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.

Analysis of infusion-site reactions in renal transplant recipients receiving peripherally administered rabbit antithymocyte globulin as compared with basiliximab.

Antithymocyte globulin rabbit (r-ATG) has been used for the treatment and prevention of acute rejection in renal transplant recipients (RTR). Current manufacturer recommendations for r-ATG dictate the need for administration through a high-flow vein (central line). Previous studies have shown peripheral administration of r-ATG to be safe; however, these studies suggest the co-administration of heparin and hydrocortisone and did not compare the infusion-site reaction rates to a control group. A retrospective analysis was conducted of adult RTR receiving r-ATG or basiliximab between January 2004 and October 2006. Each agent was administered through a dedicated peripheral line. The primary endpoint was the incidence of infusion-site reactions. Other endpoints included the need to replace the intravenous catheter and the incidence of systemic thrombosis within 1 month of transplantation. During the study period, 152 peripheral infusions of r-ATG and 92 peripheral infusions of basiliximab were administered. No difference in infusion-site reactions was noted between the groups. There was also no difference either in the need for peripheral line replacement or the rates of systemic thrombosis. Peripheral administration of r-ATG is safe and can be infused without concomitant heparin and hydrocortisone. This method of r-ATG infusion was shown to be as safe as peripherally administered basiliximab.