โ ๏ธ Specialist use only โ limited to Consultant Cardiologists and Intensivists.
Levosimendan is a calcium sensitizer and K-ATP channel opener, used in acute decompensated heart failure.
It offers inotropy without increased arrhythmia risk and may improve survival in selected patients.
๐ About
- Check BNF or equivalent for up-to-date prescribing advice (not widely available in the UK).
- Evidence base is mixed โ some trials show improved haemodynamics and reduced BNP, others no mortality benefit.
โก Mode of Action
- Positive inotrope: Increases cardiac contractility by sensitising troponin C to calcium (does not โ intracellular Caยฒโบ).
- Vasodilator: Opens ATP-dependent potassium channels in vascular smooth muscle โ reduces preload & afterload.
- Unique property: Improves contractility without significantly increasing myocardial oxygen consumption.
- Has long-acting metabolites โ effect can persist for 7โ9 days after infusion.
๐ Indications & Dose
- Indication: Acute decompensated heart failure due to left ventricular systolic dysfunction.
- Dosing: Loading dose 6 mcg/kg IV over 10 mins (omit if hypotensive), then infusion at 0.05โ0.2 mcg/kg/min for 24 h.
- Other reported uses: Cardiogenic shock, post-cardiac surgery low-output states, septic shock, Takotsubo cardiomyopathy (off-label).
๐ค Interactions
- Refer to BNF โ caution with other vasodilators, antihypertensives, and agents causing hypokalaemia.
โ ๏ธ Cautions
- Hypotension or hypovolaemia (potent vasodilator).
- Renal or hepatic impairment (metabolite clearance affected).
- Monitor electrolytes (esp. potassium).
๐ซ Contraindications
- Severe hypotension (SBP < 85 mmHg).
- Tachyarrhythmias or recent ventricular arrhythmia.
- Severe renal or hepatic failure.
๐ฅ Side Effects
- Hypotension, headache, tachycardia.
- Atrial fibrillation, hypokalaemia, nausea.
- Occasionally dizziness, insomnia.
๐ก Teaching Pearl
Unlike dobutamine (ฮฒ-agonist) and milrinone (PDE-3 inhibitor), levosimendan does not increase intracellular calcium.
This means it improves contractility without the same pro-arrhythmic burden.
๐ References
