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Chemical Compound Review

Simdax     2-[[4-[(4R)-4-methyl-6-oxo- 4,5-dihydro-1H...

Synonyms: Levosimedan, LEVOSIMENDAN, levosimendanum, AC1MHWDS, Simdax (TN), ...
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Disease relevance of LEVOSIMENDAN


Psychiatry related information on LEVOSIMENDAN

  • When the effectiveness of levosimendan was compared in non-ischemic and post-ischemic hearts, no significant differences were noted in the relative stimulatory effects on contractility and relaxation, at any given time point (time-response curve) or concentration (dose-response curve) [5].

High impact information on LEVOSIMENDAN


Chemical compound and disease context of LEVOSIMENDAN


Biological context of LEVOSIMENDAN

  • In contrast, under conditions optimal for cAMP-dependent phosphorylation, Levosimendan slightly but significantly lowered the concentration of Ca2+, yielding half-maximal uptake rates by the SR vesicles [7].
  • Moreover, it was shown that levosimendan was in fast exchange on the NMR time scale with a secondary binding site in the C-domain of both cTnC(C35S) and cTnC(A-Cys) [13].
  • Cardiac output increased by 0.7 and 1.61.min-1 (P < 0.05 for both) after 8 and 24 of levosimendan, respectively [14].
  • During administration of levosimendan, cardiac output increased by 32% (P = .002) mainly because of higher stroke volume [15].
  • AIMS: Levosimendan, a novel calcium-dependent calcium sensitizer of the myocardial contractile proteins, also enhances diastolic relaxation and induces peripheral vasodilation by opening potassium channels [15].

Anatomical context of LEVOSIMENDAN

  • They received placebo (n = 8), 8 (n = 8) or 24 (n = 7) of levosimendan after coronary artery bypass operation [14].
  • The new myofilament Ca2+ sensitizer levosimendan (LSM) is a positive inotropic and vasodilatory agent [16].
  • Effects of levosimendan on myocardial contractility and Ca2+ transients in aequorin-loaded right-ventricular papillary muscles and indo-1-loaded single ventricular cardiomyocytes of the rabbit [17].
  • Our results indicate a lowering of [Ca++]i by levosimendan consistent with opening of potassium channels and a relaxation that is independent of [Ca++]i. Our evidence points to a novel mechanism that might involve the direct effect of levosimendan on the smooth muscle contractile or regulatory proteins themselves [18].
  • We hypothesized that levosimendan, a new calcium sensitizer with potential pulmonary vasodilator properties, improves hemodynamics by unloading the right ventricle in patients with ARDS [19].

Associations of LEVOSIMENDAN with other chemical compounds


Gene context of LEVOSIMENDAN

  • Levosimendan produced a significant reduction in BNP compared to baseline, at both 48 h (744.1+/-100 vs 1136.3+/-93.7 pg/ml, p=0.04) and 5 days (446+/-119.3 vs 1136.3+/-93.7 pg/ml, p=0.03), while IL-6 values decreased after 5 days (4.8+/-1.3 vs 8.6+/-1.5 pg/ml, p=0.01) [23].
  • The CYP3A4 inhibitor intraconazole does not affect the pharmacokinetics of a new calcium-sensitizing drug levosimendan [24].
  • Levosimendan-induced improvement in contractile reserve and clinical status of severe heart failure patients, seems to be related with the reduction of major pro-inflammatory cytokines (TNF-alpha, IL-6) and soluble apoptosis signaling molecules Fas/Fas Ligand [25].
  • This raises the possibility that levosimendan may also interact with smooth muscle EF-hand proteins, such as, calmodulin, the regulatory myosin light chains, or S100 proteins [18].
  • This randomized, placebo-controlled trial showed that levosimendan administration causes a significant reduction of circulating proinflammatory cytokine interleukin-6 and soluble apoptosis mediators, such as soluble Fas and Fas ligand in patients with decompensated heart failure [26].

Analytical, diagnostic and therapeutic context of LEVOSIMENDAN


  1. Hemodynamic and neurohumoral effects of continuous infusion of levosimendan in patients with congestive heart failure. Nieminen, M.S., Akkila, J., Hasenfuss, G., Kleber, F.X., Lehtonen, L.A., Mitrovic, V., Nyquist, O., Remme, W.J. J. Am. Coll. Cardiol. (2000) [Pubmed]
  2. The calcium sensitizer levosimendan improves the function of stunned myocardium after percutaneous transluminal coronary angioplasty in acute myocardial ischemia. Sonntag, S., Sundberg, S., Lehtonen, L.A., Kleber, F.X. J. Am. Coll. Cardiol. (2004) [Pubmed]
  3. Safety and efficacy of a novel calcium sensitizer, levosimendan, in patients with left ventricular failure due to an acute myocardial infarction. A randomized, placebo-controlled, double-blind study (RUSSLAN). Moiseyev, V.S., Põder, P., Andrejevs, N., Ruda, M.Y., Golikov, A.P., Lazebnik, L.B., Kobalava, Z.D., Lehtonen, L.A., Laine, T., Nieminen, M.S., Lie, K.I. Eur. Heart J. (2002) [Pubmed]
  4. Hemodynamic improvement following levosimendan treatment in patients with acute myocardial infarction and cardiogenic shock. Russ, M.A., Prondzinsky, R., Christoph, A., Schlitt, A., Buerke, U., Söffker, G., Lemm, H., Swyter, M., Wegener, N., Winkler, M., Carter, J.M., Reith, S., Werdan, K., Buerke, M. Crit. Care Med. (2007) [Pubmed]
  5. The effects of levosimendan on the left ventricular function and protein phosphorylation in post-ischemic guinea pig hearts. Kristof, E., Szigeti, G., Papp, Z., Bodi, A., Ball, N.A., Walsh, R.A., Edes, I. Basic Res. Cardiol. (1999) [Pubmed]
  6. Influence of the novel inotropic agent levosimendan on isometric tension and calcium cycling in failing human myocardium. Hasenfuss, G., Pieske, B., Castell, M., Kretschmann, B., Maier, L.S., Just, H. Circulation (1998) [Pubmed]
  7. Effects of Levosimendan, a cardiotonic agent targeted to troponin C, on cardiac function and on phosphorylation and Ca2+ sensitivity of cardiac myofibrils and sarcoplasmic reticulum in guinea pig heart. Edes, I., Kiss, E., Kitada, Y., Powers, F.M., Papp, J.G., Kranias, E.G., Solaro, R.J. Circ. Res. (1995) [Pubmed]
  8. Dual regulation of myofilament Ca2+ sensitivity by levosimendan in normal and acidotic conditions in aequorin-loaded canine ventricular myocardium. Takahashi, R., Endoh, M. Br. J. Pharmacol. (2005) [Pubmed]
  9. Cardiogenic shock after primary percutaneous coronary intervention: Effects of levosimendan compared with dobutamine on haemodynamics. Garc??a-Gonz??lez, M.J., Dom??nguez-Rodr??guez, A., Ferrer-Hita, J.J., Abreu-Gonz??lez, P., Mu??oz, M.B. Eur. J. Heart Fail. (2006) [Pubmed]
  10. Pharmacodynamic interactions of levosimendan and felodipine in patients with coronary heart disease. Põder, P., Eha, J., Antila, S., Heinpalu, M., Planken, U., Loogna, I., Mesikepp, A., Akkila, J., Lehtonen, L. Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy. (2003) [Pubmed]
  11. Beneficial outcome after prostaglandin-induced post-partum cardiac arrest using levosimendan and extracorporeal membrane oxygenation. Krumnikl, J.J., Toller, W.G., Prenner, G., Metzler, H. Acta anaesthesiologica Scandinavica. (2006) [Pubmed]
  12. Levosimendan: a novel inotropic agent for treatment of acute, decompensated heart failure. Earl, G.L., Fitzpatrick, J.T. The Annals of pharmacotherapy. (2005) [Pubmed]
  13. Binding of levosimendan, a calcium sensitizer, to cardiac troponin C. Sorsa, T., Heikkinen, S., Abbott, M.B., Abusamhadneh, E., Laakso, T., Tilgmann, C., Serimaa, R., Annila, A., Rosevear, P.R., Drakenberg, T., Pollesello, P., Kilpelainen, I. J. Biol. Chem. (2001) [Pubmed]
  14. Effects of a new calcium sensitizer, levosimendan, on haemodynamics, coronary blood flow and myocardial substrate utilization early after coronary artery bypass grafting. Lilleberg, J., Nieminen, M.S., Akkila, J., Heikkilä, L., Kuitunen, A., Lehtonen, L., Verkkala, K., Mattila, S., Salmenperä, M. Eur. Heart J. (1998) [Pubmed]
  15. Myocardial efficiency during levosimendan infusion in congestive heart failure. Ukkonen, H., Saraste, M., Akkila, J., Knuuti, J., Karanko, M., Iida, H., Lehikoinen, P., Någren, K., Lehtonen, L., Voipio-Pulkki, L.M. Clin. Pharmacol. Ther. (2000) [Pubmed]
  16. Levosimendan improves LV systolic and diastolic performance at rest and during exercise after heart failure. Tachibana, H., Cheng, H.J., Ukai, T., Igawa, A., Zhang, Z.S., Little, W.C., Cheng, C.P. Am. J. Physiol. Heart Circ. Physiol. (2005) [Pubmed]
  17. Effects of levosimendan on myocardial contractility and Ca2+ transients in aequorin-loaded right-ventricular papillary muscles and indo-1-loaded single ventricular cardiomyocytes of the rabbit. Sato, S., Talukder, M.A., Sugawara, H., Sawada, H., Endoh, M. J. Mol. Cell. Cardiol. (1998) [Pubmed]
  18. Levosimendan, a calcium sensitizer in cardiac muscle, induces relaxation in coronary smooth muscle through calcium desensitization. Bowman, P., Haikala, H., Paul, R.J. J. Pharmacol. Exp. Ther. (1999) [Pubmed]
  19. Effects of levosimendan on right ventricular afterload in patients with acute respiratory distress syndrome: a pilot study. Morelli, A., Teboul, J.L., Maggiore, S.M., Vieillard-Baron, A., Rocco, M., Conti, G., De Gaetano, A., Picchini, U., Orecchioni, A., Carbone, I., Tritapepe, L., Pietropaoli, P., Westphal, M. Crit. Care Med. (2006) [Pubmed]
  20. Comparison between dobutamine and levosimendan for management of postresuscitation myocardial dysfunction. Huang, L., Weil, M.H., Tang, W., Sun, S., Wang, J. Crit. Care Med. (2005) [Pubmed]
  21. Influence of levosimendan, pimobendan, and milrinone on the regional distribution of cardiac output in anaesthetized dogs. Pagel, P.S., Hettrick, D.A., Warltier, D.C. Br. J. Pharmacol. (1996) [Pubmed]
  22. Mechanisms of a reduced cardiac output and the effects of milrinone and levosimendan in a model of infant cardiopulmonary bypass. Stocker, C.F., Shekerdemian, L.S., Nørgaard, M.A., Brizard, C.P., Mynard, J.P., Horton, S.B., Penny, D.J. Crit. Care Med. (2007) [Pubmed]
  23. The Ca2+-sensitizer levosimendan improves oxidative damage, BNP and pro-inflammatory cytokine levels in patients with advanced decompensated heart failure in comparison to dobutamine. Avgeropoulou, C., Andreadou, I., Markantonis-Kyroudis, S., Demopoulou, M., Missovoulos, P., Androulakis, A., Kallikazaros, I. Eur. J. Heart Fail. (2005) [Pubmed]
  24. The CYP3A4 inhibitor intraconazole does not affect the pharmacokinetics of a new calcium-sensitizing drug levosimendan. Antila, S., Honkanen, T., Lehtonen, L., Neuvonen, P.J. International journal of clinical pharmacology and therapeutics. (1998) [Pubmed]
  25. Anti-inflammatory and anti-apoptotic effects of levosimendan in decompensated heart failure: a novel mechanism of drug-induced improvement in contractile performance of the failing heart. Paraskevaidis, I.A., Parissis, J.T., Th Kremastinos, D. Current medicinal chemistry. Cardiovascular and hematological agents. (2005) [Pubmed]
  26. Effects of levosimendan on circulating pro-inflammatory cytokines and soluble apoptosis mediators in patients with decompensated advanced heart failure. Parissis, J.T., Adamopoulos, S., Antoniades, C., Kostakis, G., Rigas, A., Kyrzopoulos, S., Iliodromitis, E., Kremastinos, D. Am. J. Cardiol. (2004) [Pubmed]
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