Acutely decompensated chronic heart failure (ADHF)

Active Ingredient: Levosimendan

Indication for Levosimendan

Population group: only adults (18 years old or older)

Levosimendan is indicated for the short-term treatment of acutely decompensated chronic heart failure (ADHF) in situations where conventional therapy is not sufficient, and in cases where inotropic support is considered appropriate.

For this indication, competent medicine agencies globally authorize below treatments:

0.1-24 μg/kg

Route of admnistration


Defined daily dose

0.1 - 12 ug per kg of body weight

Dosage regimen

From 0.1 To 12 ug per kg of body weight once every day

Loading dose

12 ug per kg of body weight

Detailed description

The dose and duration of treatment should be individualised according to the patient’s clinical condition and response.

The treatment may be initiated with a loading dose of 6-12 μg/kg infused over 10 minutes followed by a continuous infusion of 0.1 μg/kg/min. The lower loading dose of 6 μg/kg is recommended for patients on concomitant intravenous vasodilators or inotropes or both at the start of the infusion. Higher loading doses within this range will produce a stronger haemodynamic response but may be associated with a transient increased incidence of adverse reactions. The response of the patient should be assessed with the loading dose or within 30 to 60 minutes of dose adjustment and as clinically indicated. If the response is deemed excessive (hypotension, tachycardia), the rate of the infusion may be decreased to 0.05 μg/kg/min or discontinued. If the initial dose is tolerated and an increased haemodynamic effect is required, the rate of the infusion can be increased to 0.2 μg/kg/min.

The recommended duration of infusion in patients with acute decompensation of severe chronic heart failure is 24 hours. No signs of development of tolerance or rebound phenomena have been observed following discontinuation of levosimendan infusion. Haemodynamic effects persist for at least 24 hours and may be seen up to 9 days after discontinuation of a 24 hour infusion.

Experience of repeated administration of levosimendan is limited. Experience with concomitant use of vasoactive agents, including inotropic agents (except digoxin), is limited. In the REVIVE programme, a lower loading dose (6 μg/kg) was administered with baseline concomitant vasoactive agents.

Active ingredient


Levosimendan enhances the calcium sensitivity of contractile proteins by binding to cardiac troponin C in a calcium-dependent manner. Levosimendan increases the contraction force but does not impair ventricular relaxation.

Read more about Levosimendan

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