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Hypertension
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Clevidipine is an ultra-short-acting third-generation calcium channel blocker. Within 1–2 minutes, it reduces peripheral resistance while not affecting cardiac filling or venous vascular tone pressures. The drug is quickly hydrolyzed by blood esterases. Its metabolism is therefore not affected by the function of the kidneys or liver. Clevidipine safely and effectively controls perioperative hypertension and hypertensive emergencies. It is implicated in less deaths than nitroprusside. The starting dose is doubled every 90 seconds until the target BP is approached. Then, the dose is increased by less than double every 5–10 minutes. The drug is preferred over nitroprusside for the majority of hypertensive emergencies. While used cautiously for acute heart failure with reduced ejection fraction, there are still negative inotropic effects. Good alternatives if clevidipine is not available include fenoldopam, nicardipine, and nitroglycerin.
Chronic hypertension and acute hypertensive crisis
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
William F. Rayburn, Lauren Plante
Data in pregnancy are limited for most of these drugs: nicardipine, nitroglycerin, sodium nitroprusside, and esmolol have been reported. Nicardipine is developing a track record in pregnancy. It has been used successfully as a second-line treatment for pre-eclampsia after failure of ketanserin, labetalol, or hydralazine (65). In a small randomized trial, intravenous nicardipine was just as efficacious as labetalol for controlling bloodpressure inhypertensiveemergency during pregnancy (66). It has definite advantages over hydralazine, being a more predictable and titratable drug, with a much shorter time to onset and quicker disappearance once discontinued. Trimethaphan and phentolamine have largely been replaced by other drugs of better efficacy and greater predictability, and ketanserin is not available in the United States. Thereare, as yet, no data on fenoldopam or clevidipine in pregnancy.
Hypertensive Emergencies and Urgencies
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
Maria Lorenza Muiesan, Anna Paini, Claudia Agabiti Rosei, Fabio Bertacchini, Massimo Salvetti
Clevidipine is a third-generation calcium antagonist inhibiting selectively extracellular calcium influx through the L-type channel, relaxing smooth muscle of small arteries and reducing peripheral vascular resistance. The advantages of clevidipine are the blood metabolism, the very short (1-minute) half-life and the rapid titration (42,47) with minimal effects on stroke volume, cardiac output or heart rate. In the PRONTO study (48) clevidipine reduced SBP and improved dyspnoea more effectively than standard treatment did, with a reduction in the need of additional IV antihypertensive drugs and in the total dose of furosemide. In AHF, several other promising drugs including ularitide, an analogue of urodilatin, and serelaxin, a recombinant version of human relaxin-2, are currently under investigation (18).
Controlled hypotensive anesthesia for endoscopic endonasal repair of cerebrospinal fluid rhinorrhea: A comparison between clevidipine and esmolol: Randomized controlled study
Published in Egyptian Journal of Anaesthesia, 2018
Clevidipine is an intravenous calcium channel antagonist that can rapidly control blood pressure by direct arterial vasodilatation [6–9]. It has a short half-life approximately one to three minutes due to rapid metabolism by blood and tissue esterases [10,11].