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# 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

- Class: [Vasopressors and inotropes](https://durgical.com/en/pharmacology/classes/vasopressors-and-inotropes/)
- Target: Cardiac troponin C (calcium sensitiser); also ATP-sensitive potassium channels
- ATC code: C01CX08

## ⚠ High-alert medication

An error with this medicine can cause serious harm: double checks and protocols are used.

## 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 →](https://durgical.com/en/conditions/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.

## Memory aid

LEVOSIMENDAN: Lets troponin SEE calcium better, and Dilates vessels.

## 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.

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## Related drugs

- [Milrinone](https://durgical.com/en/pharmacology/milrinone/)
- [Dobutamine](https://durgical.com/en/pharmacology/dobutamine/)

## Related conditions

- [Heart failure](https://durgical.com/en/conditions/heart-failure/)

[← Back to the class: Vasopressors and inotropes](https://durgical.com/en/pharmacology/classes/vasopressors-and-inotropes/)

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](https://pubchem.ncbi.nlm.nih.gov/compound/3033825) (PubChem (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=C01CX08) (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.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/levosimendan/