Angiotensin II

What is Angiotensin II?

• Angiotensin II (GIAPREZA) is a vasoconstrictor used to treat hypotension resulting from septic shock or other distributive shock.

What are the uses of this medicine?

This medicine is used to increases blood pressure in adults with septic or other distributive shock.

How does this medicine work?

• Angiotensin II raises blood pressure by vasoconstriction and increased aldosterone release.
• Direct action of angiotensin II on the vessel wall is mediated by binding to the G-protein-coupled angiotensin II receptor type 1 on vascular smooth muscle cells, which stimulates Ca 2+/calmodulin-dependent phosphorylation of myosin and causes smooth muscle contraction.

Who Should Not Use this medicine ?

• This medcine have no usage limitations.

What drug interactions can this medicine cause?

• Avoid Concomitant use of GIAPREZA with angiotensin converting enzyme (ACE) inhibitors as it may increase the response to GIAPREZA.
• Avoid Concomitant use of GIAPREZA with angiotensin II receptor blockers (ARBs) as it may decrease the response to GIAPREZA.

Is this medicine FDA approved?

• It was approved for use in the United States in 2017.

How should this medicine be used?

Recommended Dosage

• Start GIAPREZA intravenously at 20 nanograms (ng)/kg/min.
• Titrate as frequently as every 5 minutes by increments of up to 15 ng/kg/min as needed.
• During the first 3 hours, the maximum dose should not exceed 80 ng/kg/min.
• Maintenance dose should not exceed 40 ng/kg/min.
• Doses as low as 1.25 ng/kg/min may be used.

• Dilute GIAPREZA in 0.9% sodium chloride prior to use.
• Diluted solution may be stored at room temperature or under refrigeration and should be discarded after 24 hours.

Administration

• The recommended starting dosage of GIAPREZA is 20 nanograms (ng)/kg/min via continuous intravenous infusion.
• Administration through a central venous line is recommended.
• Monitor blood pressure response and titrate GIAPREZA as frequently as every 5 minutes by increments of up to 15 ng/kg/min as needed to achieve or maintain target blood pressure.
• Do not exceed 80 ng/kg/min during the first 3 hours of treatment.
• Maintenance dose 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.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As Injection: 2.5 mg/mL in a vial.

This medicine is available in fallowing brand namesː

• GIAPREZA

What side effects can this medication cause?

The most common side effects of this medicine include:

• thromboembolic events
• Deep vein thrombosis
• Thrombocytopenia
• Tachycardia
• Fungal infection
• Delirium
• Acidosis
• Hyperglycemia
• Peripheral ischemia

What special precautions should I follow?

There was a higher incidence of arterial and venous thrombotic and thromboembolic events in patients who received GIAPREZA. Use concurrent venous thromboembolism (VTE) prophylaxis.

What to do in case of emergency/overdose?

• Overdose of GIAPREZA would be expected to result in hypertension, necessitating close monitoring and supportive care.
• Effects are expected to be brief because the half-life of angiotensin II is less than one minute.

Can this medicine be used in pregnancy?

• The published data on angiotensin II use in pregnant women are not sufficient to determine a drug-associated risk of adverse developmental outcomes.

Can this medicine be used in children?

• The safety and efficacy of GIAPREZA in pediatric patients have not been established.

What are the active and inactive ingredients in this medicine?

Active ingredient:

• ANGIOTENSIN II

Inactive ingredients:

• MANNITOL
• WATER
• SODIUM HYDROXIDE
• HYDROCHLORIC ACID

Who manufactures and distributes this medicine?

• Packager: La Jolla Pharmaceutical Company

What should I know about storage and disposal of this medication?

• GIAPREZA vials should be stored in the refrigerator (36-46°F, 2-8°C).
• Discard prepared diluted solution after 24 hours at room temperature or under refrigeration.

• Dailymed label info on Angiotensin II
• FDA Angiotensin II

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