Generic
Levosimendan
1 brands available in the market
At a glance
Levosimendan is indicated for the short-term treatment of acute heart failure (AHF) in situations where conventional therapy is not sufficient and inotropic support is considered appropriate.
Description
Levosimendan is an inotropic and vasodilatory agent that acts as a calcium sensitizer. It binds to troponin C on myofibrils, increasing the sensitivity of contractile proteins to calcium, resulting in increased cardiac contractility. It also causes vasodilation by opening ATP-sensitive potassium channels in vascular smooth muscle.
Indications
- Acute heart failure (AHF) - when conventional therapy is not sufficient and inotropic support is appropriate
Therapeutic class
Positive Inotropic Drugs
Pharmacological class
Calcium Sensitizer + Potassium Channel Opener
Pharmacology
Levosimendan binds to troponin C to increase calcium sensitivity of myofibrils (inotropic effect) and opens ATP-sensitive potassium channels in vascular smooth muscle to cause vasodilation.
Mechanism of action
Increases cardiac contractility and dilates blood vessels.
Dosage
Adult Dose (IV Infusion):
- Loading dose: 6-12 mcg/kg IV over 10 minutes
- Followed by continuous infusion: 0.1 mcg/kg/min
- With concomitant vasodilators/inotropes: 6 mcg/kg loading dose
- Adjust 0.05-0.2 mcg/kg/min based on response
- Recommended infusion duration: 24 hours
Administration
- For in-hospital use only
- Administered as IV infusion
- Monitor ECG, blood pressure, and heart rate during infusion
- Monitor for at least 3-5 days after infusion completion
Missed dose
Not generally applicable (hospital administered); consult doctor if needed.
Side effects
Common Side Effects:
- Ventricular tachycardia
- Hypotension
- Headache
- Atrial fibrillation
- Ventricular extrasystoles
- Tachycardia
Precautions & warnings
- Reduce or stop infusion if hypotension or tachycardia occurs after loading dose
- Correct severe hypovolaemia before infusion
- Monitor and correct serum potassium
- Caution in ischemic heart disease, anemia, arrhythmias
- Caution with QTc-prolonging drugs
Contraindications
- Severe renal impairment (CrCl <30 mL/min)
- Severe hepatic impairment
- Children and adolescents under 18 years
- Cardiogenic shock (not studied)
Drug interactions
- Caution with other IV vasoactive drugs (risk of hypotension)
- Potentiation of orthostatic hypotension with isosorbide mononitrate
- No pharmacokinetic interactions with digoxin and beta-blockers
Food interactions
Safety with alcohol is not known; consult your doctor.
Use in pregnancy
Use in Pregnancy: No experience in pregnant women; animal studies have shown reproductive toxicity. Use only if benefits for the mother outweigh risks to the fetus.
Use in lactation
Use in Lactation: Unknown if excreted in human milk; excreted in rat milk. Women receiving levosimendan should not breastfeed.
Pediatric use
Should not be used in children and adolescents under 18 years.
Geriatric use
No dose adjustment required for elderly patients.
Renal / hepatic impairment
Renal Impairment: Mild-moderate: caution; severe (CrCl <30 mL/min): should not be used.
Hepatic Impairment: Mild-moderate: caution; severe: should not be used.
Overdose effects
Overdose may cause hypotension and tachycardia; treat with vasopressors (dopamine, adrenaline).
Storage conditions
Store in a refrigerator (2-8°C); do not freeze.
Chemical structure
Levosimendan