Clevidipine

Aka: Clevidipine, Cleviprex

1. See Also
   1. Nicardipine
   2. Dihydropyridine Calcium Channel Blocker
2. Indications
   1. Hypertensive Emergency
3. Contraindications
   1. Allergic Reaction to Clevidipine or its components
      1. Cross reactivity with soy and soybeans, egg and egg product allergies
   2. Lipid metabolism defect
   3. Severe Aortic Stenosis
   4. Pheochromocytoma
      1. Hypertensive Emergency management with Alpha Adrenergic Receptor antagonist with or without Beta Blocker
4. Mechanism
   1. Parenteral Dihydropyridine Calcium Channel Blocker
   2. Arterial Smooth Muscle dilation
   3. Decreases Peripheral Vascular Resistance (Afterload reduction)
   4. Minimal to no effect on Preload, cardiac conduction, or cardiac contractility
      1. However Calcium Channel Blockers may have negative inotropic effects
5. Pharmacokinetics
   1. Onset: <2 minutes (systolic Blood Pressure response)
   2. Half-Life: 1 minute
      1. Return to baseline Blood Pressure 5-15 minutes after discontinuing infusion
6. Dosing
   1. Start: 1-2 mg/hour IV infusion
   2. Titrate: Double dose (as often as every 90 seconds, then every 5-10 min) until approaching target Blood Pressure
      1. Blood Pressure drops 2-4 mmHg for every 1-2 mg/h
      2. Typical maintenance dose 4-6 mg/h
      3. Half of maximal effect reached at 10 mg/h
      4. Typical maximum dose 16 mg/h (absolute maximum dose 32 mg/h)
7. Adverse Effects
   1. Common
      1. Nausea or Vomiting
      2. Headache
   2. Serious
      1. Hypotension
      2. Reflex Tachycardia
      3. Congestive Heart Failure Exacerbation
      4. Rebound Hypertension
         1. Prevent by transitioning onto other antihypertensives before discontinuing Clevidipine
8. References
   1. Kristensen and LoVecchio (2020) Crit Dec Emerg Med 34(9): 28
   2. Tarascon Pharmacopeia, accessed 2/11/2021