Angiotensin II is a RESTRICTED formulary medication. All other use requires approval by the CMO or their designee.

Angiotensin II Full Guidelines for Use can be found here.  See below for summary of patient criteria:

Criteria for Use:

1. Patients who have overdosed on an Angiotensin II receptor blocker drug.
2. Patients are required to have central venous access.
3. Patients who are >18yo or who are > 14yo and > 50 kg
   1. Have been adequately fluid resuscitated (i.e., > 30ml/kg within first 3 hours).
   2. Have normal to supra cardiac output (Do not use in states of decreased LV systolic function).
   3. Have failed to achieve goal MAPS on 2 or more vasopressors at doses >2 mcg/kg/min of norepinephrine (NE) equivalents (e.g. Norepinephrine, high dose epinephrine, vasopressin). Angiotensin II should NOT be used as a first line treatment.
4. In extreme situations angiotensin II may be considered especially when the patient has contraindications for VA ECMO.
5. There is no FDA approval for children <18yo. For patients 14 yo – 17 yo parents should be informed of the use of a non-FDA approved drug and written consent obtained and placed in the patient chart prior to administration. 
6. Any use outside the above parameters including patients <14yo or <50kg must also be approved by the CMO or their delegate. Written consent required prior to initiation.

Contraindications:

1. Allergy to mannitol or angiotensin II.
2. Patients with active bleeding AND hemoglobin < 7 mg/dl
3. Angiotensin II should NOT be used as a rescue therapy for moribund patients (i.e. expected not to survive >12 – 24 hours).
4. Current use of Angiotensin II Receptor Blocker or Angiotensin-Converting Enzyme Inhibitor
5. Patients receiving total NE equivalent dose > 1 mcg/kg/min are unlikely to benefit from angiotensin II. Use should be avoided in these patients.

• Micromedex Drug Information
• FDA Daily Med Package Insert
• Recent Citations via Medline (PubMed)
• WebMD Pill Identifier