expected effects
- Blood clots in arteries or veins
- Temporary high blood pressure
- Fast heartbeat
- Reduced circulation to the hands, feet or other tissues
Get urgent medical advice
- A clot causing limb pain, swelling, colour change, numbness or coldness
- Chest pain or difficulty breathing that could indicate a clot reaching the lungs
- Severely restricted peripheral blood flow with possible tissue damage
- Severe hypertension
angiotensin II in pregnancy
Human pregnancy data are limited and reproductive studies are insufficient. Use should be avoided where possible; in a life-threatening situation, specialists must weigh potential maternal benefit against possible fetal risk.
angiotensin II while breastfeeding
It is unknown whether angiotensin II or its metabolites enter human milk, and risk to a breastfed child cannot be excluded. Breastfeeding should be discontinued during treatment.
angiotensin II interactions
Formal interaction studies have not been performed. Clinically relevant pharmacodynamic interactions include:
ACE inhibitors, such as enalapril
Recent use may increase sensitivity and the blood-pressure response.
Angiotensin II receptor blockers, such as candesartan
Recent use may reduce sensitivity and weaken the response.
Other vasopressors
Blood-pressure effects may be additive, requiring close haemodynamic review.
Common questions about angiotensin II
Answers are fully visible for fast scanning and source review.
Why is angiotensin II used in septic shock?
It can raise blood pressure by narrowing blood vessels when adequate fluids and conventional vasopressors have not corrected refractory hypotension.
Is angiotensin II the same as an angiotensin receptor blocker?
No. Angiotensin II activates angiotensin receptors and raises blood pressure; receptor blockers inhibit this pathway and usually lower blood pressure.
How is angiotensin II administered?
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.