Levosimendan

How it works

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

Prescribing in practice

• Can cause significant hypotension and tachyarrhythmias, so it should be given only with continuous cardiac and blood-pressure monitoring and is generally avoided in marked hypotension or severe outflow obstruction.
• The long-acting active metabolite means haemodynamic and electrophysiological effects may persist for days after the infusion is stopped.
• Correct hypovolaemia and significant electrolyte disturbance before and during the infusion, and consult the SPC for administration details.

Monitoring

Monitor blood pressure, heart rate and rhythm continuously, alongside serum potassium and other electrolytes, during and after the infusion.

Counselling the patient

• Explain to the patient that this medicine is given as a drip in hospital under close monitoring.
• Advise the team that low blood pressure and palpitations are recognised effects and may persist after the infusion ends.

Evidence & guidelines

Levosimendan has been evaluated in randomised trials of acute decompensated heart failure (including the SURVIVE and REVIVE studies); refer to current prescribing references for licensed indications.