Angiotensin ii parenteral
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Infusions of angiotensin II.
Drugs List
Therapeutic Indications
Uses
Catecholamine-refractory hypotension after distributive shock
Persistent refractory hypotension in adults with septic or other distributive shock despite adequate volume restitution and application of catecholamines and other vasopressor therapies.
Dosage
Adults
Initial
20nanograms/kg/minute. Down-titration may be required in patients who experience transient hypertension at this dose.
Titration
Dose may be titrated every 5 minutes in steps of up to 15nanograms/kg/minute depending on the patients response. The dose must be less than or equal to 80nanograms/kg/minute during the first 3 hours of treatment.
Maintenance
Dose may be maintained as low as 1.25nanograms/kg/minute. Maximum maintenance dose is 40nanograms/kg/minute.
Additional Dosage Information
Discontinuing treatment
Angiotensin II should be withdrawn once the underlying shock has sufficiently improved. To avoid hypotension due to abrupt withdrawal, angiotensin II should be down-titrated by gradual decrements of up to 15nanograms/kg/minute.
Administration
Intravenous infusion only via a central venous line, following dilution.
Contraindications
Children under 18 years
Breastfeeding
Precautions and Warnings
Pregnancy
Treatment to be prescribed under the supervision of a specialist
Monitor blood pressure continuously
Must be diluted before use
Monitor haemodynamics of circulation
Increased risk for venous thromboembolism - take preventive measures
Avoid abrupt withdrawal
Hospital use only
Maintain treatment at the lowest effective dose
Angiotensin II is not recommended for use in patients with non-distributive shock.
Concurrent venous thromboembolism prophylaxis should be considered during treatment.
Patients may be more sensitive to the action of angiotensin II and therefore have an increased response if they have recently received angiotensin converting enzyme inhibitors. On the other hand, patients may be less sensitive to the action of angiotensin II, and therefore have a reduced response if they have recently received angiotensin II receptor blockers.
Pregnancy and Lactation
Pregnancy
Use angiotensin II with caution during pregnancy.
The manufacturer does not recommend using angiotensin II during pregnancy unless the benefit to the patient outweighs the possible risk to the foetus. At the time of writing there is limited published information regarding the use of angiotensin II during pregnancy. Potential risks are unknown.
Lactation
Angiotensin II is contraindicated during breastfeeding.
Use of angiotensin II when breastfeeding is contraindicated by the manufacturer. The presence of angiotensin II in human breast milk in unknown. Effects on exposed infants are unknown.
Side Effects
Deep vein thrombosis (DVT)
Hypertension (transient)
Peripheral ischaemia
Tachycardia
Thromboembolism
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: November 2022
Reference Sources
Summary of Product Characteristics: Giapreza 2.5mg per ml concentrate for solution for infusion. PAION UK Ltd. Revised October 2021.
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