Source: FDA label
| Molecular formula | C50H71N13O12 |
|---|---|
| Molecular weight | 1046.2 g/mol |
| Registered trials | 880 |
| PubChem CID | 172198 |
| Drug class | Vasoconstrictor [EPC] |
| Brand names | ANGIOTENSIN II |
Mechanism of Action
12.1 Mechanism of Action Angiotensin II raises blood pressure by vasoconstriction and increased aldosterone release. Direct action of angiotensin II on the vessel wall is mediated by binding to the G-protein coupled-angiotensin II receptor type 1 on vascular smooth muscle cells, which stimulates Ca 2+ /calmodulin-dependent phosphorylation of myosin and causes smooth muscle contraction.
Key takeaways
- Angiotensin II is FDA-approved to raise blood pressure in adults with septic or other distributive shock.
- It works by directly constricting blood vessels and increasing aldosterone release.
- More than 880 trials in the clinical trial registry involve this compound or related research.
- The most frequently reported adverse events include drug ineffectiveness, death, and acute kidney injury, consistent with use in critically ill patients.
- No boxed warning is present on the current label.
What angiotensin II is
Angiotensin II is a vasoconstrictor, a drug class that works by narrowing blood vessels to raise blood pressure. It binds to the angiotensin II receptor type 1 on vascular smooth muscle cells. This binding triggers a chain of cellular signals that cause the muscle to contract, tightening the vessel wall. The same action also stimulates the release of aldosterone, a hormone involved in blood pressure regulation.
What angiotensin II is approved for
The FDA-approved indication for angiotensin II is to increase blood pressure in adults experiencing septic or other distributive shock, a life-threatening condition where blood vessels lose their ability to constrict properly. It is marketed under the brand name Angiotensin II. The current label does not carry a boxed warning.
What the evidence shows
More than 880 trials referencing angiotensin II or related compounds are registered in the clinical trial database. Sampled studies span different research contexts and phases, including a completed Phase 1 pharmacokinetics study of a related agent (AK1967, NCT06331884) and a completed Phase 2 study examining nitric oxide effects of tolvaptan (NCT01638663). A related Phase 1 trial in cord blood transplantation (NCT01300611) was terminated. These examples illustrate the breadth of research activity rather than direct evidence for the shock indication itself.
Reported side effects
Adverse event reports for angiotensin II reflect its use in critically ill patients with shock, and these counts represent reports submitted to a surveillance system, not confirmed incidence or causation. The most common reports involve treatment not working as intended, with "drug ineffective" (71 reports) and "off label use" (31) at the top. Serious outcomes are also frequently reported, including death (26), acute kidney injury (25), and toxicity to various agents (19). Circulatory complications appear as well, with distributive shock (17), peripheral ischaemia (17), and hypotension (16) reported.
FAQ
What is angiotensin II used for?
Angiotensin II is approved to raise blood pressure in adults with septic or other distributive shock. It is given in hospital settings where blood vessels have lost their normal ability to constrict. This use is based on its direct vasoconstrictor action.
How does angiotensin II work in the body?
It binds to angiotensin II receptor type 1 on the walls of blood vessels. This binding triggers smooth muscle contraction, narrowing the vessels and raising blood pressure. It also increases aldosterone release, which plays a role in blood pressure regulation.
Does angiotensin II have a boxed warning?
No, the current FDA label for angiotensin II does not include a boxed warning.
What side effects have been reported with angiotensin II?
The most frequently reported issues include the drug not working as intended, death, acute kidney injury, and low blood pressure. These are counts of submitted reports, not confirmed rates or proof that the drug caused the event. Many reports reflect the severity of the underlying shock condition being treated.
How much clinical research exists on angiotensin II?
More than 880 trials referencing angiotensin II or related compounds are registered in clinical trial databases. Sampled studies span multiple phases and research areas, including pharmacokinetics and other physiological research, though not all directly test the shock indication.
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Sources: FDA label (DailyMed) ClinicalTrials.gov FAERS PubChem
Updated 2026-08-04