Giapreza (synthetic angiotensin II) is a naturally occurring peptide hormone of the renin-angiotensin-aldosterone system (RAAS) that causes vasoconstriction and increases aldosterone release, which raises blood pressure. It is used to increase blood pressure in adults in septic shock or other distributive shocks. It is also considered as a potential drug to treat COVID-19 infection.

Giapreza dose in Adults

Giapreza dose in the treatment of Septic or other distributive shocks (off-label dosing):

• Continuous IV infusion: 

  • It includes an initial dose of 10 to 20 ng/kg/minute
  • response monitoring should be done and titrate every 5 minutes by increasing the dose up to 15 ng/kg/minute as needed.
  • Once the underlying shock has improved sufficiently, titrate down every 5 to 15 minutes by increasing up to 15 ng/kg/minute based on the response.
  • 1.25ng/kg/minute may be used as the lowest dose.

• Maximum initial dose:

  • 80 ng/kg/minute during the first 3 hours of treatment can be used.

• Maximum maintenance dose:

  • 40 ng/kg/minute can be used.

Giapreza dose in Childrens

Not recommended.

Pregnancy Risk Factor: C

• For pregnancy and lactation, animal reproduction studies have not been done.
• If treatment is required for septic shock or any other disruptive shock, then delay in treatment can increase the risk of maternal morbidity and death.

Use of synthetic angiotensin II during breastfeeding

• It is unknown if angiotensin II will be found in breast milk after the administration of this preparation.

Giapreza renal dose:

There are no dose adjustments provided in the manufacturer's labeling.

Giapreza dose in liver disease:

There are no dose adjustments provided in the manufacturer's labeling.

Common Side Effects of Giapreza (Synthetic angiotensin II) Include:

• Cardiovascular:

  • Thrombosis

Less Common Side Effects of Giapreza (Synthetic angiotensin II) Include:

• Cardiovascular:

  • Tachycardia
  • Deep Vein Thrombosis
  • Peripheral Ischemia

• Central Nervous System:

  • Delirium

• Endocrine & Metabolic:

  • Acidosis
  • Hyperglycemia

• Hematologic & Oncologic:

  • Thrombocytopenia

• Infection:

  • Fungal Infection

Contraindication to Giapreza (Synthetic angiotensin II) Include:

• The manufacturer's labeling does not list any contraindications.

Warnings and precautions

• Thrombosis:  
  • There have been reports of thromboembolic and arterial thrombotic events.
  • use concurrent venous thromboembolism (VTE) prophylaxis.

Synthetic angiotensin II: Drug Interaction

Monitor:

Blood pressure response.

How to administer Giapreza (Synthetic angiotensin II)?

IV Route: Administer by continuous IV infusion through a central venous line.

Mechanism of action of Giapreza (Synthetic angiotensin II):

Naturally occurring peptide hormone of the renin-angiotensin-aldosterone system (RAAS) that causes vasoconstriction and increases aldosterone release, which raises blood pressure.

Metabolism: In plasma, erythrocytes and major organs it is metabolized by aminopeptidase A and angiotensin-converting enzyme 2 to angiotensin-(2-8) [angiotensin III] and angiotensin-(1-7).

Half-life elimination: IV is less than1 minute

Time to peak is 5 minutes   

International Brands of Synthetic angiotensin II:

• Giapreza

Giapreza Brands in Pakistan:

Giapreza is not available in Pakistan.