Clevidipine (Cleviprex)

Rapid titratability - Onset 2-4 min and offset 5-15 min make it ideal for tight intraoperative blood pressure control.

Arterial-selective - Reduces afterload with little venodilation, so minimal effect on preload or central venous pressure.

Lipid emulsion vehicle - Same 20% lipid carrier as propofol; counts toward the daily lipid load, requires strict aseptic technique, discard 12 h after spiking the vial.

Organ-independent metabolism - Cleared by blood and tissue esterases, so no dose adjustment for hepatic or renal impairment.

Excessive effect - Hypotension resolves within minutes of stopping the infusion; reflex tachycardia may need a beta-blocker.

Drug Interactions - Additive with other antihypertensives and anesthetic agents; no significant CYP-mediated interactions.

Pediatric Implications - Safety and efficacy not established; limited data, not routinely used in children.

Obstetric Implications - Limited pregnancy data and not first-line for preeclampsia; avoid during lactation given the lack of safety data.

Absolute:

Egg or soy allergy

Defective lipid metabolism (pathologic hyperlipidemia, lipoid nephrosis, acute pancreatitis with hyperlipidemia)

Severe aortic stenosis

Relative:

Heart failure

Caution:

Patients prone to reflex tachycardia

Elderly

Start 1-2 mg/hr; double approximately every 90 s toward target, then titrate every 5-10 min.

Typical 4-6 mg/hr; maximum 16 mg/hr (up to 32 mg/hr short-term, limited by ~1000 mL/24h lipid load).

Selective L-type calcium channel blockade in arteriolar smooth muscle, producing arterial vasodilation and reduced systemic vascular resistance.

Blood and tissue esterases

Renal and fecal

Supplied as 0.5 mg/mL lipid emulsion.

Refrigerate; single-use vial, maintain strict aseptic technique, discard 12 h after spiking.