Levosimendan

Levosimendan is a calcium sensitizer - increases the sensitivity of the heart to calcium, thereby increasing cardiac compressibility without increasing intracellular calcium. Levosimendan has a positive inotropic effect due to an increase in calcium, the sensitivity of myocytes by binding to cardiac troponin C in a calcium-dependent manner. It also has a vasodilating effect, opening adenosine triphosphate (ATP) -sensitive potassium channels in the vascular smooth muscles , causing relaxation of smooth muscles. The combination of inotropic and vasodilator action leads to an increase in contraction force, a decrease in preload and a decrease in cardiac afterload. In addition, the drug has a cardioprotective effect. ^[one]

Indications

Levosimendan is used in connection with acute decompensated severe chronic heart failure .

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Licensing Status

At Orion Corporation, which initially developed levosimendan and applied for a new drug in 1998 in the United States, the FDA requested further testing and Orion withdrew the application in November 1999. Orion initially obtained permission to sell the drug in Sweden in 2000. ^[4] Since then, 60 countries around the world have approved the drug, but it is still not licensed in the United States, where it is currently under development to reduce the incidence and mortality of cardiac patients due to low cardiac output syndrome. ^[five]

Contraindications

The use of levosimendan is contraindicated in patients with: moderate to severe renal failure , severe liver failure, severe ventricular filling or outflows, severe hypotension and tachycardia . ^[6]

Side Effects

headache, arterial hypotension, arrhythmias ( atrial fibrillation , extrasystole , atrial tachycardia , ventricular tachycardia), myocardial ischemia , hypokalemia and / or nausea (Rossi, 2006).

Compositions

Levosimendan is positioned as a 2.5 mg / ml concentrated solution for infusion. The concentrate is diluted with glucose 5% solution before infusion.