levosimendan

Levosimendan is a cardiovascular drug classified as a calcium sensitizer with inodilator properties. It enhances cardiac contractility by increasing the sensitivity of troponin C to calcium, which improves systolic performance without a large rise in intracellular calcium or myocardial oxygen consumption. In addition, levosimendan opens ATP-sensitive potassium channels in vascular smooth muscle, producing vasodilation and reducing both preload and afterload.

The drug is administered by intravenous infusion, typically over 24 hours, and is generally used for short-term management in acutely decompensated heart failure. Levosimendan has two active metabolites, most notably OR-1896, which prolongs its hemodynamic effects after the infusion ends. The parent drug and its metabolites contribute to sustained benefits for several days due to their long half-lives.

Indications and regulatory status vary by region. It is approved in the European Union and many other countries for short-term treatment of acute decompensated heart failure in patients who remain symptomatic despite conventional therapy. It is not approved by the U.S. Food and Drug Administration. Dosing commonly involves a continuous infusion at about 0.05–0.2 micrograms per kilogram per minute for 24 hours, with no loading dose recommended to minimize the risk of hypotension.

Contraindications include clinically significant hypotension and left-sided obstruction such as severe aortic or mitral stenosis or other conditions where vasodilation would be harmful. Adverse effects early in treatment commonly include hypotension, headache, dizziness, and, less commonly, arrhythmias such as atrial fibrillation. Caution is advised when used with other vasodilators or inotropes, and treatment requires monitoring in a hospital setting.