When is angiotensin II used in clinical practice?

Angiotensin II (Giapreza) is used as a vasopressor in adults with vasodilatory (distributive) shock who remain hypotensive despite adequate volume resuscitation and first-line vasopressor therapy (norepinephrine, vasopressin). It is typically a third- or fourth-line agent in refractory shock.

How does angiotensin II compare to other vasopressors?

Angiotensin II works through the RAAS pathway (AT1 receptors) rather than adrenergic or vasopressin receptors, providing an alternative mechanism when catecholamine-based vasopressors are insufficient. The ATHOS-3 trial demonstrated efficacy when added to high-dose catecholamines.

Does angiotensin II improve survival?

The primary ATHOS-3 trial was not powered for mortality. Day-28 mortality was 46% vs 54% (angiotensin II vs placebo, p=0.12). Post-hoc analyses suggested survival benefit in specific subgroups (high renin, RRT patients), but these require prospective validation.

What is the recommended dose range for Angiotensin II?

The research dose range is 20 ng/kg/min starting dose, titrated to 80 ng/kg/min max, administered via Intravenous infusion, Continuous.

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Angiotensin II Dosing & Reconstitution Guide

Complete dosing reference for Angiotensin II (Cardiovascular / Vasoactive). Covers reconstitution, dose range, titration schedule, pharmacokinetics, and storage protocols for research use.

Dosing Protocol

Route: Intravenous infusion Frequency: Continuous Dose Range: 20 ng/kg/min starting dose, titrated to 80 ng/kg/min max

Safety & Contraindications

Safety: Thromboembolic events: DVT and arterial thrombosis reported more frequently with angiotensin II vs placebo in ATHOS-3 (12.9% vs 5.1%); concurrent VTE prophylaxis recommended Tachyarrhythmias reported in clinical trials Peripheral ischemia, including digital ischemia, has been reported

Contraindications: Known hypersensitivity to angiotensin II or any excipients; Should not be used as a substitute for volume resuscitation in hypovolemic shock; Caution in patients with active thromboembolic disease

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Research Use Only. The information on this page is compiled from published research literature and is provided for educational purposes only. It does not constitute medical advice. All compounds referenced are intended for in vitro research use by qualified laboratories and institutions.