Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous [preservative free]:
Giapreza: 2.5 mg/mL (1 mL)
Pharmacology
Mechanism of Action
Naturally occurring peptide hormone of the renin-angiotensin-aldosterone system (RAAS) that causes vasoconstriction and increases aldosterone release, which raises blood pressure.
Pharmacokinetics/Pharmacodynamics
Metabolism
Metabolized by aminopeptidase A and angiotensin converting enzyme 2 to angiotensin-(2-8) [angiotensin III] and angiotensin-(1-7), respectively in plasma, erythrocytes and many major organs.
Time to Peak
5 minutes
Half-Life Elimination
IV: <1 minute
Use: Labeled Indications
Septic or other distributive shock: To increase blood pressure in adults with septic or other distributive shock
Contraindications
There are no contraindications listed in the manufacturer's labeling.
Dosage and Administration
Dosing: Adult
Septic or other distributive shock (off-label dosing): Continuous IV infusion: Initial: 10 to 20 ng/kg/minute (Khanna 2017; manufacturer’s labeling); monitor response and titrate every 5 minutes by increments of up to 15 ng/kg/minute as needed. Once the underlying shock has sufficiently improved, down-titrate every 5 to 15 minutes by increments of up to 15 ng/kg/minute based on response. Doses as low as 1.25 ng/kg/minute may be used.
Maximum initial dose: 80 ng/kg/minute during the first 3 hours of treatment.
Maximum maintenance dose: 40 ng/kg/minute.
Dosing: Geriatric
Refer to adult dosing.
Reconstitution
Dilute vial in NS to a final concentration of 5,000 ng/mL or 10,000 ng/mL:
Not fluid restricted: Dilute 2.5 mg/mL vial in 500 mL NS to a final concentration of 5,000 ng/mL
Fluid restricted: Dilute 2.5 mg/mL vial in 250 mL NS to a final concentration of 10,000 ng/mL or dilute 5 mg per 2 mL vial in 500 mL NS to a final concentration of 10,000 ng/mL
Administration
IV: Administer by continuous IV infusion via central venous line.
Storage
Store intact vials at 2°C to 8°C (36°F to 46°F). May store diluted solution at room temperature or under refrigeration ≤24 hours; discard diluted solution after 24 hours.
Drug Interactions
Angiotensin II Receptor Blockers: May diminish the therapeutic effect of Angiotensin II. Monitor therapy
Angiotensin-Converting Enzyme Inhibitors: May enhance the therapeutic effect of Angiotensin II. Monitor therapy
Adverse Reactions
Percentages are the result of combination vasopressor therapy.
>10%:
Cardiovascular: Thrombosis (13%)
1% to 10%:
Cardiovascular: Tachycardia (9%), deep vein thrombosis (4%), peripheral ischemia (4%)
Central nervous system: Delirium (6%)
Endocrine & metabolic: Acidosis (6%), hyperglycemia (4%)
Hematologic & oncologic: Thrombocytopenia (10%)
Infection: Fungal Infection (6%)
Warnings/Precautions
Concerns related to adverse effects:
- Thrombosis: Arterial and venous thrombotic and thromboembolic events have been reported; use concurrent venous thromboembolism (VTE) prophylaxis.
Monitoring Parameters
Blood pressure response.
Pregnancy
Pregnancy Considerations
Animal reproduction studies have not been conducted. When treatment for septic or other disruptive shock is needed, delaying treatment due to pregnancy increases the risk of maternal and fetal morbidity and mortality.
Patient Education
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Have patient report immediately to prescriber signs of acidosis (confusion, fast breathing, fast heartbeat, abnormal heartbeat, severe abdominal pain, nausea, vomiting, fatigue, shortness of breath, or loss of strength and energy), bruising, bleeding, fast heartbeat, mood changes, or signs of blood clots (numbness or weakness on one side of the body; pain, redness, tenderness, warmth, or swelling in the arms or legs; change in color of an arm or leg; chest pain; shortness of breath; fast heartbeat; or coughing up blood) (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
