Clevidipine for acute hypertension in patients with subarachnoid hemorrhage: a pilot study

Varelas, Panayiotis N.; Abdelhak, Tamer; Corry, Jesse J.; James, Elysia; Rehman, Mohammed; Schultz, Lonni; Mays-Wilson, Kathleen; Mitsias, Panayiotis

doi:10.3109/00207454.2013.836703

Cited by 18 publications

(10 citation statements)

References 20 publications

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“…The CLASH (Clevidipine in Aneurysmal Subarachnoid Hemorrhage) study was a single-center,open-label prospective pilot study that enrolled 5 patients with aneurysmal subarachnoid hemorrhage (SAH) with BPs above a prespecified limit (set by treating physicians) requiring antihypertensive therapy. 20 All patients reached their specified SBP targets after initiation of clevidipine within 14.2 + 6.4 minutes (range 7-22 minutes) at an average infusion rate of 10.8 + 9.1 mg/h (range 2-24 mg/h). 20 ICP measurements in 2 patients with extraventricular drains did not increase after initiation of clevidipine.…”

Section: Evidence Supporting Clevidipinementioning

confidence: 90%

“…20 All patients reached their specified SBP targets after initiation of clevidipine within 14.2 + 6.4 minutes (range 7-22 minutes) at an average infusion rate of 10.8 + 9.1 mg/h (range 2-24 mg/h). 20 ICP measurements in 2 patients with extraventricular drains did not increase after initiation of clevidipine. 20 The authors concluded that clevidipine was an effective agent for BP control during SAH and postulated that SBP control may be better with clevidipine as compared to nicardipine based on historical data from their facility.…”

Section: Evidence Supporting Clevidipinementioning

confidence: 90%

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Sodium Nitroprusside as a Hyperinflation Drug and Therapeutic Alternatives

Cobb

Thornton

2018

Journal of Pharmacy Practice

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Sodium nitroprusside (SNP) is a generically available and rapid-acting intravenous (IV) vasodilator that has been used clinically for decades. Prior to 2013, the cost of SNP was relatively low, and SNP was an affordable option for the treatment of acute hypertension. However, from 2013 to 2017, average wholesale prices for SNP rose to as high as US$900 per vial, earning the drug its status as a "hyperinflation drug." Hyperinflation drugs pose a significant challenge for pharmacy departments. A multidisciplinary effort involving stakeholders from many backgrounds, including pharmacists, physicians, and nurses, is key to developing an effective cost containment strategy. A therapeutic interchange, wherein a drug with similar efficacy is substituted for another, is often an appropriate strategy to address rising drug costs. Fortunately, alternative drugs with a solid evidence base exist for the management of acute hypertension. The dihydropyridine calcium channel blockers, clevidipine and nicardipine, are IV titratable antihypertensive agents with favorable pharmacokinetic and safety profiles. Various studies indicate that clevidipine and nicardipine are effective alternatives to SNP for indications including hypertensive crisis and postoperative hypertension. Some hospitals have reported significant cost savings without adverse outcomes by substituting clevidipine or nicardipine for SNP. This article is intended to serve as a review of the evidence for clevidipine and nicardipine as potential substitutes for SNP and to provide strategies to successfully implement this therapeutic interchange.

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Section: Evidence Supporting Clevidipinementioning

confidence: 90%

Section: Evidence Supporting Clevidipinementioning

confidence: 90%

Sodium Nitroprusside as a Hyperinflation Drug and Therapeutic Alternatives

Cobb

Thornton

2018

Journal of Pharmacy Practice

View full text Add to dashboard Cite

show abstract

“…The clevidipine in aneurysmal subarachnoid hemorrhage (CLASH) study was a singlecenter, open-label prospective pilot study that enrolled 5 patients with aneurysmal subarachnoid hemorrhage (SAH) with BPs above a prespecified limit (set by treating physicians) requiring antihypertensive therapy. 20 All patients reached their specified SBP targets after initiation of clevidipine within 14.2 + 6.4 minutes (range: 7-22 minutes) at an average infusion rate of 10.8 + 9.1 mg/h (range: 2-24 mg/h). 20 The ICP measurements in 2 patients with extraventricular drains did not increase after initiation of clevidipine.…”

Section: Evidence Supporting Clevidipinementioning

confidence: 90%

“…20 All patients reached their specified SBP targets after initiation of clevidipine within 14.2 + 6.4 minutes (range: 7-22 minutes) at an average infusion rate of 10.8 + 9.1 mg/h (range: 2-24 mg/h). 20 The ICP measurements in 2 patients with extraventricular drains did not increase after initiation of clevidipine. 20 The authors concluded that clevidipine was an effective agent for BP control during SAH and postulated that SBP control may be better with clevidipine when compared to nicardipine based on historical data from their facility.…”

Section: Evidence Supporting Clevidipinementioning

confidence: 90%

Hyperinflation of Nitroprusside

Cobb

Thornton

2018

Journal of Pharmacy Practice

View full text Add to dashboard Cite

Sodium nitroprusside (SNP) is a generically available and rapid-acting intravenous (IV) vasodilator that has been used clinically for decades. Prior to 2013, the cost of SNP was relatively low, and SNP was an affordable option for the treatment of acute hypertension. However, from 2013 to 2017, average wholesale prices for SNP rose to as high as $900 per vial, earning the drug its status as a "hyperinflation drug." Hyperinflation drugs such as SNP pose a significant challenge for pharmacy departments. A multidisciplinary effort involving stakeholders from many backgrounds, including pharmacists, physicians, and nurses, is key to developing an effective plan to address the problem. A therapeutic interchange, wherein a drug with similar efficacy is substituted for another, is often an appropriate strategy in this scenario. Fortunately, alternative drugs with a solid evidence base exist for the management of acute hypertension. The dihydropyridine calcium channel blockers, clevidipine and nicardipine, are IV titratable antihypertensive agents with favorable pharmacokinetic and safety profiles. Various studies indicate that clevidipine and nicardipine are effective alternatives to SNP for indications including hypertensive crisis and postoperative hypertension. Some hospitals have reported significant cost savings without adverse outcomes by substituting clevidipine or nicardipine for SNP. This article is intended to serve as a review of the evidence for clevidipine and nicardipine as potential substitutes for SNP and to provide strategies to successfully implement this therapeutic interchange.

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“…Clevidipine can be effectively used during elective neurosurgical procedures, including neurovascular interventions, to control the BP during intraoperatively and in the postoperative period (Bekker et al, 2010; Varelas et al, 2014). …”

mentioning

confidence: 99%