Levosimendan: Indication, Dosage, Side Effect, Precaution

This information is not country-specific. Please refer to the Malaysia prescribing information.

Generic Medicine Info

Indications and Dosage

Intravenous
Congestive heart failure

Adult: Loading dose: 6-24 mcg/kg over 10 min followed by 0.05-0.2 mcg/kg/min continuous infusion, adjust according to response.

Renal Impairment

Severe: Contraindicated.

Hepatic Impairment

Severe: Contraindicated.

Contraindications

History of torsade de pointes. Severe renal and hepatic impairment.

Special Precautions

Patient w/ severe hypotension, tachycardia or w/ mechanical obstruction affecting ventricular filling or outflow; ongoing coronary ischaemic or long QTc interval. Renal and hepatic impairment.

Adverse Reactions

Headache, dizziness, hypotension, ventricular tachycardia, extrasystoles, AF, hypokalaemia, insomnia, GI disturbances and anaemia.
Potentially Fatal: Arrhythmias, tachycardia, AF w/ rapid ventricular response.

Monitoring Parameters

Closely monitor ECG, serum K concentration. Monitor haemodynamic effects for several days after the end of infusion as they may be prolonged.

Action

Description: Levosimendan is a cardiac inotrope and vasodilator w/ Ca-sensitising properties. It is dependent on Ca concentration and sensitises tropin C to Ca. It also opens ATP-sensitive K channels on vascular smooth muscle which causes coronary and systemic vasodilation.
Pharmacokinetics:
Absorption: Well absorbed. Bioavailability: 85%. Time to peak plasma concentration: 1-2 days.
Distribution: Plasma protein binding: Approx 98% (mainly albumin); approx 40% (active metabolite).
Metabolism: Extensively metabolised to its active metabolite (OR-1855 and OR-1896) which are interconverted by acetylation and de-acetylation.
Excretion: Via urine and faeces as metabolites and unchanged drug (small amount). Elimination half-life: Approx 1 hr.

MIMS Class

Other Cardiovascular Drugs

References

Anon. Levosimendan. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 07/08/2014.

Buckingham R (ed). Levosimendan. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/08/2014.

Wickersham RM. Levosimendan (Simdax by Abbott Laboratories) – A Calcium Sensitizer. Facts and Comparisons [online]. St. Louis, MO. Wolters Kluwer Clinical Drug Information, Inc. https://www.wolterskluwercdi.com/facts-comparisons-online/. Accessed 07/08/2014.

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