S. Antila et al., HEMODYNAMIC INTERACTIONS OF A NEW CALCIUM SENSITIZING DRUG LEVOSIMENDAN AND CAPTOPRIL, European Journal of Clinical Pharmacology, 49(6), 1996, pp. 451-458
Objective: Levosimendan in a new inodilator drug that sensitises tropo
nin C in heart muscle cells to calcium, thus improving contractility.
In previous studies, a single 2 mg intravenous dose of levosimendan in
creased cardiac output (GO) in healthy volunteers by about 40% and dec
reased pulmonary capillary wedge pressure in heart failure patients by
40-50%. The aim of the present, double-blind study was to evaluate th
e safety of concomitant use of levosimendan and an ACE-inhibiting drug
. Methods: The haemodynamic effects of levosimendan, given with or wit
hout captopril, were evaluated by using 2-dimensional echocardiography
, repeated blood pressure measurements and by ambulatory ECG recording
s. Twenty-four male patients with stable NYHA II-III heart failure (EF
< 40%) after a previous myocardial infarct were given, in randomised
order, a single IV infusion of levosimendan or placebo. The infusions
were repeated after 2 weeks treatment with upto 50 mg b.i.d. of captop
ril. Twelve patients received levosimendan 1 mg and twelve received 2
mg. Results: Mean CO was increased from 6.0 to 6.81 . min(-1) in patie
nts receiving 1 mg levosimendan compared to placebo, but only from 6.3
to 6.5 1 . min(-1) in patients receiving 2 mg. The increase in CO was
statistically significant when all levosimendan patients were compare
d to placebo. Heart rate did not change after either dose. Mean stroke
volume increased significantly after 1 mg but not after 2 mg of levos
imendan. The addition of captopril did not change the effects of levos
imendan. No additional decrease in systolic or diastolic blood pressur
e was observed when levosimendan and captopril were given concomitantl
y. Conclusion: It seems that concomitant treatment with captopril does
not change the haemodynamic effects of levosimendan. No adverse haemo
dynamic interactions were seen.