Peptides Academy
Angiotensin II (Giapreza)
Prescription
Angiotensin II is the potent eight-amino-acid effector peptide of the renin-angiotensin-aldosterone system (RAAS), one of the body's core blood-pressure control circuits. When blood pressure or blood volume falls, the kidney releases renin, which sets off a cascade: angiotensinogen becomes angiotensin I, and angiotensin-converting enzyme (ACE) converts that to angiotensin II. Angiotensin II then constricts blood vessels, prompts aldosterone release (promoting sodium and water retention), and helps restore blood pressure. Synthetic angiotensin II, marketed as Giapreza and approved by the FDA in 2017, harnesses this physiology as an intravenous vasopressor. Its approved use is narrow and specific: raising blood pressure in adults with septic or other distributive (vasodilatory) shock — states in which the blood vessels are pathologically dilated and blood pressure collapses despite adequate fluids. In these patients, standard vasopressors (catecholamines like norepinephrine, and often vasopressin) are the mainstay, but some remain dangerously hypotensive on high doses. Angiotensin II provides a third, mechanistically distinct pathway to vasoconstriction, allowing clinicians to raise blood pressure while potentially reducing reliance on very high catecholamine doses. In its pivotal trial (ATHOS-3), adding angiotensin II significantly improved blood-pressure response in patients with catecholamine-resistant vasodilatory shock. Mechanistically, synthetic angiotensin II binds AT1 receptors on vascular smooth muscle, triggering the same rapid, powerful vasoconstriction as the natural hormone. It is titrated by infusion in an intensive-care setting with continuous hemodynamic monitoring. As a potent vasoconstrictor, it carries a recognized risk of arterial and venous thromboembolism, so venous thromboprophylaxis is recommended during use. It is a critical-care medicine used by intensivists, not a general-purpose drug, and its place in therapy is as an adjunct for refractory shock rather than a first-line agent.
Specifications
| Origin / Manufacturer | Synthetic (human angiotensin II, octapeptide) |
| Regulatory Status | FDA-approved (Giapreza, 2017); EMA-approved |
| Active Components | Angiotensin II acetate |
| Storage | Per manufacturer: refrigerate concentrate; dilute before infusion |
| Shelf Life | Per manufacturer specification |
| Form Factor | Concentrate for solution for intravenous infusion |
Frequently Asked Questions
Reviewed by
Clinical Research Review Board
Critical Care & Cardiovascular Review
All clinical claims cross-checked against primary sources. Read our editorial policy →
Related Peptides
Angiotensin-(1-7)
Research-Grade
A counter-regulatory heptapeptide of the renin-angiotensin system that opposes the vasoconstrictive and pro-inflammatory effects of angiotensin II through the Mas receptor, with cardioprotective, anti-fibrotic, and anti-inflammatory properties.
Nesiritide
Natrecor
Nesiritide (Natrecor) is a recombinant form of human B-type natriuretic peptide (BNP), a 32-amino-acid peptide identical to the endogenous hormone produced by ventricular cardiomyocytes in response to volume overload. FDA-approved in 2001 for the treatment of acute decompensated heart failure (ADHF), it promotes vasodilation, natriuresis, and diuresis through activation of the natriuretic peptide receptor A (NPR-A) and intracellular cGMP signaling.
Terlipressin
Terlivaz / Glypressin
Long-acting vasopressin analog and prodrug — an approved hospital medicine for hepatorenal syndrome and bleeding esophageal varices in advanced liver disease.
Vasopressin
Vasostrict (argipressin)
The body's own antidiuretic hormone (ADH), used clinically as an approved intravenous vasopressor in shock and cardiac arrest — the parent molecule behind desmopressin and terlipressin.