Pharmacology · Vasopressors and inotropes
Levosimendan !
A calcium sensitiser given intravenously in acute decompensated heart failure. It strengthens contraction without raising calcium and also widens vessels.
Updated 2026-11-01
Mechanism of action
Levosimendan binds cardiac troponin C in a calcium-dependent way and stabilises its calcium-bound shape, so the myofilaments respond more to the same calcium in systole without extra energy use; relaxation in diastole is preserved. It also opens ATP-sensitive potassium channels in vessels, causing vasodilation, and at higher concentrations inhibits phosphodiesterase 3.
- Levosimendan binds troponin C in a calcium-dependent way
- Myofilaments respond more to the same systolic calcium
- Opening of vascular potassium channels causes vasodilation
- Cardiac output rises with lower afterload
Pharmacokinetics
- Half-life
- Elimination half-life about 1 hour (PubChem); its effects last longer
Indications
- Short-term treatment of acutely decompensated severe chronic heart failure (approved in some countries, not in the USA) Heart failure →
Adverse effects
- Low blood pressure, from vasodilation
Contraindications
- Hypersensitivity to levosimendan
Key interactions
- Other vasodilators and antihypertensives
- Additive fall in blood pressure
What is monitored
- Continuous ECG
- Blood pressure
- Heart rate
- Urine output and signs of perfusion
Administration and safety
- Intravenous infusion by pump in a monitored setting; follow the local product information for dilution and compatibility.
- Correct low blood volume before starting, because vasodilation can lower blood pressure.
Nursing care
- Check blood pressure and heart rate often; report hypotension.
- Continuous ECG during the infusion.
- Effects outlast the infusion: monitoring continues after it ends.
Pregnancy and breastfeeding
Human data are lacking; it is used only if the benefit justifies the risk.
Test yourself
Think of the answer, then tap the question to see it.
How does levosimendan increase contractility without raising intracellular calcium?
It binds troponin C and stabilises its calcium-bound shape, so the myofilaments respond more strongly to the same calcium.
Which additional action of levosimendan causes vasodilation?
Opening of ATP-sensitive potassium channels in vascular smooth muscle.
Which enzyme does levosimendan also inhibit at higher concentrations?
Phosphodiesterase 3, the same enzyme blocked by milrinone.
Related drugs
Related conditions
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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Levosimendan | C14H12N6O | CID 3033825 - PubChem (PubChem (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); Farmacología básica y clínica (Katzung), cap. 13 (McGraw Hill, 2025); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 33 (McGraw Hill, 2023).
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Representative model, for educational purposes only.