====== Clevidipine ======

Clevidipine is an ultra–short-acting [[cardio:ccb:dhp|Dihydropyridine Calcium Channel Blocker]] (DHP CCB).

It is a potent, rapidly titratable intravenous arterial vasodilator used in hypertensive emergencies.

Used in:

  * Hypertensive emergency
  * Perioperative blood pressure control
  * Neurocritical care BP management

→ [[cardio:ccb:start|Calcium Channel Blockers]]

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===== Mechanism of Action =====

Clevidipine blocks L-type calcium channels in vascular smooth muscle.

This results in:

  * Rapid arterial vasodilation
  * ↓ Systemic Vascular Resistance
  * ↓ Afterload

Minimal effect on:

  * SA node
  * AV node
  * Myocardial contractility

Primary action = vascular.

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===== Pharmacokinetics (Key Feature) =====

Clevidipine is unique among DHPs.

Half-life:
  * ~1 minute

Metabolism:
  * Rapid hydrolysis by plasma and tissue esterases
  * Not dependent on liver or kidney function

Onset:
  * 2–4 minutes

Offset:
  * Very rapid after stopping infusion

Formulation:
  * Lipid emulsion (similar to propofol)

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===== Clinical Use =====

Hypertensive Emergency:

  * Rapid BP control
  * Easy titration
  * Short duration allows tight control

Perioperative Hypertension:

  * Cardiac surgery
  * Vascular surgery

Neurocritical Care:

  * Stroke
  * Intracranial hemorrhage
  * Subarachnoid hemorrhage

Provides smooth arterial vasodilation.

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===== Clevidipine vs [[cardio:ccb:nicardipine|Nicardipine]] =====

Clevidipine:

  * Ultra–short half-life
  * Faster titration
  * Not renally/hepatically cleared
  * Lipid-based formulation

Nicardipine:

  * Longer half-life
  * More gradual offset
  * Aqueous formulation

Clevidipine allows finer BP control.

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===== Adverse Effects =====

Common:

  * Reflex tachycardia
  * Headache
  * Hypotension

Special Considerations:

  * Lipid formulation (monitor triglycerides in prolonged infusions)
  * Contraindicated in:
      * Egg allergy
      * Soy allergy
      * Disorders of lipid metabolism

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===== Contraindications =====

Avoid in:

  * Severe aortic stenosis
  * Defective lipid metabolism
  * Egg/soy hypersensitivity

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===== Clinical Pearls =====

  * DHP CCB
  * Ultra–short-acting IV agent
  * Rapid onset and offset
  * Ideal for tightly controlled BP reduction
  * Does NOT affect AV node
  * Excellent ICU drug

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===== Related =====

  * [[cardio:ccb:start|Calcium Channel Blockers]]
  * [[cardio:ccb:dhp|Dihydropyridines]]
  * [[cardio:ccb:nicardipine|Nicardipine]]
  * [[cardio:hypertension:start|Hypertension]]