Giapreza (Angiotensin II)

[Dexmetaketapropofol]

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Just had a meeting with one of their reps. Interested to know if you guys are using this for CPB vasoplegia. I know their trial was for Septic shock (Distributive shock)

 

[DM27]

Starting to, no impressions yet.

 

[deleted162650]

Sounds like a delicious Italian dish. Pairs well with a nice Chianti.

 

[dchz]

I'd be interested in how much this drug costs.

 

[vector2]

I'd be interested in how much this drug costs.

In addition to that, I'm also interested in some longer term data on thrombotic risk and AKI. Angiotensin II has a variety of effects beyond just vasoconstriction.

 

[Dexmetaketapropofol]

From what I gathered today it's approx $1500 per vial (assuming that it's used in an average weight base dose approx 20 nano/kg/min over 24 hours). This is about double what vasopressin would cost.

However, medicare will reimburse 1/2 the cost making it comparable to vasopressin cost. Thrombotic risk (grade 2) which was non-lifethreatening in their studies was greatly increased.

I'm interested to see how their studies are showing it's effect on PVR also...

 

[facted]

From what I gathered today it's approx $1500 per vial (assuming that it's used in an average weight base dose approx 20 nano/kg/min over 24 hours). This is about double what vasopressin would cost.

However, medicare will reimburse 1/2 the cost making it comparable to vasopressin cost. Thrombotic risk (grade 2) which was non-lifethreatening in their studies was greatly increased.

I'm interested to see how their studies are showing it's effect on PVR also...

Vasopressin is $700 a vial??? Really??? I found a Jama article from 2016 saying it was $138 which is still a lot more than I thought!!!

 

[Dexmetaketapropofol]

Vasopressin is $700 a vial??? Really??? I found a Jama article from 2016 saying it was $138 which is still a lot more than I thought!!!

Actually I think it is much less than $700 but the rep was using that approximate figure as a cost comparison. I think it's only a few hundred, but I'd have to check with our pharmacy to see what they pay for it. I'm sure there was some exaggeration on their part to sell the product

 

[Hamhock]

To counteract ACEi-induced refractory hypotension?

HH

 

[Dexmetaketapropofol]

To counteract ACEi-induced refractory hypotension?

HH

No, it's trial was as a vasoactive adjuvant to standard of care therapy for Septic shock and distributive shock. It was a small trial however, N = around 315 patients. FDA gave approval for this.

If it works, I think it could possibly a great tool for CPB vasoplegia. I believe Mayo is doing their own trial for this purpose...

 

[Hamhock]

No, it's trial was as a vasoactive adjuvant to standard of care therapy for Septic shock and distributive shock. It was a small trial however, N = around 315 patients. FDA gave approval for this.

If it works, I think it could possibly a great tool for CPB vasoplegia. I believe Mayo is doing their own trial for this purpose...

Yes, I saw that trial and have spent time reviewing this med for our hospital.

I guess I was asking: Are you (anesthesiologists) not excited about this drug for ACEi-induced hypotension?

I was thinking that -- and CPB vasoplegia -- would be equally enticing indications. Then all the sepsis stuff.

I guess I was trying to post too quickly/shorthand...my fault for poor communication.

HH

 

[Dexmetaketapropofol]

Yes, I saw that trial and have spent time reviewing this med for our hospital.

I guess I was asking: Are you (anesthesiologists) not excited about this drug for ACEi-induced hypotension?

I was thinking that -- and CPB vasoplegia -- would be equally enticing indications. Then all the sepsis stuff.

I guess I was trying to post too quickly/shorthand...my fault for poor communication.

HH

Well, usually when we have refractory hypotension post induction and we know it's secondary to ACEI, we grab a little vasopressin 0.5 to 2 units usually does the trick (for me anyways). Also, with the majority of preop clinics avoiding the use of ACEI before day surgery, it isn't a common problem. If it is a problem, it's usually counteracted quickly.

CPB vasoplegia poses a much more cumbersome issue which a multi-modal approach may still prove to be a challenging hemodynamic case. I'm looking forward to seeing what other studies they come up with regarding this so I can compare apples to apples (CPB vasoplegia vs their studied sepsis patients).