PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 11368286

Levosimendan.

D P Figgitt·P S Gillies·K L Goa
View original source ↗Export metadata ↓

Abstract

Levosimendan, a pyridazinone-dinitrile derivative, is a calcium sensitiser with additional action on adenosine triphosphate (ATP)-sensitive potassium channels. It is used intravenously (IV) for the treatment of decompensated cardiac failure. At therapeutic doses, levosimendan exhibits enhanced contractility with no increase in oxygen demands. It also produces antistunning effects without increasing myocardial intracellular calcium concentrations or prolonging myocardial relaxation. Levosimendan also causes coronary and systemic vasodilation. In patients with decompensated congestive heart failure (CHF), IV levosimendan significantly reduced the incidence of worsening CHF or death. IV levosimendan significantly increased cardiac output or cardiac index and decreased filling pressure in the acute treatment of stable or decompensated CHF in large, double-blind, randomised trials and after cardiac surgery in smaller trials. Levosimendan is well tolerated, with the most common adverse events (headache, hypotension, nausea) being secondary to vasodilation. It has not been shown to be arrhythmogenic. Levosimendan has shown no clinically important pharmacokinetic interactions with captopril, felodipine, beta-blockers, digoxin, warfarin, isosorbide-5-mononitrate, carvedilol, alcohol (ethanol) or itraconazole.

Explore related subjects

Biological AvailabilityCardiotonic AgentsCoronary CirculationHalf-LifeHeart FailureHumansHydrazonesProtein BindingPyridazinesRandomized Controlled Trials as TopicSimendanJournal ArticleReview

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

D P Figgitt, P S Gillies, K L Goa. 2001. Levosimendan.. https://doi.org/10.2165/00003495-200161050-00006

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2002

Increased nitric oxide bioavailability in endothelial cells contributes to the pleiotropic effect of cerivastatin.

BACKGROUND: Although statins preserve endothelial function by reducing serum cholesterol levels, it has been suggested they may also stimulate nitric oxide (NO) synthase in endothelium with concurrent increase in superoxide (O2-) generation, leading to impairment of NO activity. Therefore, measurements of biologically active NO and O2- in endothelium after exposure to the HMG-CoA reductase inhibitor cerivastatin were undertaken to evaluate its potential effect on NO biological activity. METHODS AND RESULTS: Highly sensitive electrochemical NO and O2- microsensors were placed near the surface of a single human umbilical vein endothelial cell, and the kinetics of NO and O2- release were recorded in vitro. Cerivastatin demonstrated a time-dependent effect on NO release in endothelial cells. The initial release (approximately the first 3 minutes) was concentration-dependent (0.01 to 10 micromol/L) and was similar to that observed for typical NO synthase agonists calcium ionophore or acetylcholine. Cerivastatin stimulated NO release at a favorable rate and scavenged O2-, which led to the preservation of the active concentration of NO. The sustained effect (after approximately 6 hours) of cerivastatin on endothelium was associated with an approximately 35% increase in NO release as compared with the initial effect. In contrast to the initial effect, the sustained effect of cerivastatin was shown at concentrations approximately 100-fold lower and was dependent on inhibition of endothelial HMG-CoA reductase. CONCLUSIONS: These data provide direct evidence to prove that in the presence of cerivastatin, the NOS system in endothelium operates with high efficiency toward increasing NO activity by activation of NO release and by concurrent inactivation of O2-.

Biological Availability↗
PubMed2002

Effects of Fe(III) chemical speciation on dissimilatory Fe(III) reduction by Shewanella putrefaciens.

Shewanella putrefaciens, a heterotrophic member of the gamma-proteobacteria is capable of respiring anaerobically on Fe(III) as the sole terminal electron acceptor (TEA). Recent genetic and biochemical studies have indicated that anaerobic Fe(III) respiration by S. putrefaciens requires outer-membrane targeted secretion of respiration-linked Fe(III) reductases. Thus, the availability of Fe(III) to S. putrefaciens may be governed by equilibrium chemical speciation both in the solution phase and at the bacterial cell-aqueous or cell-mineral interface. In the present study, effects of Fe(III) speciation on rates of bacterial Fe(III) reduction have been systematically examined by cultivating S. putrefaciens anaerobically on a suite of Fe(III)-organic complexes as the sole TEA. The suite of Fe(III)-organic complexes spans the range of stability constants normally encountered in natural water systems and includes Fe(III) complexed to citrate, 5-sulfosalicylate, NTA, salicylate, tiron, and EDTA. Rates of bacterial Fe(III) reduction in the presence of dissolved chelating agents correlate with the thermodynamic stability constants of the Fe(III)-organic complexes, implying that chemical speciation governs Fe(III) bioavailability. Equilibrium Fe(III) sorption experiments measured the reversible coordination of Fe(III) with S. putrefaciens as a function of cell/Fe(III) concentration, time, and activity of competing chelating agents. Results show that S. putrefaciens readily sorbs dissolved Fe(III) but that adsorption is restricted by the presence of strong Fe(III)-chelating agents. Our results indicate that dissimilatory Fe(III) reduction by S. putrefaciens is controlled by equilibrium competition for Fe(III) between dissolved organic ligands and strongly sorbing functional groups on the cell surface.

Biological Availability↗
PubMed2002

Reactions of hydroxyl radical with humic substances: bleaching, mineralization, and production of bioavailable carbon substrates.

In this study, we examine the role of the hydroxyl (OH*) radical as a mechanism for the photodecomposition of chromophoric dissolved organic matter (CDOM) in sunlit surface waters. Using gamma-radiolysis of water, OH* was generated in solutions of standard humic substances in quantities comparable to those produced on time scales of days in sunlit surface waters. The second-order rate coefficients of OH* reaction with Suwannee River fulvic (SRFA; 2.7 x 10(4) s(-1) (mg of C/L)(-1)) and humic acids (SRHA; 1.9 x 10(4) s(-1) (mg of C/L)(-1)) are comparable to those observed for DOM in natural water samples and DOM isolates from other sources but decrease slightly with increasing OH* doses. OH* reactions with humic substances produced dissolved inorganic carbon (DIC) with a high efficiency of approximately 0.3 mol of CO2/mol of OH*. This efficiency stayed approximately constant from early phases of oxidation until complete mineralization of the DOM. Production rates of low molecular weight (LMW) acids including acetic, formic, malonic, and oxalic acids by reaction of SRFA and SRHA with OH* were measured using HPLC. Ratios of production rates of these acids to rates of DIC production for SRHA and for SRFA were similar to those observed upon photolysis of natural water samples. Bioassays indicated that OH* reactions with humic substances do not result in measurable formation of bioavailable carbon substrates other than the LMW acids. Bleaching of humic chromophores by OH* was relatively slow. Our results indicate that OH* reactions with humic substances are not likely to contribute significantly to observed rates of DOM photomineralization and LMW acid production in sunlit waters. They are also not likely to be a significant mechanism of photobleaching except in waters with very high OH* photoformation rates.

Biological Availability↗