II. Indications
III. Contraindications
-
Allergic Reaction to Clevidipine or its components
- Cross reactivity with soy and soybeans, egg and egg product allergies
- Lipid Metabolism defect
- Severe Aortic Stenosis
- Exercise caution in Congestive Heart Failure
-
Pheochromocytoma
- Hypertensive Emergency management with Alpha Adrenergic ReceptorAntagonist with or without Beta Blocker
IV. Mechanism
- Parenteral Dihydropyridine Calcium Channel Blocker
- Arterial Smooth Muscle dilation
- Decreases Peripheral Vascular Resistance (Afterload reduction)
- Minimal to no effect on Preload, cardiac conduction, or cardiac contractility
- However Calcium Channel Blockers may have negative inotropic effects
V. Pharmacokinetics
- Onset: <2 minutes (systolic Blood Pressure response)
-
Half-Life: 1 minute
- Return to baseline Blood Pressure 5-15 minutes after discontinuing infusion
- Key advantage over Nicardipine in Hypertensive Emergency
VI. Dosing
- Start: 1-2 mg/hour IV infusion
- Titrate: Double dose (as often as every 90 seconds, then every 5-10 min) until approaching target Blood Pressure
- Blood Pressure drops 2-4 mmHg for every 1-2 mg/h
- Target
- Typical maintenance dose 4-6 mg/h
- Half of maximal effect reached at 10 mg/h
- Maximum
- Typical maximum dose 16 mg/h
- Absolute maximum dose 32 mg/h
VII. Adverse Effects
- Common
- Serious
- Hypotension
- Reflex Tachycardia
- Congestive Heart Failure Exacerbation
- Rebound Hypertension
- Prevent by transitioning onto other Antihypertensives before discontinuing Clevidipine
VIII. Safety
- Pregnancy Category C
- Unknown Safety in Pregnancy
IX. References
- (2022) Presc Lett, Resource #381108, Comparison of Calcium Channel Blockers
- Kristensen and LoVecchio (2020) Crit Dec Emerg Med 34(9): 28
- Tarascon Pharmacopeia, accessed 2/11/2021