Active Ingredient: Angiotensin II
Angiotensin II is indicated for the treatment of refractory hypotension in adults with septic or other distributive shock who remain hypotensive despite adequate volume restitution and application of catecholamines and other available vasopressor therapies.
For this indication, competent medicine agencies globally authorize below treatments:
For:
Intravenous, 20 nanograms angiotensin II per kilogram of body weight, once every minute, over the duration of 5 minutes. Afterwards, intravenous, between 1.25 nanograms angiotensin II per kilogram of body weight and 40 nanograms angiotensin II per kilogram of body weight, once every minute.
The recommended starting dosage is 20 nanograms (ng)/kg per minute via continuous intravenous infusion.
When initiating angiotensin II, it is important to closely monitor blood pressure response and adjust dose accordingly.
Once an infusion has been established, the dose may be titrated as frequently as every 5 minutes in steps of up to 15 ng/kg per minute, as needed, depending on the patient’s condition and target mean arterial pressure. Approximately one in every four patients experienced transient hypertension with the angiotensin II 20 ng/kg per minute starting dose in clinical trials, thus needing dose down-titration. For critically ill patients, the usual target mean arterial pressure is 65-75 mmHg. Do not exceed 80 ng/kg per minute during the first 3 hours of treatment. Maintenance doses should not exceed 40 ng/kg per minute. Doses as low as 1.25 ng/kg per minute may be used.
It is important to administer angiotensin II at the lowest compatible dose to achieve or maintain adequate arterial blood pressure and tissue perfusion. The median duration of treatment in clinical trials was 48 hours (range: 3.5 to 168 hours).
In order to minimise the risk of adverse events derived from prolonged vasoconstriction, treatment with angiotensin II should be withdrawn once underlying shock is sufficiently improved. Down-titrate by gradual decrements of up to 15 ng/kg per minute, as needed, based on blood pressure, in order to avoid hypotension due to abrupt withdrawal.
Angiotensin II should only be administered by continuous intravenous infusion under close monitoring of haemodynamics and end-organ perfusion.
It is recommended to be administered via a central venous line.
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