Names and pronunciation
(klev-id′i-peen) Cleviprex
PDF page 295
Loading InternPractice…
Drug reference
(klev-id′i-peen) Cleviprex
PDF page 295
Func. class.: Calcium channel blocker (L-type)
PDF page 295
Chem. class.: Dihydropyridine
PDF page 295
ACTION: L-type calcium channels mediate the influx of calcium during depolarization in arterial smooth muscle; reduces mean arterial B/P by decreasing systemic vascular resistance
PDF page 295
USES: Reduction of B/P when oral therapy is not feasible
PDF page 295
CONTRAINDICATIONS: Hyper- sensitivity to this product, eggs, soya leci- thin; defective lipid metabolism; severe aortic stenosis, pancreatitis Precautions: Pregnancy, labor, breast- feeding, children <18 yr, heart failure, hyperlipidemia, chronic hypertension, pheochromocytoma
PDF page 295
SIDE EFFECTS CNS: Headache CV: Reflex tachycardia, hypotension, rebound hypertension, atrial fibrillation GI: Nausea, vomiting MS: Arthralgia GU: Acute renal failure
PDF page 295
DOSAGE AND ROUTES • Adult: CONTINUOUS IV 1-2 mg/hr; dose may be doubled q90sec initially; as B/P reaches goal, adjust dose less frequently (q5-10min) with smaller in- creases in dose; most patients require 4-6 mg/hr, max 32 mg/hr; no more than 1000 mL should be infused per 24-hr period due to lipid load restrictions
PDF page 295
Available forms: Single-dose vial 50, 100 mL (0.5 mg/mL)
PDF page 295
Administer: Intermittent IV INFUSION route • Do not give through same line as other medications; do not dilute, do not filter • Gently invert several times before use; do not use if discolored or if particulate matter is present • Give through central or peripheral line at 1-2 mg/hr; use infusion device • Store vials in refrigerator; do not freeze; leave vials in carton until use; product is photosensitive, but protection C from light during administration is not required Solution compatibilities: water for injec- tion, 0.9% NaCl, D5W/0.9% NaCl, D5/LR, LR, 10% amino acid
PDF page 295
Assess: • Cardiac status: Monitor B/P, pulse, respiration, ECG; some patients have de- veloped severe angina, acute MI if ob- structive CAD is severe; if not transitioned to other antihypertensive therapies after clevidipine infusion, patients should be monitored ≥8 hr for rebound hyperten- sion; monitor for rebound hypertension after product stoppage • Pregnancy/breastfeeding: no well- controlled studies; use in pregnancy only if benefits outweigh fetal risk; ex- cretion is unknown, use cautiously in breastfeeding
PDF page 295
Evaluate: • Therapeutic response: decreased B/P
PDF page 295
CLINICAL CONSIDERATIONS
PDF page 295
Patient and caregiver information: • To notify prescriber immediately if neurologic symptoms, visual changes, or symptoms of HF occur • To inform the patient of reason for product, expected result • To continue follow-up for hyperten- sion in patients with hypertension • To notify prescriber if pregnancy is planned or suspected, or if breastfeeding
PDF pages 295, 296
PHARMACOKINETICS Onset 2-4 min; half-life initially 1 min, terminal 15 min; metabolized via ester- ases in blood, extravascular tissues; excreted in urine 63%-74%, feces 7%-22%; protein binding >99%
PDF page 295
• Adult: CONTINUOUS IV 1-2 mg/hr; dose may be doubled q90sec initially; as B/P reaches goal, adjust dose less frequently (q5-10min) with smaller in- creases in dose; most patients require 4-6 mg/hr, max 32 mg/hr; no more than 1000 mL should be infused per 24-hr period due to lipid load restrictions
PDF page 295