Clevidipine

Clevidipine is an ultra–short-acting 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

→ Calcium Channel Blockers

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.

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)

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.

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.

Common:

• Reflex tachycardia
• Headache
• Hypotension

Special Considerations:

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

Avoid in:

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

• 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

• Calcium Channel Blockers
• Dihydropyridines
• Nicardipine
• Hypertension