Clevidipine
Drug | Clevidipine |
Brand names | Cleviprex ® |
Indications | Hypertension and hypertensive emergency. Treatment of postoperative hypertension. |
Mechanism of action | Ultra-short acting calcium channel blocker (CCB). Half-life: 5 minutes. Rapidly inactivated by esterases. |
Effects | • Clevidipine is a dihydropyridine L-type calcium channel blocker. Clevidipine is highly selective for vascular smooth muscle cells and has little or no effect on myocardial contractility or conduction. Clevidipine reduces mean arterial blood pressure (MAP) by decreasing systemic vascular resistance (SVR). Clevidipine does not reduce cardiac filling pressure (pre-load), since it has no effects on the venous capacitance vessels. Hence, Clevidipine reduces blood pressure without affecting cardiac filling pressures. • Clevidipine is more effective than nitroglycerin, nitroprusside, and nicardipine in hypertensive emergencies. |
Time to onset of action | 2-4 minutes |
Duration of action | 5-15 minutes |
Delivery | IV (infusion). |
Dose | Initial dose: 1-2 mg/h iv. Increase as necessary. Rapid titration is possible. Maximum dose: 21 mg/h iv. Common therapeutic dose: 4-6 mg/h. Clevidipine is administered in lipid emulsion (containing soy, egg), of which the maximum dose per 24 hours is 1000 mL. |
Adverse effects | Headache. Nausea. Fever. Atrial fibrillation. Worsening of heart failure. |
Caution | • Used cautiously in patients with acute heart failure. • Clevidipine can cause reflex tachycardia. • Contraindicated in severe aortic stenosis due to risk of hypotension. |