Heart & blood Vasopressor peptide
Angiotensin II
Regulatory status
Status at a glance
503A compounding status
Not nominated
We found no pending nomination for the 503A bulks list. Unless the substance has another legal pathway (for example, a USP monograph or use in an FDA-approved drug), 503A pharmacies generally may not compound with it.
- FDA approval
- An FDA-approved product contains this peptide
- 503B outsourcing
- Not determined
- Anti-doping (WADA)
- Not on the WADA Prohibited List
- DEA schedule
- Not a controlled substance
About peptide status
Most peptides discussed here are not FDA-approved for any use, and products labeled “research use only” are not for human use. Removal from Category 2 does not authorize compounding. PCAC votes are non-binding recommendations; FDA and HHS make the final decisions.
This is not medical or legal advice, and we do not publish dosing, sourcing or reconstitution information. Talk with a licensed clinician before using any peptide.
If you think you are having a medical emergency, call 911.
Key takeaway
Angiotensin II is a natural peptide hormone and the main active signal of the renin-angiotensin system, which the body uses to raise blood pressure by tightening blood vessels. A synthetic version is FDA-approved as Giapreza, an intravenous drug given in intensive care to raise dangerously low blood pressure in adults with septic or other distributive shock. In its pivotal ATHOS-3 trial it raised blood pressure in about 70% of patients compared with 23% on placebo, though it also carries a risk of blood clots.
At a glance
- FDA status
- FDA-approved peptide, sold as Giapreza, given as an intravenous infusion in intensive care
- How it works
- Synthetic copy of a natural hormone that raises blood pressure by constricting blood vessels
- Main uses
- Raising blood pressure in adults with septic or other distributive shock, usually alongside other vasopressors
- Key trial
- Raised blood pressure in about 70% of patients in its pivotal trial, compared with 23% on placebo
- Evidence strength
- FDA approved
Summary
Angiotensin II is a natural hormone that raises blood pressure. A synthetic form, Giapreza, is FDA-approved for shock. See how it works and what trials show.
What is angiotensin II?
Angiotensin II is a peptide hormone made of eight amino acids that the body uses to control blood pressure, and a synthetic form of it is used as a drug. It is the main active molecule of the renin-angiotensin system, the hormone cascade that regulates blood pressure and fluid balance.
As a medicine, it is a laboratory-made copy of the human hormone, developed by La Jolla Pharmaceutical, now part of Innoviva, and sold as Giapreza. It is given only as a continuous intravenous infusion in a hospital, not as an injection a person takes at home.
The history of angiotensin II
Angiotensin II was discovered twice at once, and that is how it got its name. The table below traces it from discovery to approval.
| Period | Event |
|---|---|
| Late 1930s and early 1940s | Two research groups independently isolated the same blood-pressure-raising substance from the kidney's renin pathway. A team led by Irvine Page in the United States called it angiotonin, while a group led by Eduardo Braun-Menéndez in Argentina called it hypertensin. For years the literature carried both names. |
| 1958 | The two camps compromised and blended their terms into a single word, angiotensin, which is still used today |
| 2017 | Approved by the FDA as an intravenous drug for shock, more than seven decades after its discovery |
For most of the following decades, the molecule was studied as a hormone and as a target to block, since many common blood-pressure medicines (ACE inhibitors and ARBs) work by reducing its activity. Using the hormone itself as a treatment came much later, when it was developed as an intravenous drug for shock.
How does angiotensin II work?
Angiotensin II raises blood pressure by binding to receptors on the muscle lining the blood vessels and making them tighten. It acts mainly through the AT1 receptor on vascular smooth muscle, and activating it constricts the vessels, which raises blood pressure quickly. This is the final active step of the renin-angiotensin system: the kidney releases renin, which starts a chain that produces angiotensin I, and an enzyme called ACE converts that into angiotensin II, the potent form.
Beyond directly tightening vessels, angiotensin II signals the adrenal glands to release aldosterone, a hormone that makes the body hold on to sodium and water, and it promotes the release of vasopressin, another blood-pressure hormone. In shock, this matters because it gives clinicians a way to raise blood pressure through a pathway separate from the standard catecholamine drugs such as norepinephrine, which helps when those drugs alone are not enough.
In the pivotal ATHOS-3 trial of patients with vasodilatory shock who were already on high-dose vasopressors, adding angiotensin II raised blood pressure to the target in 69.9% of patients, compared with 23.4% on placebo. It is given as a continuous infusion and adjusted to blood pressure, and because the peptide is cleared from the blood within about a minute, its effect can be dialed up or down quickly.
Is it FDA-approved?
Editor’s note
Status: FDA-approved peptide, sold as Giapreza, given as an intravenous infusion in intensive care
Category: FDA-approved · Primary body area: Heart & blood
Yes. The FDA approved angiotensin II as Giapreza in December 2017 to increase blood pressure in adults with septic or other distributive shock. It was a notable approval because it introduced a new type of vasopressor, giving intensive care teams a hormone-based option to add when standard drugs are not controlling dangerously low blood pressure.
What is angiotensin II prescribed for?
Angiotensin II is prescribed in the intensive care unit to raise blood pressure in adults whose blood pressure is dangerously low from septic or other distributive shock, a state in which the blood vessels lose their tone and dilate. It is typically added on top of standard vasopressors such as norepinephrine and vasopressin for patients who are not responding adequately to those alone, rather than used first. It is a short-term, closely monitored hospital treatment, not an outpatient medication.
What are the side effects?
The most important safety concern is a risk of blood clots. In its trial, angiotensin II was associated with thrombotic events, including deep vein thrombosis, and the label recommends giving clot-prevention treatment (venous thromboembolism prophylaxis) while a patient is receiving it. According to the prescribing information, other reported effects included:
- Low platelet counts
- A fast heart rate
- Fungal infection
- Delirium
- Acidosis
- High blood sugar
- Reduced blood flow to the hands and feet
Because it is used only in intensive care, patients receiving it are already under close monitoring.
Sources: FDA prescribing information for Giapreza (angiotensin II); the pivotal ATHOS-3 randomized controlled trial in the New England Journal of Medicine (Khanna et al., 2017, DOI: 10.1056/NEJMoa1704154), indexed on PubMed; and published histories of the renin-angiotensin system. This document is educational and does not constitute medical advice.
Registered human trials
0 registered human trials on ClinicalTrials.gov that we reviewed
Sources
- [1]
- [2]
- [3]
- PMID 11751697
- [4]
AT1 receptor (PDF)
- [5]
Compare every peptide’s status in the peptide regulatory status database
More for Heart & blood
View all heart & blood peptides →- In clinical trials Heart & blood
Balixafortide
Balixafortide is an investigational peptide that blocks the CXCR4 receptor, studied by Polyphor in combination with chemotherapy for metastatic breast cancer. An early single-arm trial suggested activity, but the pivotal Phase 3 trial did not show a benefit over chemotherapy alone, and development has effectively stopped. As of 2026 it is not approved.
- FDA-approved Heart & blood
Bivalirudin
Bivalirudin is a synthetic 20-amino acid peptide anticoagulant, derived in design from the leech protein hirudin, that directly and reversibly blocks thrombin, the central enzyme in blood clotting. Sold as Angiomax, it is given intravenously during coronary procedures such as angioplasty and stenting to prevent clots, including in people who cannot receive heparin. In a large trial of heart-attack patients, using it instead of heparin plus a second blood thinner reduced major bleeding and lowered 30-day death rates.
- FDA-approved Heart & blood
Desirudin
Desirudin (formerly sold as Iprivask) is a recombinant form of hirudin, the natural anticoagulant from the medicinal leech, that was used to prevent blood clots after hip replacement surgery. It directly and specifically blocks thrombin, the central enzyme of the clotting cascade. It was FDA-approved in the U.S. in 2003, but Iprivask has since been discontinued and no desirudin product is currently sold in the U.S.
- FDA-approved Heart & blood
Desmopressin
Desmopressin (desmopressin acetate; brands include DDAVP and Nocdurna) is a synthetic version of the antidiuretic hormone vasopressin, engineered to concentrate urine without raising blood pressure. It treats central diabetes insipidus, bedwetting, nighttime urination, and certain bleeding disorders. It has been FDA-approved in the U.S. since 1978 and comes as tablets, a sublingual form, nasal spray, and injection.
- FDA-approved Heart & blood
Echinocandins
The echinocandins (caspofungin, micafungin, and anidulafungin; sold as Cancidas, Mycamine, and Eraxis) are antifungal lipopeptides that attack the fungal cell wall, a structure human cells lack. They are a preferred option for invasive Candida infections and are generally well tolerated. All three have been FDA-approved in the U.S. since the 2000s, a fourth (rezafungin, sold as Rezzayo) was approved in 2023, and all are given intravenously.
- FDA-approved Heart & blood
Eptifibatide
Eptifibatide (sold as Integrilin) is a small cyclic peptide, modeled on a molecule from rattlesnake venom, that blocks the final step of platelet clumping to prevent dangerous clots during heart attacks and stenting. It is given intravenously in acute coronary syndrome and during coronary procedures. It has been FDA-approved in the U.S. since 1998, and its main risk is bleeding.