angiotensin II: clinical use

Prescribing considerations

• Reserve for adults with adequately volume-restored septic or other distributive shock that remains hypotensive despite catecholamines and other available vasopressors.
• Prescribing should be led by a physician experienced in shock management in an acute hospital setting.
• Use venous thromboembolism prophylaxis unless contraindicated; consider non-pharmacological measures when anticoagulant prophylaxis is unsuitable.
• Avoid abrupt withdrawal because hypotension or worsening shock may occur.
• A vasopressor response is demonstrated, but an effect on morbidity or mortality has not been established.

Contraindications and cautions

• Hypersensitivity to angiotensin II or any excipient.
• Use is not recommended for non-distributive shock, including cardiogenic shock, because these patients were excluded from clinical trials.
• Exercise particular caution regarding thromboembolism and peripheral ischaemia.

Monitoring

• Continuous arterial blood-pressure and haemodynamic response
• End-organ and peripheral tissue perfusion
• Clinical signs of venous or arterial thrombosis
• Need for accompanying vasopressors
• Hypotension during withdrawal

Clinical pharmacology

Angiotensin II activates vascular AT1 receptors, producing calcium-dependent smooth-muscle contraction, vasoconstriction and aldosterone release. It has a plasma half-life of less than one minute and is cleaved in blood and multiple tissues.

Formulation and product differences

• Sterile, clear and colourless concentrate for solution for infusion.
• Requires dilution before use and is intended for single use.
• Central venous administration is recommended.
• Contains mannitol and is essentially sodium-free.

Solution for infusion

Route: Intravenous

Strengths: 2.5 mg/mL