• Mechanism of action
    • 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
      • 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
    • Vasodilation
      • Decreases preload and afterload
      • Increases coronary perfusion
      • Chance of hypotension
  • Advantages as an inotrope
    • No tachyphylaxis
    • No arrhythmia risk
    • Not antagonized by beta blockers
  • Studies
    • LIDO study
      • Compared levosimendan with dobutamine in heart failure
      • Hemodynamic improvement was more with levosimendan
      • Mortality was lower with levosimendan
    • RUSSLAN study
      • Compared levosimendan with placebo in post MI heart failure
      • Levosimendan decreased mortality and worsening of heart failure
  • Adverse effects
    • Hypotension
    • Headache
  • Available product
    • Injection: 2.5 mg/mL (5 mL, 10 mL)
  • 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.