Version May 2024
Septic shock or other vasodilatory shock states (adjunctive agent):
Continuous infusion: IV: Initial: 10 to 20 ng/kg/minute; titrate dose by up to 10 to 15 ng/kg/minute every 5 minutes based on goal MAP. Once shock has sufficiently improved, decrease dose by ≤15 ng/kg/minute every 5 to 15 minutes based on response. Doses as low as 1.25 ng/kg/minute may be used (Ref).
Maximum initial dose: IV: 80 ng/kg/minute during the first 3 hours of treatment.
Maximum maintenance dose: IV: 40 ng/kg/minute.
No dosage adjustments are expected; angiotensin II clearance is not dependent on kidney function.
No dosage adjustments are expected; angiotensin II clearance is not dependent on hepatic function.
Refer to adult dosing.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Adverse reaction incidence reported in adults on concomitant vasopressor therapy.
>10%: Cardiovascular: Thromboembolic disease (13%; deep vein thrombosis [4%])
1% to 10%:
Cardiovascular: Peripheral ischemia (4%), tachycardia (9%)
Endocrine & metabolic: Acidosis (6%), hyperglycemia (4%)
Hematologic & oncologic: Thrombocytopenia (10%)
Infection: Fungal infection (6%)
Nervous system: Delirium (6%)
Postmarketing:
Cardiovascular: Bradycardia (Busse 2017), cardiac arrhythmia (including atrial fibrillation and sinus tachycardia) (Wieruszewski 2021), orthostatic dizziness (Busse 2017), orthostatic hypotension (Busse 2017), worsening of heart failure (Busse 2017)
Gastrointestinal: Mesenteric ischemia (Wieruszewski 2021)
Hepatic: Increased serum transaminases (Wieruszewski 2021)
Nervous system: Headache (Busse 2017)
Respiratory: Exacerbation of asthma (Busse 2017; Millar 1995)
There are no contraindications listed in the manufacturer's labeling.
Concerns related to adverse effects:
• Bronchoconstriction: Exacerbation of asthma has been reported; use with caution (Busse 2017; Millar 1995).
• Extravasation: Angiotensin II is an irritant with vesicant-like properties; avoid extravasation (Stefanos 2023).
• Heart failure: Exacerbation of heart failure has been reported; use with caution (Busse 2017; Cohn 1965).
• Thrombosis: Arterial and venous thrombotic and thromboembolic events have been reported; use concurrent venous thromboembolism prophylaxis.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Giapreza: 0.5 mg/mL (1 mL)
Solution, Intravenous [preservative free]:
Giapreza: 2.5 mg/mL (1 mL)
No
Solution (Giapreza Intravenous)
0.5 mg/mL (per mL): $540.00
2.5 mg/mL (per mL): $1,944.00
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
IV: Administer as a continuous IV infusion via an infusion pump. Central line administration is recommended.
Irritant with vesicant-like properties; avoid extravasation.
Extravasation management: If extravasation occurs, stop infusion immediately; leave cannula/needle in place temporarily but do NOT flush the line; gently aspirate extravasated solution, then remove needle/cannula; elevate extremity; apply dry warm compresses; initiate phentolamine antidote (Ref).
Phentolamine: SUBQ: Dilute 5 to 10 mg in 10 mL NS and administer into extravasation site as soon as possible after extravasation; if IV catheter remains in place, administer initial dose IV through the infiltrated catheter; may repeat in 60 minutes if patient remains symptomatic (Ref).
Septic shock or other vasodilatory shock states: To increase BP in adults with septic or other distributive shock.
Sound-alike/look-alike issues:
Angiotensin II may be confused with angiotensin II receptor blockers
Angiotensin II may be confused with angiotensin converting enzyme inhibitors
ATII (abbreviation for Angiotensin II) may be confused with ATIII (abbreviation for Antithrombin)
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Angiotensin II Receptor Blockers: May diminish the therapeutic effect of Angiotensin II. Risk C: Monitor therapy
Angiotensin-Converting Enzyme Inhibitors: May enhance the therapeutic effect of Angiotensin II. Risk C: Monitor therapy
Animal reproduction studies have not been conducted. When treatment for septic or other disruptive shock is needed, delaying treatment due to pregnancy increases the risk of maternal and fetal morbidity and mortality.
It is not known if angiotensin II is present in breast milk following administration of this preparation.
BP (or mean arterial pressure), heart rate, signs and symptoms of thromboembolism, platelet count, lactate.
Naturally occurring peptide hormone of the renin-angiotensin-aldosterone system (RAAS) that causes vasoconstriction and increases aldosterone release, which raises blood pressure.
Metabolism: Metabolized by aminopeptidase A and angiotensin converting enzyme 2 to angiotensin-(2-8) [angiotensin III] and angiotensin-(1-7), respectively in plasma, erythrocytes and many major organs.
Half-life elimination: IV: <1 minute
Time to peak: 5 minutes
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