Drug Information: Clevidipine
Clevidipine is a dihydropyridine calcium channel blocker used for the rapid reduction of blood pressure in situations where oral therapy is not feasible or desirable. It is primarily used in acute hypertension settings, such as hypertensive emergencies, perioperative hypertension, and acute severe hypertension. Because of its rapid onset and offset, clevidipine allows for precise titration of blood pressure, making it a valuable tool in critical care and emergency medicine.
Category
Antihypertensive
Mechanism of Action
Clevidipine is a dihydropyridine calcium channel blocker that works by selectively blocking L-type calcium channels in vascular smooth muscle. These channels are responsible for regulating calcium influx into the cells, which is essential for vascular smooth muscle contraction. By blocking these channels, clevidipine reduces intracellular calcium levels, leading to vasodilation and a subsequent decrease in systemic blood pressure. Clevidipine is highly selective for vascular smooth muscle, which minimizes its effect on cardiac contractility and conduction. This selectivity is crucial in managing acute hypertension, as it allows for blood pressure reduction without significantly compromising cardiac function. Its rapid metabolism by esterases in the blood and tissues contributes to its short half-life (approximately 1 minute), enabling precise blood pressure control and rapid recovery upon discontinuation.
Clinical Uses
Clevidipine is primarily indicated for the management of acute hypertension when oral therapy is not feasible or desirable. This includes situations such as hypertensive emergencies, where a rapid and controlled reduction in blood pressure is required to prevent end-organ damage. It is also used in perioperative settings to manage hypertension that may arise during or after surgery. Furthermore, clevidipine is useful in patients with severe hypertension, including those in intensive care units (ICUs), where precise blood pressure titration is critical. Its rapid onset and offset make it particularly valuable for managing labile blood pressure fluctuations and achieving target blood pressure goals quickly and safely. Studies have shown clevidipine to be effective in controlling blood pressure in various clinical scenarios, providing a valuable alternative to other intravenous antihypertensive agents.
Dosage
Adult Dosage: Clevidipine is administered intravenously as a continuous infusion. The initial dose is typically 1-2 mg/hour, doubled every 90 seconds to 2 minutes until the desired blood pressure is achieved. The maximum dose is generally 32 mg/hour. Dosage should be titrated based on individual blood pressure response and clinical judgement.
Pediatric Dosage: The safety and efficacy of clevidipine in pediatric patients have not been established. Therefore, it is not typically used in this population.
Indications
Common indications for Clevidipine include:
- Acute hypertension
- Hypertensive emergencies
- Perioperative hypertension
- Severe hypertension in ICU settings
Contraindications
Clevidipine is contraindicated in patients with:
- Hypersensitivity to clevidipine or any of its components
- Severe aortic stenosis
- Allergy to soy or eggs (due to the lipid emulsion formulation)
- Impaired lipid metabolism (e.g., hyperlipidemia, lipoid nephrosis)
FAQ
Q: What is Clevidipine used for?
A: Clevidipine is used to rapidly lower blood pressure in situations such as hypertensive emergencies, perioperative hypertension, and severe hypertension when oral medication is not appropriate.
Q: How quickly does Clevidipine work?
A: Clevidipine has a rapid onset of action, with blood pressure reduction typically occurring within 2-4 minutes of starting the infusion.
Q: How is Clevidipine administered?
A: Clevidipine is administered intravenously as a continuous infusion.
Q: What are the common side effects of Clevidipine?
A: Common side effects may include headache, nausea, atrial fibrillation, and hypotension.
Q: Can Clevidipine be used in patients with heart failure?
A: Clevidipine can be used with caution in patients with heart failure, but it is important to monitor for any signs of worsening heart failure.
Q: What should I do if my blood pressure gets too low while taking Clevidipine?
A: If your blood pressure gets too low, the infusion rate should be reduced or stopped, and you should notify your healthcare provider immediately.
Q: Is Clevidipine safe to use during pregnancy?
A: Clevidipine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Discuss with your healthcare provider before use.
Q: What makes Clevidipine different from other antihypertensive medications?
A: Clevidipine’s rapid onset and short half-life allow for precise titration of blood pressure, making it particularly useful in acute settings where close control is necessary.
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