Clevidipine

Administration

• Type: Calcium channel blockers, anti-hypertensive, dihydropyridine
• Dosage Forms: 0.5 mg/mL (50 mL, 100 mL) emulsion
• Routes of Administration: IV
• Common Trade Names: Cleviprex

Adult Dosing

Hypertension

• 1-2 mg IV per hour
  • Titration: Double dose at 90 second intervals toward blood pressure goal.
    • For every 1-2 mg/hour increase should see 2-4 mm Hg reduction

Special Populations

Pregnancy Rating

• C

Lactation risk

• Unknown

Renal Dosing

None

Hepatic Dosing

None

Contraindications

• Allergy to class/drug
• Allergy to soybeans, soy products, eggs, egg products
• Severe aortic stenosis

Adverse Reactions

Serious

• Atrial fibrillation
• Renal failure
• MI (<1%)
• Intestinal obstruction (<1%)
• Hypertriglyceridemia - similar to propofol, formulated with 20% fat emulsion, risk of developing pancreatitis

Common

• Insomnia
• Nausea
• Fever
• Headache

Pharmacology

• Onset: 2-4 minutes
• Half-life: 1 minute
• Metabolism: hydrolysis by esterases in blood
• Excretion: Urine (63-74%); feces (7 to 22%)

Mechanism of Action

• Dihydropyridine CCB with arterial vasodilating activity. Inhibits calcium ion influx through L-type calcium channels. Decreases MAP and systemic vascular resistance.

Comments

• $1.67 per mL (25 mg/50mL or 50 mg/100 mL)

Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

Indication	Dose	Context	Route	Population
Hypertensive emergency	1-2 mg/hr, titrate by doubling q90 sec	Antihypertensive	IV drip	Adult
Nontraumatic thoracic aortic dissection	1-2mg/hr, double q90sec until approaching goal	Blood pressure control (vasodilator) after beta-blockade	IV	Adult
Stroke (main)	1-2 mg/hr IV, double dose q2-5 min, max 21 mg/hr	BP control in acute stroke	IV drip	Adult

See Also

• Subarachnoid hemorrhage
• Hemorrhagic stroke
• Hypertensive emergency
• Nicardipine

References

• American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122(5):1122-1131. doi: 10.1097/01.AOG.0000437382.03963.88. [PubMed 24150027]
• Aronson S, Dyke CM, Stierer KA, et al, “The ECLIPSE Trials: Comparative Studies of Clevidipine to Nitroglycerin, Sodium Nitroprusside, and Nicardipine for Acute Hypertension Treatment in Cardiac Surgery Patients,” Anesth Analg, 2008, 107(4):1110-21. [PubMed 18806012]
• Cleviprex (clevidipine) [prescribing information]. Cary, NC: Chiesi USA, Inc; October 2017.
• Funder JW, Carey RM, Mantero F, et al. The management of primary aldosteronism: case detection, diagnosis, and treatment: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(5):1889-1916. doi: 10.1210/jc.2015-4061. [PubMed 26934393]
• Keating GM. Clevidipine: a review of its use for managing blood pressure in perioperative and intensive care settings. Drugs. 2014;74(16):1947-1960. [PubMed 25312594]
• Levy JH, Mancao MY, Gitter R, et al, “Clevidipine Effectively and Rapidly Controls Blood Pressure Preoperatively in Cardiac Surgery Patients: The Results of the Randomized, Placebo-Controlled Efficacy Study of Clevidipine Assessing Its Preoperative Antihypertensive Effect in Cardiac Surgery-1,” Anesth Analg, 2007, 105(4):918-25. [PubMed 17898366]
• Marik PE and Varon J, “Hypertensive Crises: Challenges and Management,” Chest, 2007, 131(6); 1949-62. [PubMed 17565029]
• Peacock WF, Varon J, Garrison N, et al, “IV Clevidipine for Hypertension: Safety, Efficacy, and Transition to Oral Therapy,” Ann Emerg Med, 2007, 50(3 Suppl 1):8-9.
• Singla N, Warltier DC, Gandhi SD, et al, “Treatment of Acute Postoperative Hypertension in Cardiac Surgery Patients: An Efficacy Study of Clevidipine Assessing Its Postoperative Antihypertensive Effect in Cardiac Surgery-2 (ESCAPE-2), a Randomized, Double- Blind, Placebo-Controlled Trial,” Anesth Analg, 2008, 107(1):59-67. [PubMed 18635468]
• Varon J, “Treatment of Acute Severe Hypertension: Current and Newer Agents,” Drugs, 2008, 68(3):283-97. [PubMed 18257607]
• Yancy CW, Jessup M, Bozkurt B, et al; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):e240-e327. [PubMed 23741058]
• Zhang JG, Dehal SS, Ho T, et al, “Human Cytochrome P450 Induction and Inhibition Potential of Clevidipine and Its Primary Metabolite H152/81,” Drug Metab Dispos, 2006, 34(5):734-37. [PubMed 16501008]