Levosimendan
Indications
Levosimendan is a hospital medicine used for the short-term treatment of severe, suddenly worsening chronic heart failure (acute decompensated heart failure), when standard treatment is not enough and extra support for the heart's pumping is needed.
How It Works
Levosimendan is a calcium sensitiser. It makes the heart muscle more responsive to the calcium already present inside its cells, so each beat is stronger without greatly increasing the heart's oxygen demand. It also opens potassium channels in blood vessel walls, which relaxes and widens the vessels and reduces the workload on the heart. An active breakdown product keeps working for several days after the infusion ends.
Dosage and Administration
Levosimendan is given only in hospital by a doctor or nurse as a slow infusion into a vein, usually over about 24 hours, with continuous monitoring of heart rhythm, blood pressure and urine output. The dose is as prescribed and is based on body weight and how the patient responds. The concentrate must be diluted before use.
Interactions
- Other medicines that widen blood vessels, such as nitrates (for example Isosorbide Mononitrate): may cause a larger fall in blood pressure.
- Medicines that lower potassium, such as diuretics: low potassium increases the risk of heart rhythm problems and is corrected before treatment.
The medical team reviews all current medicines before starting.
Contraindications
Levosimendan should not be used in people allergic to it, or with severe narrowing of heart valves or other blockages that limit the heart's filling or emptying, very low blood pressure, a very fast heart rate, a history of a dangerous rhythm called torsades de pointes, or severe kidney or liver impairment.
Side Effects
Common side effects include headache, low blood pressure, fast or irregular heartbeat, dizziness, nausea, low potassium and low haemoglobin. Serious heart rhythm problems can occur.
The team monitors patients closely during and after the infusion. Tell the nurse at once, or get urgent medical help after discharge, if you have chest pain, a racing or pounding heartbeat, fainting or severe dizziness, worsening breathlessness, or signs of an allergic reaction such as swelling of the face or a widespread rash.
Pregnancy and Lactation
There is little experience of use in pregnancy, so it is used only if the doctor judges the benefit outweighs the risk. Its active products may pass into breast milk; breastfeeding is usually avoided for at least 14 days after the infusion, or as advised by the doctor.
Precautions and Warnings
Blood pressure, heart rhythm and blood salts are monitored for several days because the effect lasts after the infusion stops. Low blood volume and low potassium are corrected first. Extra care is taken in people with kidney or liver problems, heart rhythm disorders or coronary artery disease.
Overdose
An overdose may cause very low blood pressure and a fast heart rate. The infusion is stopped or slowed and the team provides supportive treatment, including fluids and monitoring for several days.
Therapeutic Class
Calcium sensitiser and inodilator (heart failure medicine).
Storage
Store in a refrigerator at 2 to 8°C, do not freeze, as directed on the pack. Kept and prepared by hospital staff, out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.
All brands of Levosimendan