clevidipine (Rx)

Brand and Other Names:Cleviprex
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

infusion solution

  • 0.5mg/mL

Hypertension

1-2 mg/hr (2-4 mL/hr), double dose q90sec initially; as blood pressure approaches goal, increase dose by less than doubling, and increase time between adjustments to q5-10min  

Maintenance: 4-6 mg/hr; not to exceed 21 mg/hr (1000 mL within 24 hour period)

Renal Impairment

Dose adjustment not necessary

Hepatic Impairment

Dose adjustment not necessary

Safety and efficacy not established

Initiate dosing at the low end of the dosage range

Hypertension

1-2 mg/hr (2-4 mL/hr), double dose q90sec initially; as blood pressure approaches goal, increase dose by less than doubling, and increase time between adjustments to q5-10min  

Maintenance: 4-6 mg/hr; not to exceed 21 mg/hr (1000 mL within 24 hour period)

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Interactions

Interaction Checker

and clevidipine

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      Serious - Use Alternative

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            Contraindicated (0)

              Serious - Use Alternative (1)

              • lofexidine

                lofexidine, clevidipine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.

              Monitor Closely (63)

              • acebutolol

                acebutolol and clevidipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • aldesleukin

                aldesleukin increases effects of clevidipine by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • alfuzosin

                alfuzosin and clevidipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              • amifostine

                amifostine, clevidipine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.

              • amlodipine

                amlodipine and clevidipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              • asenapine

                asenapine and clevidipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              • atenolol

                atenolol, clevidipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

              • avanafil

                avanafil increases effects of clevidipine by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • betaxolol

                betaxolol, clevidipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

              • bisoprolol

                bisoprolol, clevidipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

              • bretylium

                clevidipine, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.

              • calcium acetate

                calcium acetate decreases effects of clevidipine by pharmacodynamic antagonism. Use Caution/Monitor.

              • calcium carbonate

                calcium carbonate decreases effects of clevidipine by pharmacodynamic antagonism. Use Caution/Monitor.

              • calcium chloride

                calcium chloride decreases effects of clevidipine by pharmacodynamic antagonism. Use Caution/Monitor.

              • calcium citrate

                calcium citrate decreases effects of clevidipine by pharmacodynamic antagonism. Use Caution/Monitor.

              • calcium gluconate

                calcium gluconate decreases effects of clevidipine by pharmacodynamic antagonism. Use Caution/Monitor.

              • carbidopa

                carbidopa increases effects of clevidipine by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.

              • carvedilol

                carvedilol and clevidipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • celiprolol

                celiprolol, clevidipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

              • clarithromycin

                clarithromycin will increase the level or effect of clevidipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Increased effect of calcium channel blockers may lead to hypotension, edema, decreased HR, and acute kidney injury due to reduced renal blood flow

              • diltiazem

                clevidipine and diltiazem both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              • doxazosin

                doxazosin and clevidipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              • esmolol

                esmolol, clevidipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

              • felodipine

                clevidipine and felodipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              • isradipine

                clevidipine and isradipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              • itraconazole

                itraconazole will increase the level or effect of clevidipine by Other (see comment). Modify Therapy/Monitor Closely. CCBs elicit negative inotropic effects which may be additive to those of itraconazole; additionally, itraconazole can inhibit the metabolism of calcium channel blockers. Monitor for adverse reactions. Concomitant drug dose reduction may be necessary.

              • labetalol

                labetalol and clevidipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • lasmiditan

                clevidipine increases effects of lasmiditan by pharmacodynamic synergism. Use Caution/Monitor. Lasmiditan has been associated with a lowering of heart rate (HR). In a drug interaction study, addition of a single 200-mg dose of lasmiditan to propranolol decreased HR by an additional 5 bpm compared to propranolol alone, for a mean maximum of 19 bpm.

              • levodopa

                levodopa increases effects of clevidipine by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.

              • lurasidone

                lurasidone increases effects of clevidipine by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.

              • magnesium supplement

                magnesium supplement, clevidipine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Calcium channel blockers may increase toxic effects of magnesium; magnesium may increase hypotensive effects of calcium channel blockers.

              • maraviroc

                maraviroc, clevidipine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of hypotension.

              • mefloquine

                mefloquine increases levels of clevidipine by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

              • metformin

                clevidipine decreases effects of metformin by pharmacodynamic antagonism. Use Caution/Monitor. Patient should be closely observed for loss of blood glucose control; when drugs are withdrawn from a patient receiving metformin, patient should be observed closely for hypoglycemia.

              • methylphenidate

                methylphenidate will decrease the level or effect of clevidipine by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

              • metoprolol

                metoprolol and clevidipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • moxisylyte

                moxisylyte and clevidipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              • nadolol

                nadolol and clevidipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • nebivolol

                nebivolol, clevidipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

              • nicardipine

                clevidipine and nicardipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              • nifedipine

                clevidipine and nifedipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              • nisoldipine

                clevidipine and nisoldipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              • nitroglycerin rectal

                nitroglycerin rectal, clevidipine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Marked orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used concomitantly. Observe for possible additive hypotensive effects during concomitant use. .

              • nitroglycerin sublingual

                clevidipine, nitroglycerin sublingual. Either increases toxicity of the other by additive vasodilation. Modify Therapy/Monitor Closely. Marked orthostatic hypotension reported with concomitant use.

              • nitroprusside sodium

                clevidipine increases effects of nitroprusside sodium by pharmacodynamic synergism. Use Caution/Monitor.

              • ombitasvir/paritaprevir/ritonavir & dasabuvir

                ombitasvir/paritaprevir/ritonavir & dasabuvir will increase the level or effect of clevidipine by altering metabolism. Modify Therapy/Monitor Closely. May decrease calcium channel blocker dose if necessary

              • penbutolol

                penbutolol and clevidipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • phenoxybenzamine

                phenoxybenzamine and clevidipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              • phentolamine

                phentolamine and clevidipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              • pindolol

                pindolol and clevidipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • prazosin

                prazosin and clevidipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              • propranolol

                propranolol and clevidipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • silodosin

                silodosin and clevidipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              • sodium sulfate/?magnesium sulfate/potassium chloride

                clevidipine, sodium sulfate/?magnesium sulfate/potassium chloride. Either increases effects of the other by unknown mechanism. Use Caution/Monitor. Monitor for hypotension or muscle weakness in patients receiving calcium channel blockers with elevated serum magnesium concentrations.

              • sodium sulfate/potassium sulfate/magnesium sulfate

                clevidipine, sodium sulfate/potassium sulfate/magnesium sulfate. Either increases effects of the other by unknown mechanism. Use Caution/Monitor. Monitor for hypotension or muscle weakness in patients receiving calcium channel blockers with elevated serum magnesium concentrations.

              • sotalol

                sotalol and clevidipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • tadalafil

                tadalafil increases effects of clevidipine by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • temsirolimus

                clevidipine increases toxicity of temsirolimus by Other (see comment). Use Caution/Monitor. Comment: Combination of mTOR inhibitors with calcium channel blockers increases risk of angioedema.

              • terazosin

                terazosin and clevidipine both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              • timolol

                timolol and clevidipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • verapamil

                clevidipine and verapamil both increase anti-hypertensive channel blocking. Use Caution/Monitor.

              • voriconazole

                voriconazole increases levels of clevidipine by decreasing metabolism. Use Caution/Monitor.

              • xipamide

                xipamide increases effects of clevidipine by pharmacodynamic synergism. Use Caution/Monitor.

              Minor (23)

              • agrimony

                agrimony increases effects of clevidipine by pharmacodynamic synergism. Minor/Significance Unknown.

              • atracurium

                clevidipine increases effects of atracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

              • brimonidine

                brimonidine increases effects of clevidipine by pharmacodynamic synergism. Minor/Significance Unknown.

              • cisatracurium

                clevidipine increases effects of cisatracurium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

              • cornsilk

                cornsilk increases effects of clevidipine by pharmacodynamic synergism. Minor/Significance Unknown.

              • fo-ti

                fo-ti increases effects of clevidipine by pharmacodynamic synergism. Minor/Significance Unknown.

              • forskolin

                forskolin increases effects of clevidipine by pharmacodynamic synergism. Minor/Significance Unknown.

              • lithium

                clevidipine increases toxicity of lithium by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of neurotoxicity.

              • maitake

                maitake increases effects of clevidipine by pharmacodynamic synergism. Minor/Significance Unknown.

              • metipranolol ophthalmic

                metipranolol ophthalmic increases effects of clevidipine by pharmacodynamic synergism. Minor/Significance Unknown.

              • octacosanol

                octacosanol increases effects of clevidipine by pharmacodynamic synergism. Minor/Significance Unknown.

              • onabotulinumtoxinA

                clevidipine increases effects of onabotulinumtoxinA by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

              • pancuronium

                clevidipine increases effects of pancuronium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

              • porfimer

                clevidipine decreases levels of porfimer by unspecified interaction mechanism. Minor/Significance Unknown.

              • rapacuronium

                clevidipine increases effects of rapacuronium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

              • reishi

                reishi increases effects of clevidipine by pharmacodynamic synergism. Minor/Significance Unknown.

              • rocuronium

                clevidipine increases effects of rocuronium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

              • shepherd's purse

                shepherd's purse, clevidipine. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.

              • succinylcholine

                clevidipine increases effects of succinylcholine by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

              • tizanidine

                tizanidine increases effects of clevidipine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • treprostinil

                treprostinil increases effects of clevidipine by pharmacodynamic synergism. Minor/Significance Unknown.

              • vecuronium

                clevidipine increases effects of vecuronium by pharmacodynamic synergism. Minor/Significance Unknown. Ca Channel Blockers interfere w/Ach release from prejunctional axon.

              • verteporfin

                clevidipine increases levels of verteporfin by pharmacodynamic synergism. Minor/Significance Unknown.

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              Adverse Effects

              >10%

              AFib (21%)

              Nausea (21%)

              1-10%

              Acute renal failure (9%)

              Headache (6%)

              Vomiting (3%)

              <1%

              Cardiac arrest

              Myocardial infarction

              Postmarketing Reports

              Increased blood triglycerides

              Ileus

              Nausea

              Hypersensitivity

              Hypotension

              Reflex tachycardia

              Decreased oxygen saturation (possible pulmonary shunting)

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              Warnings

              Contraindications

              Hypersensitivity to drug, soy or egg products

              Defective lipid metabolism

              Acute pancreatitis if accompanied by hyperlipidemia

              Severe aortic stenosis

              Cautions

              Use aseptic technique and discard unused product within 12hr of stopper puncture

              May produce systemic hypotension and reflex tachycardia; if either occurs, decrease dose of drug; there is limited experience with short-duration therapy with beta-blockers as a treatment for drug-induced tachycardia; beta-blocker use for this purpose not recommended

              Drug contains approximately 0.2 g of lipid per mL (2.0 kcal); lipid intake restrictions may be necessary for patients with significant disorders of lipid metabolism; for these patients, a reduction in quantity of concurrently administered lipids may be necessary to compensate for amount of lipid infused as part of drug formulation

              Dihydropyridine calcium channel blockers can produce negative inotropic effects and exacerbate heart failure; monitor heart failure patients carefully

              Drug is not a beta-blocker, does not reduce heart rate, and gives no protection against effects of abrupt beta-blocker withdrawal; beta-blockers should be withdrawn only after gradual reduction in dose

              Patients who receive prolonged infusions and are not transitioned to other antihypertensive therapies should be monitored for possibility of rebound hypertension for at least 8 hr after infusion is stopped

              There is no information to guide use of drug in treating hypertension associated with pheochromocytoma

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              Pregnancy & Lactation

              Pregnancy

              Available data based on post-marketing reports with use in pregnant women are not sufficient to inform a drug-associated risk for major birth defects, miscarriage, or adverse maternal or fetal outcomes; there are risks to mother and fetus associated with poorly controlled hypertension in pregnancy

              Hypertension in pregnancy increases maternal risk for pre-eclampsia, gestational diabetes, premature delivery, and delivery complications (eg, need for cesarean section and postpartum hemorrhage); hypertension increases fetal risk for intrauterine growth restriction and intrauterine death; pregnant women with hypertension should be carefully monitored and managed accordingly

              Animal data

              • In animal studies, drug was associated with increased incidences of intrauterine deaths, slightly reduced fetal weight, retarded skeletal development, abortion, and embryo lethality at doses higher than the expected human dose
              • No evidence of embryo-fetal malformation was found with continuous IV infusion of clevidipine administered to pregnant rats and rabbits during the period of organogenesis at multiples of 2.8 and 7.6 times the expected human dose of 16 mg/hr respectively

              Lactation

              There are no data on presence of drug in human milk, effects on breastfed infant, or on milk production

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Calcium channel blocker (dihydropyridine): inhibits transmembrane influx of extracellular Ca ions across membranes of myocardial cells and vascular smooth muscle cells, without changing serum calcium concentrations, resulting in inhibition of cardiac and vascular smooth muscle contraction, thereby dilating main coronary and systemic arteries

              Pharmacokinetics

              Onset: 2-4 minutes

              Protein Bound: 99.5%

              Metabolized in blood and extravascular tissues

              Half-Life: Initial 1 minute; terminal 15 minutes

              Excretion: Urine (63-74%); feces (7-22%)

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              Administration

              IV Compatibilities

              Not diluted but compatible w/ following solvents: SWI; NS; D5W; D5/NS; D5/LR; LR; 10% aminoacid

              IV Administration

              Milky white emulsion

              No preservatives-use within 4 hr of puncturing stopper

              Doesn't need dilution

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              Images

              No images available for this drug.
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              Patient Handout

              Patient Education
              clevidipine intravenous

              NO MONOGRAPH AVAILABLE AT THIS TIME

              USES: Consult your pharmacist.

              HOW TO USE: Consult your pharmacist.

              SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Consult your pharmacist.

              DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: No monograph available at this time.

              MISSED DOSE: Consult your pharmacist.

              STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

              Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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              NC NOT COVERED – Drugs that are not covered by the plan.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.