Simendan
Generic Name
Levosimendan
Manufacturer
Orion Pharma (original developer), various generic manufacturers
Country
Finland (Orion Pharma), various countries for generics
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| simendan 125 mg injection | ৳ 4,000.00 | N/A |
Description
Overview of the medicine
Levosimendan is a calcium sensitizer and an ATP-sensitive potassium channel opener primarily used in the treatment of acutely decompensated severe chronic heart failure. It improves cardiac contractility without significantly increasing myocardial oxygen demand and induces vasodilation.
Uses & Indications
Dosage
Adults
Initial loading dose of 6-12 micrograms/kg over 10 minutes, followed by a continuous infusion of 0.05-0.2 micrograms/kg/min for 24 hours. Dosage should be adjusted based on patient response and tolerability.
Elderly
No specific dose adjustment generally required, but close monitoring advised.
Renal_impairment
Use with caution; may require dose adjustment if creatinine clearance is <30 mL/min.
How to Take
Administered via slow intravenous infusion, typically through a central or large peripheral vein. Must be diluted before use.
Mechanism of Action
Levosimendan exerts its positive inotropic effect by increasing the calcium sensitivity of cardiac troponin C, promoting better contractile force without a significant increase in intracellular calcium. It also causes vasodilation by opening ATP-sensitive potassium channels in vascular smooth muscle cells.
Pharmacokinetics
Onset
Hemodynamic effects typically start within 5-10 minutes.
Excretion
Excreted mainly in urine (54%) and feces (44%).
Half life
Approximately 1 hour for levosimendan itself, but its active metabolites have a half-life of about 75-80 hours.
Absorption
Administered intravenously; bioavailability is 100%.
Metabolism
Primarily metabolized by conjugation to inactive metabolites and active metabolites (OR-1855 and OR-1896) in the gut and liver.
Side Effects
Contraindications
- Severe hypotension or tachycardia
- Severe renal impairment (CrCl <10 mL/min) or severe hepatic impairment
- Mechanical obstruction affecting ventricular filling or outflow (e.g., severe aortic stenosis)
- History of Torsade de Pointes
Drug Interactions
Nitrates
May potentiate hypotensive effects.
Other vasodilators or antihypertensives
Increased risk of hypotension.
Storage
Store in a refrigerator (2°C - 8°C). Do not freeze. Protect from light.
Overdose
Symptoms include hypotension and tachycardia. Management involves discontinuing the infusion, initiating supportive measures, and administering appropriate fluids and vasopressors if necessary.
Pregnancy & Lactation
Use in pregnancy only if potential benefit justifies the potential risk to the fetus. Not recommended during breastfeeding; decide whether to discontinue breastfeeding or the drug.
Side Effects
Contraindications
- Severe hypotension or tachycardia
- Severe renal impairment (CrCl <10 mL/min) or severe hepatic impairment
- Mechanical obstruction affecting ventricular filling or outflow (e.g., severe aortic stenosis)
- History of Torsade de Pointes
Drug Interactions
Nitrates
May potentiate hypotensive effects.
Other vasodilators or antihypertensives
Increased risk of hypotension.
Storage
Store in a refrigerator (2°C - 8°C). Do not freeze. Protect from light.
Overdose
Symptoms include hypotension and tachycardia. Management involves discontinuing the infusion, initiating supportive measures, and administering appropriate fluids and vasopressors if necessary.
Pregnancy & Lactation
Use in pregnancy only if potential benefit justifies the potential risk to the fetus. Not recommended during breastfeeding; decide whether to discontinue breastfeeding or the drug.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 3 years when stored unopened. Once diluted, it should be used within 24 hours.
Availability
Hospitals, specialized cardiac care units
Approval Status
Approved in EU and many other countries for acute decompensated heart failure; not FDA approved in US.
Patent Status
Patent expired (generic versions available)
Clinical Trials
SHOWTIME, LIDO, REVIVE, SURVIVE trials have evaluated Levosimendan in acute heart failure.
Lab Monitoring
- Blood pressure
- Heart rate
- ECG
- Fluid balance
- Serum electrolytes (especially potassium)
- Renal function (creatinine, urine output)
Doctor Notes
- Monitor hemodynamics closely (BP, HR, CVP, PCWP) during infusion.
- Adjust dose based on patient's clinical response and adverse events, especially hypotension.
- Ensure adequate volume status before initiating therapy.
Patient Guidelines
- This medicine is administered in a hospital setting under close medical supervision.
- Report any discomfort immediately to your healthcare provider.
- Avoid sudden changes in body position to prevent dizziness.
Missed Dose Advice
Not applicable for continuously monitored hospital-administered infusion.
Driving Precautions
As this drug is administered in a hospital setting for severe conditions, driving is not applicable.
Lifestyle Advice
- Follow your doctor's advice on diet and exercise for heart health.
- Avoid smoking and excessive alcohol consumption.
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Global Brand Names
International brand names for this medicine. Click a brand to search for detailed information.