How is synthetic human angiotensin II used in the treatment of sepsis/septic shock?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

Angiotensin II, the major bioactive component of the renin-angiotensin-aldosterone system (RAAS), serves as one of the body’s central regulators of blood pressure. It raises blood pressure by vasoconstriction and increased aldosterone release; direct action of angiotensin II on the vessel wall is mediated by binding to the G-protein–coupled angiotensin II receptor type 1 on vascular smooth muscle cells, which stimulates Ca2+/calmodulin-dependent phosphorylation of myosin and causes smooth muscle contraction. It is indicated for adults with septic or other distributive shock.

It is initiated at 20 ng/kg/min IV by continuous infusion. Monitor blood pressure response every 5 minutes and titrate by increments of up to 15 ng/kg/min as needed to achieve or maintain target blood pressure, not exceeding 80 ng/kg/min during the first 3 hours of treatment. Maintenance ranges from 1.25 ng/kg/min and should not exceed 40 ng/kg/minute.

Thromboembolism was observed in clinical trials. It should be administered with concurrent venous thromboembolic prophylaxis.


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