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Mechanism of action
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Calcium sensitizer- sensitizes myocardium to calcium
- Drug binds to troponin C- this stabilizes calcium induced change in tropomyosin- hence actin-myosin crossbridge formation is facilitated and prolonged
- Contractile apparatus is sensitized to available calcium
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Since calcium is not increased (unlike other inotropes)-
- Myocardial oxygen demand is not increased
- No increase in arrhythmias
- No binding to troponin C during diastole when calcium level is low (binding to troponin C is dependent on calcium levels)- hence no diastolic dysfunction
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Vasodilation
- Decreases preload and afterload
- Increases coronary perfusion
- Chance of hypotension
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Advantages as an inotrope
- No tachyphylaxis
- No arrhythmia risk
- Not antagonized by beta blockers
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Studies
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LIDO study
- Compared levosimendan with dobutamine in heart failure
- Hemodynamic improvement was more with levosimendan
- Mortality was lower with levosimendan
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RUSSLAN study
- Compared levosimendan with placebo in post MI heart failure
- Levosimendan decreased mortality and worsening of heart failure
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Adverse effects
- Hypotension
- Headache
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Available product
- Injection: 2.5 mg/mL (5 mL, 10 mL)
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Dosage
- 6-24 mcg/kg over 10 minutes followed by a continuous infusion of 0.05-0.2 mcg/kg/minute, adjusted according to response.
Archive for category Uncategorized
Levosimendan
Feb 2
