Hospital Pharmacy - July/August 2018 - 230

778224
research-article2018

HPXXXX10.1177/0018578718778224Hospital PharmacyBaker and Levien

Formulary Drug Reviews
Hospital Pharmacy
2018, Vol. 53(4) 230-233
© The Author(s) 2018
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https://doi.org/10.1177/0018578718778224
DOI: 10.1177/0018578718778224
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Angiotensin II
Danial E. Baker1 and Terri L. Levien1

Abstract
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Generic Name: Angiotensin II
Proprietary Name: Giapreza (La Jolla Pharmaceutical Co)
Approval Rating: 1P
Therapeutic Class: Vasoactive Agents
Similar Drugs: Norepinephrine
Sound- or Look-Alike Names: Angiotensin II Receptor
Blockers

Indications
Angiotensin II is approved to increase blood pressure in
adults with septic or other distributive shock.1,2

Clinical Pharmacology

Clearance of angiotensin II is not dependent on renal or
hepatic function.1

Comparative Efficacy
Indication: Distributive Shock
Vasopressors (eg, norepinephrine, vasopressin, vasopressin
analogues) are used to stabilize critically ill patients during
shock. The addition of angiotensin II to the drug regimen
may reduce catecholamine vasopressor requirements.
However, the exact role of angiotensin II in the treatment of
distributive shock requires further investigation.3,4
Studies

Angiotensin II is a vasoconstrictor that can increase blood
pressure and aldosterone release. The vasoconstrictor effects
of angiotensin II are the result of its direct action on the vessel
wall, mediated by binding to the G-protein-coupled angiotensin II receptor type 1 on vascular smooth muscle cells,
which stimulates Ca2+/calmodulin-dependent phosphorylation of myosin and causes smooth muscle contraction.1

Drug: Angiotensin II vs Placebo
Reference: Khanna A, et al, 2017 Angiotensin II for the
Treatment of High-Output Shock 3 (ATHOS-3 trial)1,5
Study Design: Randomized, double-blind, placebocontrolled, multicenter study
Study Funding: La Jolla Pharmaceutical Company
Patients: 321 patients (18 years and older) with vasodilatory shock (cardiac index greater than 2.3 L/min/m2 or
central venous oxygen saturation greater than 70% coupled with central venous pressure of more than 8 mm Hg,
with a mean arterial pressure between 55 and 70 mm Hg)
despite intravenous (IV) volume resuscitation with at
least 25 mL/kg of body weight over the previous 24 hours

Pharmacokinetics
The plasma half-life of angiotensin II is less than 1 minute.
Angiotensin II is metabolized by aminopeptidase A and
angiotensin-converting enzyme 2 to angiotensin-(2-8)
(angiotensin III) and angiotensin-(1-7), respectively, in
plasma, erythrocytes, and other organs. Angiotensin II type 1
receptor-mediated activity of angiotensin III is approximately 40% of angiotensin II; however, aldosterone synthesis activity is similar to angiotensin II. Angiotensin-(1-7)
exerts the opposite effects of angiotensin II on angiotensin II
type 1 receptors and causes vasodilation.1

1

Washington State University, Spokane, USA

Corresponding Author:
Terri L. Levien, Clinical Professor, Pharmacotherapy Department, College
of Pharmacy and Pharmaceutical Sciences, Washington State University,
PO Box 1495, Spokane, WA 99210-1495, USA.
Email: levient@wsu.edu
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