Adult Dosing

Hypertension

• Initial dose: 1–2 mg/hr
• Titrate: Double the dose at q90 seconds initially; as blood pressure approaches goal, increase dose by less than doubling and lengthen the time between dose adjustments to q5–10 min
• Maintenance dose: 4–6 mg/hr; Max: 32 mg/hr, however limited data on 32 mg/hr; so no more than 21 mg/hr is recommended per 24 hour period (due to lipid load restrictions)
• Transit to PO antihypertensive as soon as possible
• Note: Each 1-2 mg/hr increase produces 2-4 mmHg decrease in systolic BP

Pediatric Dosing

• Safety and effectiveness have not been established in children below 18 yrs of age

[Outline]

• Adult Dosing
• Pediatric Dosing

• Calcium channel blocker used for hypertension
• Note: Should be indicated when oral therapy is not feasible/desirable

• Hypersensitivity to any of the ingredients of the product
• Known allergies to soybeans, soy products, eggs, or egg products
• Defective lipid metabolism (Pathologic hyperlipemia, lipoid nephrosis)
• Acute pancreatitis with hyperlipidemia
• Severe aortic stenosis

Renal Dose Adjustment

• Renal impairment: No dose adjustments

Hepatic Dose Adjustment

• Hepatic impairment: No dose adjustments

• Decrease the dose if systemic hypotension and reflex tachycardia develops
• Restrict lipid intake in patients with significant disorders of lipid metabolism
• Does not reduce heart rate; does not give protection against the effects of abrupt beta-blocker withdrawal; discontinue beta-blocker only after gradually reducing the dose
• Monitor heart failure patient carefully as it causes negative inotropic effects and exacerbate heart failure
• Monitor BP and heart rate continuously during infusion till the vital signs stabilize; titrate dose cautiously; rapid upward titration can cause hypotension and reflex tachycardia
• Patients who receive prolonged infusions and are not transitioned to other antihypertensives should be monitored for atleast 8 hrs after stopping the infusion for the possibility of rebound hypertension

Cautions: Use cautiously in

• Heart failure
• Hyperlipidemia
• Elderly population (Titrate dose cautiously, initiate therapy at low end of dose range)

Pregnancy Category:C

Breastfeeding: Excretion in human milk is unknown; as many drugs are excreted in human milk, manufacturer has advised to consider possible infant exposure when the drug is administered to nursing mother.

• CV: Hypotension and reflex tachycardia, atrial fibrillation, myocardial infarction, rebound HTN, cardiac arrest
• CNS: Headache
• GI: Nausea, vomiting
• GU: Acute renal failure

• L-type calcium channel blocker; inhibits calcium ion influx during depolarization in vascular smooth muscle and myocardium
• Rapidly metabolized by plasma and tissue esterases to inactive metabolites; CYP450: none
• Renally excreted: 63–74%; feces: 7–22%
• Half-life: Biphasic
• Initial phase: 1 min (85-90% elimination)
• Terminal phase: 15 mins

US Trade Name(s)

• Cleviprex

US Availability

Cleviprex

• INJ: 0.5 mg/mL (50, 100 mL vial)

Canadian Trade Name(s)

• N/A

Canadian Availability

• N/A

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

[Outline]

Cardiovascular

Calcium Channel Blockers