Angiotensin II is a RESTRICTED formulary medication. All other use requires approval by Pharmacy Leadership.

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 > 0.2 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 Pharmacy Leadership. 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