What is the use of Cleviprex (Clevidipine)?

From the Guidelines

Cleviprex (clevidipine) is recommended as a safe and effective treatment for acute hypertension in patients undergoing cardiac surgery, with a starting dose of 1-2 mg/hour, which can be doubled every 90 seconds until the target blood pressure is reached, with a maximum dose of 32 mg/hour 1.

Key Points

• Cleviprex works quickly, with onset within 2-4 minutes and a short half-life of about 1 minute, allowing for precise blood pressure control.
• It's administered as a lipid emulsion that requires no dilution but needs protection from light and should be discarded after 12 hours if opened.
• Cleviprex selectively dilates arterioles without affecting cardiac filling pressures or causing reflex tachycardia.
• It's metabolized by blood and tissue esterases, making it safe for patients with kidney or liver dysfunction.
• However, it should be used cautiously in patients with lipid metabolism disorders due to its lipid emulsion formulation, and it's contraindicated in patients with egg or soy allergies, defective lipid metabolism, or severe aortic stenosis.

Indications

• Acute hypertension in patients undergoing cardiac surgery
• Perioperative hypertension
• Acute sympathetic discharge or catecholamine excess states
• Acute pulmonary edema

Dosage and Administration

• Starting dose: 1-2 mg/hour
• Dose titration: double every 90 seconds until target blood pressure is reached
• Maximum dose: 32 mg/hour
• Maximum duration: 72 hours

Contraindications

• Egg or soy allergies
• Defective lipid metabolism
• Severe aortic stenosis

Precautions

• Use cautiously in patients with lipid metabolism disorders
• Monitor for signs of allergic reactions or lipid metabolism disorders
• Protect from light and discard after 12 hours if opened

From the FDA Drug Label

Cleviprex is a dihydropyridine calcium channel blocker indicated for the reduction of blood pressure when oral therapy is not feasible or not desirable. (1) Cleviprex is indicated for the reduction of blood pressure when oral therapy is not feasible or not desirable. Cleviprex is a dihydropyridine calcium channel blocker indicated for the reduction of blood pressure when oral therapy is not feasible or not desirable. (1)

The primary use of Cleviprex is for the reduction of blood pressure when oral therapy is not feasible or not desirable 2, 2, 2.

• The indication is for patients who require a reduction in blood pressure.
• Cleviprex is a dihydropyridine calcium channel blocker.
• It is used when oral therapy is not feasible or not desirable.

From the Research

Overview of Cleviprex

• Cleviprex, also known as clevidipine, is a late-generation dihydropyridine calcium channel antagonist used for the reduction of blood pressure when oral therapy is not feasible or desirable 3.
• It is a lipophilic, short-acting, third-generation dihydropyridine calcium channel blocker approved for use in the management of acute hypertension when oral agents are not feasible 4.

Pharmacological Properties

• Clevidipine inhibits L-type calcium channels in a voltage-dependent manner and exhibits a high degree of vascular selectivity in vitro 3.
• It has a rapid onset and offset of effect, with a half-life of approximately 1 minute, and is metabolized via hydrolysis by esterases in the blood and extravascular tissues 3, 4.
• Clevidipine is highly plasma protein bound and rapidly distributed, with a low volume of distribution at steady state 3.

Therapeutic Efficacy

• Intravenous clevidipine is effective in the treatment of both acute preoperative and postoperative hypertension in adult cardiac surgery patients 3, 5, 6.
• It is also effective in lowering blood pressure in adults with acute severe hypertension 3, 7.
• Clevidipine has been shown to be more effective than sodium nitroprusside or nitroglycerin in the perioperative setting, and has an efficacy similar to that of nicardipine in the postoperative setting 3, 6.

Safety and Tolerability

• Clevidipine is generally well tolerated in cardiac surgery patients with acute hypertension, with a safety profile similar to that of sodium nitroprusside, nitroglycerin, or nicardipine 3, 4, 6.
• The most common treatment-emergent adverse events associated with clevidipine include atrial fibrillation, sinus tachycardia, headache, nausea, and vomiting 3, 4, 7.
• Clevidipine does not appear to inhibit or induce cytochrome P-450 isoenzymes, and does not accumulate in the body 4.