Clevidipine: a short-acting intravenous dihydropyridine calcium channel blocker for the management of hypertension.

Drugs used to acutely lower blood pressure have specific indications and precautions for use. Clevidipine is a third-generation parenteral dihydropyridine calcium channel blocker that received United States Food and Drug Administration approval in August 2008 for blood pressure reduction when oral therapy is not feasible or desirable. Formulated as an injectable oil-in-water emulsion, the drug is a short-acting arterial-selective vasodilator. Clinical efficacy and safety trials of clevidipine have primarily focused on blood pressure management during cardiac surgery and in patients with acute severe hypertension (in intensive care units and emergency departments). In phase III trials, clevidipine demonstrated efficacy in blood pressure lowering, with a relatively low occurrence of adverse events. Reflex tachycardia, atrial fibrillation, and acute renal failure were observed in these studies and merit additional analysis. The lack of specific clinical outcomes documenting improved morbidity and mortality rates as compared with other agents, the small numbers of treated patients, and concerns regarding the lipid formulation necessitate further investigation to help define the therapeutic role of clevidipine.