Most peptides discussed on this site sit outside UK medicines law — research reagents with no marketing authorisation. Angiotensin II is the opposite case. It is a short peptide that is also a UK-licensed prescription medicine, and it is worth understanding precisely because it shows where the line between a research compound and a licensed medicine actually falls.

What angiotensin II is

Angiotensin II is an octapeptide — eight amino acids — and the principal effector hormone of the renin-angiotensin-aldosterone system (RAAS). It is generated from angiotensin I by angiotensin-converting enzyme (ACE). Its classical actions are vasoconstriction and stimulation of aldosterone release, both of which raise blood pressure and conserve sodium. Within the RAAS, angiotensin II is the peptide that performs the acute haemodynamic work.

Because it is a peptide, angiotensin II cannot be given orally; it is administered by continuous intravenous infusion and is handled as a hospital medicine.

Giapreza: the licensed form

Giapreza (angiotensin II acetate) is indicated for the treatment of refractory hypotension in adults with septic or other distributive shock who remain hypotensive despite adequate volume restitution and catecholamines and other available vasopressor therapies. It is a prescription-only medicine, intended for use in an acute, hospital setting, and should be prescribed by physicians experienced in the treatment of shock.

The UK marketing authorisation is held by PAION UK Ltd. The electronic medicines compendium records the UK marketing authorisation number as PLGB 59768/0003, first authorised on 1 January 2021, with the latest renewal dated 10 June 2024. The EU authorisation (EU/1/19/1384) was granted on 23 August 2019 through the centralised procedure, and the US approved the same product in 2017 — a rare instance in which UK, EU and US routes have all been used for the same peptide. The UK position is stated here from the UK register; the EU and US positions are given only as a jurisdiction comparison.

The evidence: ATHOS-3

The authorisation rests principally on ATHOS-3 (Angiotensin II for the Treatment of High-Output Shock), a Phase 3 randomised controlled trial in adults with vasodilatory shock receiving high-dose vasopressors. The trial compared angiotensin II with placebo, added to standard vasopressor therapy, and assessed the proportion of patients reaching a target mean arterial pressure. The results were published in the New England Journal of Medicine in 2017.

The safety profile in the product information reflects the mechanism: because angiotensin II is a vasoconstrictor, the most common adverse effects include thromboembolic events, transient hypertension, tachycardia and peripheral ischaemia. Treatment is titrated to the lowest dose that achieves adequate mean arterial pressure and is withdrawn as soon as the underlying shock improves, to limit prolonged vasoconstriction.

Why this matters for how we grade peptides

Angiotensin II is a useful counter-example to two opposite errors. The first is the assumption that all peptides are unlicensed — they are not; several are fully licensed medicines. The second is the assumption that a licensed peptide is therefore suitable for self-directed use — it is not; Giapreza is an intensive-care vasopressor given by infusion under specialist supervision.

For a UK reader trying to place a compound, the useful question is not whether it is a peptide but what its regulatory route is. Angiotensin II sits at the licensed end of that spectrum, and it is graded here on the strength of its randomised trial evidence rather than on its chemistry.

Bottom line

  • Angiotensin II is an octapeptide and the effector hormone of the RAAS.
  • Giapreza (angiotensin II acetate) holds a UK marketing authorisation — PLGB 59768/0003 — for refractory hypotension in septic or other distributive shock.
  • Its authorisation rests on the ATHOS-3 Phase 3 trial, published in the New England Journal of Medicine in 2017.
  • It is a hospital-only, prescription-only infusion, and it is not a research reagent.

Research use only. Nothing in this article is medical advice, and nothing here should be read as guidance on the use of any compound in humans.

This article is AI-researched and editorially reviewed. It is provided for research and educational purposes only and is not medical advice. Research peptides are not licensed for human consumption in the UK.