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Angiotensin II

Medically reviewed by Last updated on Jun 23, 2020.


(an jee oh TEN sin too)

Index Terms

  • Angiotensin 2
  • ATII

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous [preservative free]:

Giapreza: 2.5 mg/mL (1 mL)

Brand Names: U.S.

  • Giapreza

Pharmacologic Category

  • Vasoactive Agent


Naturally occurring peptide hormone of the renin-angiotensin-aldosterone system (RAAS) that causes vasoconstriction and increases aldosterone release, which raises blood pressure.


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.

Time to Peak

5 minutes

Half-Life Elimination

IV: <1 minute

Use: Labeled Indications

Septic or other distributive shock: To increase blood pressure in adults with septic or other distributive shock


There are no contraindications listed in the manufacturer's labeling.

Dosing: Adult

Septic or other distributive shock (off-label dosing): Continuous IV infusion: Initial: 10 to 20 ng/kg/minute (Khanna 2017; manufacturer’s labeling); monitor response and titrate as frequently as every 5 minutes by increments of up to 15 ng/kg/minute as needed. Once the underlying shock has sufficiently improved, down-titrate every 5 to 15 minutes by increments of up to 15 ng/kg/minute based on response. Doses as low as 1.25 ng/kg/minute may be used.

Maximum initial dose: 80 ng/kg/minute during the first 3 hours of treatment.

Maximum maintenance dose: 40 ng/kg/minute.

Dosing: Geriatric

Refer to adult dosing.


Dilute vial in NS to a final concentration of 5,000 ng/mL or 10,000 ng/mL:

Not fluid restricted: Dilute 2.5 mg/mL vial in 500 mL NS to a final concentration of 5,000 ng/mL.

Fluid restricted: Dilute 2.5 mg/mL vial in 250 mL NS to a final concentration of 10,000 ng/mL.


IV: Administer by continuous IV infusion via central venous line.


Store intact vials at 2°C to 8°C (36°F to 46°F). May store diluted solution at room temperature or under refrigeration ≤24 hours; discard diluted solution after 24 hours.

Drug Interactions

Angiotensin II Receptor Blockers: May diminish the therapeutic effect of Angiotensin II. Monitor therapy

Angiotensin-Converting Enzyme Inhibitors: May enhance the therapeutic effect of Angiotensin II. Monitor therapy

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Percentages are the result of combination vasopressor therapy.


Cardiovascular: Thrombosis (13%)

1% to 10%:

Cardiovascular: Tachycardia (9%), deep vein thrombosis (4%), peripheral ischemia (4%)

Central nervous system: Delirium (6%)

Endocrine & metabolic: Acidosis (6%), hyperglycemia (4%)

Hematologic & oncologic: Thrombocytopenia (10%)

Infection: Fungal Infection (6%)


Concerns related to adverse effects:

• Thrombosis: Arterial and venous thrombotic and thromboembolic events have been reported; use concurrent venous thromboembolism (VTE) prophylaxis.

Monitoring Parameters

Blood pressure response.

Pregnancy Considerations

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.

Patient Education

What is this drug used for?

• It is used to treat low blood pressure.

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Acidosis like confusion, fast breathing, fast heartbeat, abnormal heartbeat, severe abdominal pain, nausea, vomiting, fatigue, shortness of breath, or loss of strength and energy.

• Bruising

• Bleeding

• Fast heartbeat

• Mood changes

• Blood clots like numbness or weakness on one side of the body; pain, redness, tenderness, warmth, or swelling in the arms or legs; change in color of an arm or leg; chest pain; shortness of breath; fast heartbeat; or coughing up blood.

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine’s uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

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Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.