Angiotensin II (medication)

Angiotensin II(Ang II) is a medication that is used to treathypotensionresulting fromseptic shockor other distributive shock. It is a syntheticvasoconstrictorpeptide that is identical to human hormoneangiotensin IIand is marketed under the brand nameGiapreza.TheFood and Drug Administrationapproved the use of angiotensin II in December 2017 to treat low blood pressure resulting fromseptic shock.

Angiotensin II

Clinical data
Trade names	Giapreza
AHFS/Drugs.com	Monograph
Routes of administration	Intravenous injection
Drug class	Vasoconstrictor
ATC code	C01CX09(WHO)
Legal status
Legal status	US:℞-only EU:Rx-only
Pharmacokineticdata
Protein binding	None
Metabolism	Proteolysisbyglutamyl aminopeptidase,angiotensin converting enzyme 2
Metabolites	Angiotensin III,angiotensin-(1-7)
Eliminationhalf-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
PubChemCID	172198
DrugBank	DB11842
ChemSpider	150504
UNII	M089EFU921
KEGG	D02014 as salt:D11142
CompTox Dashboard(EPA)	DTXSID30196288
Chemical and physical data
Formula	C50H71N13O12
Molar mass	1046.197g·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 U.S.Food and Drug Administration(FDA) considers it to be afirst-in-class medication.

Medical uses

Angiotensin II is avasoconstrictorused to increase blood pressure in adults with septic or other distributive shock. Angiotensin II is a naturally occurring hormone secreted as part of the renin-angiotensin system that results in powerful systemic vasoconstriction.Thevasopressoreffects of angiotensin have been studied since it was first isolated in the late 1930s.Vasopressors are defined as agents that combatvasodilatory shockby inducingperipheral vasoconstriction.Commonly used vasopressors includecatecholamine(e.g.,dopamine,norepinephrine,epinephrine) andnon-catecholamine(e.g.,vasopressin). but these agents are not always effective in reversing vasodilatory shock, and their use can be associated with significant side effects includinglimb ischemiaand cardiacarrhythmia.Angiotensin II is as a treatment option that can increase blood pressure and allow catecholamine dose reductions.

Angiotensin II must be administered as anintravenous infusiondiluted in 0.9% sodium chloride prior to use.

Adverse effects

Angiotensin II treated patients are at an increased risk ofthromboembolic 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)].It is recommended that patients be on concurrent venous thromboembolism prophylaxis. Other adverse reactions includethrombocytopenia,tachycardia,fungal infection,delirium,acidosis,hyperglycemia,and peripheralischemia.

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.