Clevidipine as a therapeutic and cost-effective alternative to sodium nitroprusside in patients with acute aortic syndromes

Abstract

Intravenous clevidipine appears to be a safe and effective alternative to sodium nitroprusside for the management of high blood pressure during acute aortic dissection. In the USA, clevidipine could represent a cost effective therapy providing similar outcomes than sodium nitroprusside.

Medical or endovascular management of acute type B aortic dissection

“…Other medications such as nitroprusside (a vasodilator) and clevidipine (a calcium channel blocker) have been also used. 14 Our hemodynamic targets are a heart rate of<70 beats per minute and systolic blood pressure between 100 and 120 mm Hg. Refractory hypertension, as well as the need for systolic blood pressure >120 mm Hg for adequate vital organ perfusion in patients with severe chronic hypertension, usually prompts us to proceed with surgical intervention.…”

New clues for optimal diagnosis and treatment of an old foe: the acute aortic syndrome

“…8 In all patients with diagnosed acute aortic syndromes, management of blood pressure is a key aspect of management and vasodilators are indicated in those with elevated blood pressure after establishing adequate heart rate control. Sodium nitroprusside is frequently used in this setting; however, Alviar et al 9 cite cost as a potential issue impacting access and thus evaluated intravenous clevidipine, a calcium antagonist with favourable pharmacodynamics including rapid onset and short half-life as an alternative. Compared with sodium nitroprusside in a non-randomised retrospective case series of 85 patients with acute aortic syndromes at the Cleveland Clinic, the haemodynamic control found was similar between the groups as was safety, suggesting clevidipine as a cost-saving alternative.…”

“…Compared with sodium nitroprusside in a non-randomised retrospective case series of 85 patients with acute aortic syndromes at the Cleveland Clinic, the haemodynamic control found was similar between the groups as was safety, suggesting clevidipine as a cost-saving alternative. 9…”

Nicardipine or Nitroprusside for Postoperative Blood Pressure Control in Infants After Surgery for Congenital Heart Disease: Single-Center Retrospective Noninferiority and Cost Analysis, 2016–2020

“…The first are nitrovasodilators such as sodium nitroprusside, but this category of agent carries a risk of cyanide toxicity and methemoglobinemia (2). The drug is also now expensive, prompting exploration of alternative agents (3)(4)(5). The second are calcium channel blockers, which were previously avoided in infant cardiac surgery cases because of concern for myocardial depression and dysrhythmia (2,6).…”