From the Guidelines
Cleviprex (clevidipine) is an appropriate choice for managing hypertensive emergencies in patients with end-stage renal disease (ESRD). The recommended starting dose is 1-2 mg/hour administered as a continuous intravenous infusion, which can be doubled every 90 seconds initially, then doubled every 5-10 minutes as needed to a maximum of 32 mg/hour until the target blood pressure is reached. Clevidipine is particularly suitable for ESRD patients because it undergoes rapid metabolism by blood and tissue esterases, independent of renal function, with a half-life of approximately 1 minute 1. This pharmacokinetic profile allows for quick onset (2-4 minutes) and offset of action, providing excellent titratability without drug accumulation in renal failure. Unlike some other antihypertensives, no dose adjustment is required for ESRD patients. The medication is formulated in a lipid emulsion, so monitoring triglyceride levels is recommended for infusions exceeding 48 hours. Blood pressure should be continuously monitored during administration, and once stabilized, patients should be transitioned to oral antihypertensive therapy appropriate for ESRD patients. Potential side effects include headache, nausea, and reflex tachycardia, though the latter is less common than with other vasodilators.
Some key points to consider when using Cleviprex in ESRD patients include:
- The importance of continuous blood pressure monitoring to avoid overshooting and potential organ damage
- The need for careful dose titration to achieve the desired blood pressure target
- The potential for triglyceride accumulation with prolonged infusions, necessitating regular monitoring
- The suitability of clevidipine for patients with acute renal failure, as noted in Table 20 of the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline 1
Overall, Cleviprex is a valuable option for managing hypertensive emergencies in ESRD patients, offering a favorable pharmacokinetic profile and minimal requirements for dose adjustment. However, it is essential to carefully monitor patients and adjust the dose as needed to achieve optimal blood pressure control and minimize potential side effects.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Cleviprex Drip for Hypertensive Emergency in ESRD
- Cleviprex, also known as clevidipine, is a calcium channel blocker that has been shown to be effective in treating hypertensive emergencies 2, 3, 4.
- It has a favorable pharmacokinetic profile, making it a promising alternative to other drugs used in hypertensive emergencies 4.
- The use of cleviprex in patients with end-stage renal disease (ESRD) is not specifically addressed in the provided studies, but its effectiveness in reducing blood pressure in various clinical settings, including acute ischemic stroke and heart failure, has been endorsed by guidelines 5.
- In general, the selection of an antihypertensive agent for use in hypertensive emergency should be based on the agent's pharmacology and patient-specific factors, such as comorbidity and the presence of end-organ damage 6.
- Other antihypertensive agents, such as labetalol, esmolol, fenoldopam, and nicardipine, may also be considered for use in hypertensive emergencies, depending on the individual patient's characteristics and clinical presentation 2, 3, 6.