Parenteral clevidipine for the acute control of blood pressure in the critically ill patient: a review.
Clevidipine is a new calcium channel blocker of the dihydropyridine class that is characterized by its ultra-short onset of action, vascular selectivity, small volume of distribution and extremely high clearance that coupled together result in an extremely short half-life of approximately 1 minute therefore permitting a rapid titration to the desired effect. Structurally similar to other dihydropyridines, clevidipine has an extra ester link that allows its rapid hydrolization to its inactive carboxylic acid metabolite in blood and extravascular tissues. Clevidipine's metabolites are then primarily eliminated through urine and fecal pathways. Clevidipine does not affect cytochrome P450 (CYP) enzymes and no clinically significant drug interactions have been determined. In trials like the ESCAPE trials, ECLIPSE, and VELOCITY, clevidipine demonstrated a significant improvement in the management of acute hypertension when compared to placebo as shown in both ESCAPE trials. The ECLIPSE trial compared clevidipine to other drugs currently used in the management of acute hypertension, such as sodium nitroprusside, nitroglycerine and nicardipine; clevidipine was superior to all three agents; in providing blood pressure support, safety and tolerability clevidipine also showed a significant reduction in mortality rate (4.7% vs 1.7%, P =0.0445) when compared to sodium nitroprusside. In the VELOCITY trial clevidipine demonstrated a reduction in blood pressure of 6% at the 3 minute mark, 15% within 9.5 minutes and 27% at the 18 hour mark.
Peacock
W Frank
WF
The Cleveland Clinic, Cleveland, OH, USA.
Angeles
Jorge E
JE
Soto
Karina M
KM
Lumb
Philip D
PD
Varon
Joseph
J
J Hypertens. 1995 Aug;13(8):915-24
8557970
Postgrad Med. 1993 Feb;93(2):92-6, 101-4, 108-10
8433961
Acta Anaesthesiol Scand. 2000 Feb;44(2):186-93
10695913
Drugs. 2008;68(3):283-97
18257607
Am J Cardiol. 1985 Mar 1;55(6):652-6
3976506
Am J Public Health. 1988 Jun;78(6):636-40
3369591
Hypertension. 2003 Dec;42(6):1206-52
14656957
Ann Thorac Surg. 2004 Mar;77(3):761-6; discussion 766-8
14992867
Anesthesiology. 1976 Apr;44(4):345-8
1259195
Can Anaesth Soc J. 1980 May;27(3):254-9
6769567
Am Heart J. 1986 Jan;111(1):226-8
3946155
Angiology. 1990 Nov;41(11 Pt 2):992-1004
2248428
Cardiovasc Drug Rev. 2004 Fall;22(3):227-50
15492770
Crit Care. 2003 Oct;7(5):374-84
12974970
Anesthesiology. 1979 Jun;50(6):481-3
453572
Eur J Anaesthesiol. 2003 Sep;20(9):697-703
12974590
Am J Cardiol. 1989 Feb 2;63(6):40C-42C
2913756
QJM. 1995 Sep;88(9):641-7
7583078
JAMA. 1986 Mar 28;255(12):1607-13
3005672
Blood Press Suppl. 2011 Apr;1:20-5
21091269
Br Med J. 1980 Oct 4;281(6245):921-3
7427510
Vasc Health Risk Manag. 2008;4(3):615-27
18827911
Emerg Med Clin North Am. 2005 Nov;23(4):1141-58
16199342
Anesth Analg. 2007 Oct;105(4):918-25, table of contents
17898366
Anesthesiology. 2002 May;96(5):1086-94
11981147
JAMA. 2003 May 21;289(19):2560-72
12748199
Ann Emerg Med. 2009 Mar;53(3):329-38
18534716
Circulation. 1994 Nov;90(5 Pt 2):II256-61
7955262
Br J Anaesth. 1984 Jul;56(7):711-24
6145438
Chest. 2007 Jun;131(6):1949-62
17565029
Hypertension. 1996 Jan;27(1):144-7
8591878
Q J Med. 1958 Jan;27(105):117-53
13506014
Br Med J. 1973 Mar 3;1(5852):507-10
4692673
Anesth Analg. 2008 Jul;107(1):59-67
18635468
Am J Med. 1987 Mar 30;82(3B):29-36
2882675
Anesthesiology. 1979 Aug;51(2):127-30
453612
Anesth Analg. 2008 Oct;107(4):1110-21
18806012
Anesthesiology. 2000 Apr;92(4):993-1001
10754618
Circulation. 2004 Aug 31;110(9):1168-76
15339866
Heart Dis Stroke. 1992 Nov-Dec;1(6):373-8
1344134
Anesth Analg. 1995 Jul;81(1):152-62
7598246
Br J Anaesth. 2000 Nov;85(5):683-9
11094580
Semin Dial. 2006 Nov-Dec;19(6):502-12
17150051
Br J Clin Pharmacol. 1999 May;47(5):531-8
10336577
Br J Anaesth. 1975 Jan;47(1):70-4
238547