Levosimendan (ICU — Calcium Sensitiser)

How it works

It increases myocardial contractility by sensitising cardiac troponin C to calcium without raising intracellular calcium, and opens vascular ATP-sensitive potassium channels to produce systemic and coronary vasodilatation; an active metabolite prolongs its haemodynamic effect for days.

Prescribing in practice

• It commonly causes hypotension and tachyarrhythmias, so blood pressure and the cardiac rhythm must be monitored continuously and significant hypovolaemia corrected before starting.
• Effects persist well beyond the infusion because of its long-acting active metabolite, so haemodynamic monitoring should continue after the infusion ends.
• Use with caution in significant renal or hepatic impairment and in patients with hypokalaemia, which should be corrected beforehand.

Monitoring

Monitor continuous ECG, blood pressure, serum potassium and haemodynamic response throughout and for a period after the infusion.

Counselling the patient

• This is a heart-support drug given as a drip in critical care to help a weakened heart pump more effectively.
• Its benefit can last for several days after the drip finishes.
• Low blood pressure and a fast or irregular heartbeat are recognised effects that the team will watch for closely.

Evidence & guidelines

Randomised trials including SURVIVE and LIDO informed its haemodynamic profile; it improves haemodynamics in acute heart failure though a clear mortality benefit has not been established.