Clevidipine

FDA label

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Titration Double the dose at ~90-second intervals initially; as BP approaches goal, increase by less than doubling and lengthen interval to every 5-10 minutes.

Renal Initial 1-2 mg/hr appropriate in moderate-to-severe renal impairment; titrate to blood pressure (not specifically studied)

Hepatic Initial 1-2 mg/hr appropriate in abnormal hepatic function; titrate to blood pressure (not specifically studied)

Because of lipid load, no more than 1000 mL (avg 21 mg/hr) per 24 h; little experience beyond 72 h.

Instructions

• IV use only via a calibrated infusion device; give by central or peripheral line
• Invert vial gently before use; maintain aseptic technique; use within 12 h of stopper puncture and discard unused portion
• Do not dilute; do not administer in the same line as other medications
• Monitor blood pressure and heart rate continuously; monitor for rebound hypertension for at least 8 h after stopping if not transitioned to oral therapy

Contraindications

• Allergy to soy or eggs (soybean/egg products)
• Defective lipid metabolism (pathologic hyperlipemia, lipoid nephrosis, acute pancreatitis with hyperlipidemia)
• Severe aortic stenosis

Cautions

• Hypotension and reflex tachycardia with rapid titration
• Lipid intake (~0.2 g lipid/mL); adjust concurrent lipids in disorders of lipid metabolism
• Negative inotropy; may exacerbate heart failure
• No protection against abrupt beta-blocker withdrawal
• Rebound hypertension after prolonged infusion
• Pheochromocytoma (no data)

Adverse reactions

• Headache
• Nausea
• Vomiting
• Atrial fibrillation (perioperative)
• Acute renal failure (perioperative)

Pregnancy Pregnancy Category C; animal studies show increased maternal and fetal mortality and prolonged gestation; use only if potential benefit justifies risk.

Lactation Unknown whether excreted in human milk; consider possible infant exposure.