Bedside Snapshot

Use It For: Hypertensive emergency needing titratable IV control; BP lowering before and after stroke thrombolysis or thrombectomy; ICH; aortic dissection after rate control; perioperative hypertension
Adult Dose: Start 1–2 mg/hr IV infusion; double every 90 sec initially, then smaller steps every 5–10 min near goal. Usual 4–6 mg/hr; most need 16 mg/hr or less (limited experience to 32 mg/hr; max 1,000 mL per 24 hr)
Pediatric Dose: Not established in children (under 18 yr): specialist or pediatric critical care protocol use only
Onset / Duration: IV infusion: 2–4 min / BP recovers 5–15 min after stopping
Do Not Give / Hold If: Soy or egg allergy; defective lipid metabolism; severe aortic stenosis. Reduce if below target, or SBP falls >25% in hour 1 with no dissection, severe preeclampsia or pheochromocytoma crisis; stroke/ICH: own targets
Watch For: Hypotension (BP below target); reflex tachycardia (rising heart rate); falling SpO₂ from pulmonary shunting; rebound hypertension for at least 8 hr after a prolonged infusion if no oral agent has been started
Reversal / Rescue: No specific reversal: stop or reduce the infusion (effect fades in 5–15 min); support BP with IV fluid and a vasopressor per protocol if needed
Must Remember: One concentration, 0.5 mg/mL lipid emulsion: mL/hr = mg/hr × 2. Dedicated line, discard the vial 12 hr after puncture, and count it in the daily lipid load (2 kcal/mL)

Indications

Emergency & Prehospital

Hypertensive emergency with acute target-organ damage: IV BP control you can titrate, for when you can't use oral therapy or don't want to. Differs from FDA label: the label gives only the general indication. It says nothing about emergencies or target-organ damage
Acute ischemic stroke before or after reperfusion: BP control around IV thrombolysis (IVT) or endovascular thrombectomy (EVT). Without reperfusion, a BP below 220/120 mmHg is not treated in the first 48–72 hr
Spontaneous intracerebral hemorrhage (ICH): early, smooth systolic BP (SBP) lowering. The 2025 AHA/ACC and 2022 AHA/ASA targets don't match (see Adult Dosing)
Acute aortic dissection: Only after IV beta-blockade (esmolol, labetalol). Or after IV diltiazem or verapamil, when beta-blockers are contraindicated

Differs from FDA label: The label names no stroke, ICH, aortic dissection or aSAH use. It gives no BP targets for any of them. Here, the uses and targets follow the guidelines cited below.

ED / ICU / Transport

Perioperative hypertension: cardiac surgery and other surgical patients
Aneurysmal subarachnoid hemorrhage (aSAH): smooth BP control before the aneurysm is secured. Avoid severe hypertension, hypotension and wide swings. Target per the neurosurgery or neurocritical care protocol

Other Uses

Severe hypertension in pregnancy or postpartum: not a first-line agent. The American College of Obstetricians and Gynecologists (ACOG) names three agents as the most commonly used: IV labetalol, IV hydralazine and oral immediate-release nifedipine. Treat SBP 160 or more or DBP 110 or more mmHg as soon as possible (within 30–60 min), once confirmed over 15 min or more

Not for severe hypertension without organ damage: In nonpregnant adults, BP above 180/120 mmHg with no acute target-organ damage gets oral treatment. Start, restart or intensify oral agents (2025 AHA/ACC guideline). Not with an IV infusion.

Dosing & Administration

Adult dosing below is fixed in mg/hr. You titrate to the BP response.

Available Forms

Ready-to-use injectable emulsion: 0.5 mg/mL in 50 mL (25 mg) and 100 mL (50 mg) single-use vials. It is a milky white emulsion in soybean oil and egg phospholipids. The only US concentration. Nothing to mix.
Lipid content: about 0.2 g lipid per mL (2 kcal/mL).

Adult Dosing

Indication	Dose & Route	Repeat / Max	Notes
Acute BP reduction / hypertensive emergency	Start 1–2 mg/hr IV infusion; double every 90 sec initially, then increase by less than double every 5–10 min near goal	Usual 4–6 mg/hr; most need 16 mg/hr or less; limited experience up to 32 mg/hr. Max 1,000 mL (average 21 mg/hr) per 24 hr; little experience beyond 72 hr	Each 1–2 mg/hr step lowers SBP about 2–4 mmHg. No compelling condition: SBP down no more than 25% in hour 1, then to 160/100 mmHg over 2–6 hr, then toward normal over 24–48 hr. Compelling condition (aortic dissection, severe preeclampsia or eclampsia, pheochromocytoma crisis): SBP below 140 mmHg in hour 1 (below 120 for aortic dissection); in pregnancy, follow the obstetric protocol. Stroke and ICH have their own targets (rows below). Differs from FDA label: the label sets no BP targets; the targets shown follow the AHA/ACC hypertension guideline.
Acute ischemic stroke, IVT or EVT candidate	Start 1–2 mg/hr IV infusion; titrate as above, or per the stroke protocol	Label limits as above. Before IVT: below 185/110 mmHg, then below 180/105 mmHg for at least 24 hr after. EVT without IVT: 185/110 mmHg or less before, then 180/105 mmHg or less during the procedure and for 24 hr after	After successful EVT for anterior-circulation LVO (mTICI 2b–3): an SBP target below 140 mmHg for the first 72 hr is harmful. After IVT in mild to moderate stroke: an intensive target below 140 (vs below 180) gives no benefit. The 2026 AHA/ASA stroke guideline sets BP targets but gives no agent-specific dosing
Acute ischemic stroke, no IVT or EVT	Usually none in the first 48–72 hr (permissive hypertension); if the stroke team orders lowering, start 1–2 mg/hr IV infusion and titrate slowly	Below 220/120 mmHg: do not start antihypertensives (no benefit). At 220/120 mmHg or above: benefit of treatment uncertain; if lowered, aim for an initial reduction of about 15%	Lower sooner only for a comorbidity that needs urgent BP control (e.g., acute coronary syndrome, acute heart failure, aortic dissection, symptomatic ICH after thrombolysis, preeclampsia or eclampsia), with an individualized target per the stroke team
Spontaneous ICH, mild to moderate, SBP 150–220 mmHg	Start 1–2 mg/hr IV infusion; titrate as above	Limits as above; SBP 130 to <140 mmHg, kept for at least 7 days; withhold antihypertensives if SBP falls below 130 mmHg (2025 AHA/ACC). The 2022 AHA/ASA ICH guideline gives a target of 140 mmHg (range 130–150); follow the stroke or neurocritical care protocol	Start within 2 hr of onset, at target within 1 hr (2022 AHA/ASA); titrate carefully and avoid large swings. Large or severe ICH, or surgical decompression planned: intensive lowering is not established; set the target with neurosurgery or neurocritical care
Acute aortic dissection	Start 1–2 mg/hr IV infusion after beta-blockade (or IV diltiazem or verapamil if beta-blockers are contraindicated); titrate as above	Limits as above; SBP below 120 mmHg (or lowest BP with adequate perfusion), heart rate 60–80 bpm	Rate control first: reflex tachycardia raises aortic wall stress. Arterial line
Perioperative hypertension (cardiac surgery)	Start 1–2 mg/hr IV infusion; titrate as above	Limits as above; titrate to the surgical SBP range	Kept SBP in the target range better than nitroglycerin or nitroprusside and as well as nicardipine; no difference in MI, stroke or renal dysfunction at 30 days (ECLIPSE)

Dosing weight: Don't dose by weight. Titrate to BP response.

Pediatric Dosing

Not established in children: The FDA label says safety and effectiveness under 18 years are not established. Pediatric data come from small case series. Use only under a pediatric critical care or anesthesia protocol. Otherwise, follow the institution's pediatric antihypertensive protocol. See Pediatric Vital Signs for age-based BP.

Continuous Infusion

Setting	Example Concentration	Start	Titrate	Usual Range / Max
Adult, peripheral or central line	0.5 mg/mL ready-to-use (single commercial concentration)	1–2 mg/hr (2–4 mL/hr)	Double every 90 sec initially; near goal, smaller steps every 5–10 min	Usual 4–6 mg/hr (8–12 mL/hr); most 16 mg/hr (32 mL/hr) or less; 32 mg/hr (64 mL/hr) limited experience

Pump rate at 0.5 mg/mL

mL/hr = mg/hr × 2. Example: 6 mg/hr = 12 mL/hr

Preparation & Administration

Dilution: none; do not dilute. Invert gently to mix; inspect for particles or discoloration.
Line: peripheral or central; no other medications in the same line.
Pump requirement: calibrated infusion pump (smart pump with drug library); never IV push.
Aseptic technique: No antimicrobial preservative. The 0.005% disodium edetate only slows microbial growth. Use within 12 hr of stopper puncture, then discard.
Priming and changes: It is a low-volume infusion, so prime the tubing and check for dead space. Keep pauses short at vial or set changes (BP rebounds within 5–15 min). Change tubing per the institutional lipid-emulsion policy.
Light: Keep vials in the carton until use (photosensitive). Light protection is not needed during the infusion.

Dosing Notes:

Oral transition: start the oral agent before you stop (1 hr before in VELOCITY). Then stop or taper while you watch BP.
A prolonged infusion with no oral agent? Watch for rebound hypertension for at least 8 hr.
Renal and hepatic impairment: see Special Populations.

Contraindications & Precautions

Contraindications

Allergy to soybeans, soy products, eggs or egg products (lipid emulsion vehicle).
Defective lipid metabolism: pathologic hyperlipemia, lipoid nephrosis, or acute pancreatitis accompanied by hyperlipidemia.
Severe aortic stenosis: Afterload reduction lowers coronary perfusion and myocardial oxygen delivery. Nicardipine is also contraindicated (advanced aortic stenosis). Lower BP cautiously, with cardiology or anesthesia input and an arterial line.

Precautions

Heart failure: Dihydropyridines can be negatively inotropic. Monitor closely.
Patients on chronic beta-blockers: Clevidipine offers no protection against beta-blocker withdrawal. Taper. Never stop abruptly.
Pheochromocytoma: There are no data to guide use in pheochromocytoma-related hypertension.
Significant lipid disorders or other IV lipids (propofol, parenteral nutrition): Reduce other lipids to offset the clevidipine lipid load.

Hold / Reassess If

BP below target, or SBP falls more than 25% within the first hour when there is no compelling condition: reduce the rate.
Pronounced reflex tachycardia: reduce the rate. The label does not recommend beta-blockers to treat it.
Falling SpO₂ without another cause: suspect pulmonary shunting; reduce or stop.
New neurologic deficit after BP lowering in stroke or ICH: stop titrating down; reassess the target with the stroke team.
Rate approaching the 24-hr lipid limit (1,000 mL) or infusion beyond 72 hr: add or switch to another agent.

Adverse Effects & Toxicity

Common

Headache (6.3% in severe hypertension)
Nausea (4.8%) and vomiting (3.2%) in severe hypertension
Brief (about 30-min) placebo-controlled ESCAPE trials in cardiac surgery: atrial fibrillation 21% vs 12% and nausea 21% vs 12% (postoperative use); acute renal failure 9% vs 2% (preoperative use)
Larger ECLIPSE trials: no adverse reaction more than 2% more common than with nitroglycerin, nitroprusside or nicardipine
Reflex tachycardia and hypotension, mostly with rapid upward titration

Serious / Life-Threatening

Effect	Recognition	Management
Hypotension and overshoot	BP below target; new neuro deficit, chest pain or oliguria	Reduce or stop; IV fluid, vasopressor per protocol if needed
Reflex tachycardia, myocardial ischemia	Rising heart rate, ST changes, chest pain; MI and cardiac arrest in under 1%	Reduce the rate; 12-lead ECG; treat ischemia per ACS protocol
Hypoxemia	Falling SpO₂ (possible pulmonary shunting)	Reduce or stop; give oxygen; consider another agent
Hypersensitivity	Urticaria, bronchospasm, hypotension	Stop; treat anaphylaxis with IM epinephrine
Hypertriglyceridemia, ileus	Rising triglycerides; abdominal distension	Reduce other lipids; switch agents

Overdose & Toxicity Management

Signs: There is no human overdose experience. Trials gave doses up to 106 mg/hr (1,153 mg total). Expected effects: hypotension and reflex tachycardia.
Immediate: Stop the infusion and support BP. The antihypertensive effect falls within 5–15 min.
Antidote: None. The short half-life makes stopping the infusion the treatment.

Monitoring

Parameter	When / How Often	Target / Act If
Clinical: blood pressure	Continually until stable and at every titration step; arterial line for dissection or labile BP	Below target, or first-hour fall over 25% (no compelling condition): reduce
Clinical: heart rate and rhythm	Continuous ECG	Pronounced tachycardia or new AF: reduce the rate
Clinical: SpO₂	Continuous	Unexplained fall: suspect shunting; reduce or stop
Clinical: neurologic status	Stroke or ICH: with each BP change, per protocol	New deficit after BP lowering: stop titrating down; notify the stroke team
Clinical: rebound hypertension	At least 8 hr after a prolonged infusion with no oral agent	Above goal: restart or start an oral agent
Laboratory: triglycerides	Prolonged infusion, lipid disorders, other IV lipids	Rising: reduce other lipids; consider another antihypertensive. Abdominal pain or distension: check lipase (pancreatitis)
Infusion safety: vial and volume	Each vial change and at handoff	Vial punctured over 12 hr ago: discard. Near 1,000 mL in 24 hr: switch agent

Interactions & Compatibility

Clinically Significant Interactions

Drug / Class	Effect	What To Do
Other IV antihypertensives (nicardipine, nitroglycerin, labetalol, hydralazine)	Additive hypotension	Titrate one agent at a time; reduce clevidipine first if BP overshoots
Propofol, parenteral nutrition lipids	Additive lipid load; propofol adds hypotension	Count total lipid; reduce other lipid sources in lipid disorders
Sedatives and anesthetics	Additive hypotension, especially at induction	Lower the clevidipine rate before induction or sedation boluses
Chronic beta-blockers (e.g., metoprolol)	No protection against beta-blocker withdrawal	Continue or taper; do not stop abruptly
CYP450 substrates, inhibitors and inducers	None expected: clevidipine and its metabolites neither inhibit nor induce CYP enzymes	No adjustment

IV Compatibility

Diluents: none; give undiluted.
May run with: Water for Injection, 0.9% NaCl, D5W, D5/0.9% NaCl, D5/lactated Ringer's, lactated Ringer's and 10% amino acid.
Dedicated line or lumen: do not give other medications in the same line.
Verify with an institutional compatibility resource.

Special Populations

Pediatrics: Safety and effectiveness under 18 years are not established. Specialist use only (see Pediatric Dosing).
Pregnancy: Postmarketing data are not enough to show a drug-linked risk of birth defects, miscarriage or other adverse outcomes. Animal studies at doses above the human dose showed fetal loss and prolonged labor. They showed no malformations. Poorly controlled hypertension harms mother and fetus. Use the standard obstetric agents (IV labetalol, IV hydralazine, oral immediate-release nifedipine). If BP stays severely high despite them, get emergent anesthesia, maternal-fetal medicine or critical care consultation.
Lactation: There is no data on presence in human milk, effects on the breastfed infant or milk production.
Older Adults: Trials showed no overall differences in safety or effectiveness (620 patients 65 or older). Start at the low end and titrate cautiously.
Renal Impairment: No specific adjustment is established. Esterase elimination is unlikely to be affected by renal dysfunction, so the usual 1–2 mg/hr start applies. Start at the low end in older adults, who more often have reduced renal, hepatic or cardiac function.
Hepatic Impairment: No specific adjustment is established. Esterase elimination is unlikely to be affected by hepatic dysfunction. The usual 1–2 mg/hr start is appropriate.
Obesity / Dosing Weight: Dosing is fixed in mg/hr, not weight-based. Titrate to BP.
Soy, Egg or Lipid Disorders: Contraindicated with soy or egg allergy and with defective lipid metabolism. Choose nicardipine or labetalol instead.

Field & Transport Considerations

Scope: Critical-care transport RN and paramedic (CCT), ED and ICU. At interfacility transfer, it is usually already running. Varies by state and agency protocol.
Storage & Stability: Refrigerate vials at 2–8°C (36–46°F) in the carton. Don't freeze them. Vials may be kept at 25°C (77°F) for up to 2 months. Mark the date. They must not go back into the refrigerator. Discard 12 hr after the stopper is punctured.
Carried Concentration: One concentration only (0.5 mg/mL). So mL/hr is always double the mg/hr. The milky white emulsion looks like propofol, so label both lines.
Infusions in Transport: Dedicated pump channel and line. A 50 mL vial lasts about 4 hr at 6 mg/hr (12 mL/hr). At 16 mg/hr (32 mL/hr), it lasts only about 1.5 hr. Bring enough vials for delays, and change them without a pause, because BP rebounds within minutes.
Handoff Essentials: current rate in mg/hr and mL/hr, BP target and indication, last titration and BP response, vial puncture time, total volume in the last 24 hr, other antihypertensives and the oral transition plan.

Clinical Pearls

Aortic dissection: rate before pressure: Clevidipine causes reflex tachycardia, and that raises aortic wall stress. Get an IV beta-blocker in first (IV diltiazem or verapamil if beta-blockers are contraindicated) and bring the heart rate to 60–80 bpm. After that, add clevidipine until SBP is below 120 mmHg.

Know the ceiling: In mild to moderate essential hypertension, the effect levels off at about a 25% fall from baseline SBP. Half-maximal comes at about 10 mg/hr. Still far from goal at high rates? A second agent is the move. Don't chase the dose into the lipid limit.

Falling SpO₂ on a vasodilator: Postmarketing reports include desaturation, from possible pulmonary shunting. SpO₂ falling with no other cause? Reduce or stop.

Clevidipine vs nicardipine:

Clevidipine: offset 5–15 min, low infusion volume, lipid emulsion with egg and soy contraindications
Nicardipine: no lipid load, slower offset, and more volume at standard concentrations
Evidence: A 2026 meta-analysis (9 studies, 8 retrospective) found similar efficacy and safety. In stroke, neurocritical and general hypertensive-crisis subgroups, clevidipine reached target SBP faster and used less volume. Superiority was not consistent.

Plan the exit early: Clevidipine is gone in minutes, but oral agents are slow to work. Start the oral antihypertensive before the drip comes off.

Exam discriminator: Egg or soy allergy in the stem, or hypertriglyceridemic pancreatitis, rules clevidipine out. Pick nicardipine or labetalol. Severe aortic stenosis rules out both dihydropyridines, nicardipine included. The stem asks which calcium channel blocker wears off fastest? The answer is clevidipine (blood esterase metabolism).

Pharmacology

Mechanism of Action

L-type calcium channel blockade in arterial smooth muscle → arteriolar dilation → lower systemic vascular resistance and BP.
No effect on venous capacitance → preload (cardiac filling pressure) is preserved.
Baroreflex response → heart rate rises. Clevidipine itself does not slow the heart.
No QT prolongation at therapeutic or supratherapeutic concentrations.

Pharmacokinetics

Route	Onset	Peak	Duration
IV infusion	2–4 min	Follows each rate change; plateaued at about a 25% SBP fall in mild to moderate hypertension	BP recovers 5–15 min after stopping

Half-life: initial phase about 1 min (85–90% of elimination); terminal about 15 min. No tolerance or hysteresis in infusions up to 72 hr.
Metabolism: Blood and tissue esterases break it down by ester hydrolysis, not through hepatic CYP enzymes. The products are an inactive carboxylic acid metabolite and formaldehyde.
Active metabolites: None. The main metabolite (half-life about 9 hr) has no antihypertensive effect.
Elimination: 63–74% in urine and 7–22% in feces (radiolabeled dose).
Protein binding / Vd: more than 99.5% protein bound; volume of distribution 0.17 L/kg.

Names & Classification

Generic Name: Clevidipine (racemic; both enantiomers equipotent)
Brand Names: Cleviprex (US; also marketed under this name in other countries)
Pharmacologic Class: Dihydropyridine L-type calcium channel blocker
Therapeutic Class: IV antihypertensive (arterial vasodilator)
Controlled Substance: Not controlled
ISMP High-Alert: No: IV calcium channel blockers are not on the ISMP acute-care list; still run as a titrated infusion on a smart pump
Look-Alike / Sound-Alike: None commonly reported; practical mix-up risk with propofol (both milky white emulsions on pumps)

References

Chiesi USA, Inc. (2022). CLEVIPREX (clevidipine) injectable emulsion, for intravenous use: prescribing information (updated 11/2025). DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f9290625-b723-4eda-bab8-a97bef6041f6
Jones, D. W., Ferdinand, K. C., Taler, S. J., Johnson, H. M., Shimbo, D., et al. (2025). 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation and management of high blood pressure in adults. Hypertension, 82(10), e212–e316. https://doi.org/10.1161/HYP.0000000000000249
Prabhakaran, S., Gonzalez, N. R., Zachrison, K. S., Adeoye, O., Alexandrov, A. W., et al. (2026). 2026 guideline for the early management of patients with acute ischemic stroke: A guideline from the American Heart Association/American Stroke Association. Stroke, 57(8), e316–e436. https://doi.org/10.1161/STR.0000000000000513
Greenberg, S. M., Ziai, W. C., Cordonnier, C., Dowlatshahi, D., Francis, B., et al. (2022). 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: A guideline from the American Heart Association/American Stroke Association. Stroke, 53(7), e282–e361. https://doi.org/10.1161/STR.0000000000000407
Isselbacher, E. M., Preventza, O., Hamilton Black, J., Augoustides, J. G., Beck, A. W., et al. (2022). 2022 ACC/AHA guideline for the diagnosis and management of aortic disease. Circulation, 146(24), e334–e482. https://doi.org/10.1161/CIR.0000000000001106
American College of Obstetricians and Gynecologists. (2020). Gestational hypertension and preeclampsia: ACOG Practice Bulletin No. 222 (reaffirmed 2026). Obstetrics & Gynecology, 135(6), e237–e260. https://doi.org/10.1097/AOG.0000000000003891
Ullah, T., Khan, H., Khan, A., Agha, S. A. U., Malik, A. A., et al. (2026). Comparative efficacy and safety of clevidipine versus nicardipine in hypertensive emergencies: A systematic review and meta-analysis. Clinical Cardiology, 49(7), e70419. https://doi.org/10.1002/clc.70419
Aronson, S., Dyke, C. M., Stierer, K. A., Levy, J. H., Cheung, A. T., et al. (2008). The ECLIPSE trials: Comparative studies of clevidipine to nitroglycerin, sodium nitroprusside, and nicardipine for acute hypertension treatment in cardiac surgery patients. Anesthesia & Analgesia, 107(4), 1110–1121 (landmark trial). https://doi.org/10.1213/ane.0b013e31818240db
Baxter Healthcare Corporation. (2026). CARDENE IV (nicardipine hydrochloride in dextrose or sodium chloride injection) for intravenous use: prescribing information (updated 3/2026). DailyMed, U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=f12cea0d-b7cd-41d8-b551-2c74cc7f5f4e

Last updated October 2026 Spotted something wrong? Report an error and include the page URL.

Medical Disclaimer

For Educational Purposes Only: This content is intended for educational reference and should not be used for clinical decision-making.
Not a Substitute for Professional Judgment: Always consult your local protocols, institutional guidelines, and supervising physicians.
Verify Before Acting: Users are responsible for verifying information through authoritative sources before any clinical application.

AI Assistance Notice

AI was used to assist in organizing, paraphrasing, and formatting this information.

Clevidipine (Cleviprex)