Angiotensin II (medication)

Angiotensin II, sold under the brand name Giapreza, is a medication that is used to treat hypotension resulting from septic shock or other distributive shock. It is a synthetic vasoconstrictor peptide that is identical to human hormone angiotensin II.^[3] The Food and Drug Administration approved the use of angiotensin II in December 2017 to treat low blood pressure resulting from septic shock.^[4]

Angiotensin II

Clinical data
Trade names	Giapreza
Other names	Ang II
AHFS/Drugs.com	Monograph
License data	US DailyMed: Angiotensin II
Routes of administration	Intravenous injection
Drug class	Vasoconstrictor
ATC code	C01CX09 (WHO)
Legal status
Legal status	US: ℞-only[1] EU: Rx-only[2]
Pharmacokinetic data
Protein binding	None
Metabolism	Proteolysis by glutamyl aminopeptidase, angiotensin converting enzyme 2
Metabolites	Angiotensin III, angiotensin-(1-7)
Elimination half-life	Less than one minute (IV administration)
Identifiers
IUPAC name L-alpha-aspartyl-L-arginyl-L-valyl-L-tyrosyl-L-isoleucyl-L-histidyl-L-prolyl-L-phenylalanine
CAS Number	4474-91-3
PubChem CID	172198
DrugBank	DB11842
ChemSpider	150504
UNII	M089EFU921
KEGG	D02014 as salt: D11142
CompTox Dashboard (EPA)	DTXSID30196288
Chemical and physical data
Formula	C50H71N13O12
Molar mass	1046.197 g·mol−1
3D model (JSmol)	Interactive image
SMILES CC[C@H](C)[C@@H](C(=O)N[C@@H](CC1=CN=CN1)C(=O)N2CCC[C@H]2C(=O)N[C@@H](CC3=CC=CC=C3)C(=O)O)NC(=O)[C@H](CC4=CC=C(C=C4)O)NC(=O)[C@H](C(C)C)NC(=O)[C@H](CCCN=C(N)N)NC(=O)[C@H](CC(=O)O)N
InChI InChI=InChI=1S/C50H71N13O12/c1-5-28(4)41(47(72)59-36(23-31-25-54-26-56-31)48(73)63-20-10-14-38(63)45(70)60-37(49(74)75)22-29-11-7-6-8-12-29)62-44(69)35(21-30-15-17-32(64)18-16-30)58-46(71)40(27(2)3)61-43(68)34(13-9-19-55-50(52)53)57-42(67)33(51)24-39(65)66/h6-8,11-12,15-18,25-28,33-38,40-41,64H,5,9-10,13-14,19-24,51H2,1-4H3,(H,54,56)(H,57,67)(H,58,71)(H,59,72)(H,60,70)(H,61,68)(H,62,69)(H,65,66)(H,74,75)(H4,52,53,55)/t28-,33-,34-,35-,36-,37-,38-,40-,41-/m0/s1 Key:CZGUSIXMZVURDU-JZXHSEFVSA-N

The US Food and Drug Administration (FDA) considers it to be a first-in-class medication.^[5] It is approved as a generic medication.^[6]

Medical uses

Angiotensin II is a vasoconstrictor used to increase blood pressure in adults with septic or other distributive shock.^[1] Angiotensin II is a naturally occurring hormone secreted as part of the renin-angiotensin system that results in powerful systemic vasoconstriction.^[7][8] The vasopressor effects of angiotensin have been studied since it was first isolated in the late 1930s.^[9]

Adverse effects

Angiotensin II treated patients are at an increased risk of thromboembolic events. There was a higher incidence of arterial and venous thrombotic and thromboembolic events in patients who received angiotensin II compared to placebo treated patients in the ATHOS-3 study [13% (21/163 patients) vs. 5% (8/158 patients)].^[10] It is recommended that patients be on concurrent venous thromboembolism prophylaxis. Other adverse reactions include thrombocytopenia, tachycardia, fungal infection, delirium, acidosis, hyperglycemia, and peripheral ischemia.^[1]

Angiotensin II acts on angiotensin receptor (AT1) on presynaptic adrenergic nerves → release of catecholamine → excessive catecholamine can be harmful as it can cause myocyte necrosis.^[11]