• Angiotensin II injection for intravenous use has been approved by US FDA in December 2017 for treating low blood pressure in adult patients with septic or distributive shock.
Angiotensin II is a synthetic human vasoconstrictor which is prescribed for increasing blood pressure in adult patients to treat low blood pressure with septic shock or distributive shock.
Angiotensin II also stimulates the release of another hormone known as aldosterone which promotes the retention of sodium in the kidney and contributes to the rise in blood pressure.
Angiotensin II should not be used in patients with
• Allergy to angiotensin II
• Children below 18 years of age
The recommended initial dose of angiotensin II is 20 ng/kg/min administered as a continuous infusion directly into the vein, preferably through a central venous line.
• Maintenance dose: 40 ng/kg/min
• Maximum dose: 80 ng/kg/min
• Angiotensin II injection should be diluted with 0.9% sodium chloride solution and should be administered intravenously.
• The diluted solution should be prepared to achieve a final concentration of either 10,000 ng/ml in fluid restricted patients or 5000 ng/ml.
• The unused solution should be discarded.
• Patients should be monitored for arterial and venous thrombotic or thromboembolic events (clots in the arteries or veins) particularly deep vein thrombosis.
• Preventive steps should be taken to prevent venous thromboembolism.
• Patients should be advised to report to the emergency center in case of abnormal heartbeat, shortness of breath, swelling of arms or legs or coughing up blood.
• Deep vein thrombosis
• Low platelet levels
• Increased heartrate
• Fungal infection
• High blood sugar level
• Peripheral ischemia (reduced blood flow to the limbs)
• An overdose of angiotensin II results in severe hypertension which requires strict monitoring and supportive medical care.
• Angiotensin-converting enzyme inhibitor drugs such as lisinopril, captopril, enalapril, ramipril may increase the response to angiotensin II.
• Angiotensin II receptor blocker drugs such as losartan, valsartan, telmisartan, candesartan and olmesartan decrease the action of angiotensin II injection when administered together ; the combination should be avoided.
• Angiotensin II vials should be stored in a refrigerator at 2°C to 8°C.
• The prepared diluted solution should be discarded after 24 hours irrespective of whether it is kept at room temperature or in a refrigerator.
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