Abstract

USE OF LEVOSIMENDAN IN CARDIOVASCULAR DISEASE: INSIGHTS OF PHARMACOLOGICAL ACTIONS AND CLINICAL STUDIES

Patel Shreya and Bhatt Parloop*

ABSTRACT

The purpose of this review is to examine the use of levosimendan in cardiovascular disease in relation to its pharmacological actions explored through various clinical studies. Levosimendan is an active enantiomer of simendan. It is a calcium sensitizer developed for treatment of decompensated heart failure, with its effects independent of beta adrenergic receptor which appears beneficial in cases of severe, intractable heart failure. The pharmacological effects of levosimendan are increased cardiac contractility through calcium sensitization of troponin C, vasodilation, and cardio-protection. The vasodilation and cardio-protection effects are interacted to the opening of sarcolemmal and mitochondrial potassium-ATP channels, respectively. Given its pharmaco-dynamic description, levosimendan could be a possible novel agent for the treatment of right ventricular failure caused by pulmonary hypertension. Levosimendan is generally administered as 24-hrs infusion, with or without a loading dose, but dosing needs adjustment in patients with severe liver or renal dysfunction. In spite of some favorable reports, the role of levosimendan in critical illness has not been thoroughly evaluated. Levosimendan is usually well tolerated in acute heart failure patients. The most common adverse events are tachycardia, hypotension, atrial fibrillation, hypokalaemia, and headache.

Keywords: Levosimendan, calcium sensitizer, congenital heart disease, acute heart failure, cardiac surgery, cardiogenic shock, right ventricular dysfunction, left ventricular dysfunction.