Last update Oct. 1, 2023

Levosimendan

High Risk

Poorly safe. Evaluate carefully. Use safer alternative or interrupt breastfeeding 3 to 7 T ½ (elimination half-lives). Read the Comment.

Levosimendan is a calcium sensitizer, cardiac inotrope and vasodilator, indicated to treat acute decompensation of heart failure. It is administered as an intravenous infusion for 24 hours.

At the time of the last update, we found no published data on its excretion in breast milk.

Its low molecular weight and the low fixation of its active metabolites to plasma proteins, suggest that its excretion in breast milk could be significant, in fact, in a treated mother levosimendan was not found in breast milk, but its active metabolite OR-1896 was found in a measurable amount: 0.1 ng/mL. (Benlolo 2004)

Until further published data on this drug in relation to lactation are known, safer alternatives are preferable. (Kearney 2018)

It is advisable to wait at least 5 ½ T (5 x 80 = 400 hours: 16 days) before resuming breastfeeding, to ensure the elimination of the active metabolite of levosimendan from the organism, as indicated by the manufacturer. (AEMPS 2021)

 

Alternatives

  • Digitoxin (Possibly safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.)
  • Digoxin ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Dobutamine Hydrochloride ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Norepinephrine ( Safe. Compatible. Minimal risk for breastfeeding and infant.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Group

Levosimendan belongs to this group or family:

Tradenames

Main tradenames from several countries containing Levosimendan in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 84 ± 4 %
Molecular weight 280 daltons
Protein Binding 98 (metabol: 40) %
pKa 5.77 -
Tmax 48 hours
1 (metabol: 75 - 80) hours

References

  1. AEMPS. Levosimendan. Ficha técnica. 2021 Full text (in our servers)
  2. Kearney L, Wright P, Fhadil S, Thomas M. Postpartum Cardiomyopathy and Considerations for Breastfeeding. Card Fail Rev. 2018 Abstract Full text (link to original source) Full text (in our servers)
  3. Benlolo S, Lefoll C, Katchatouryan V, Payen D, Mebazaa A. Successful use of levosimendan in a patient with peripartum cardiomyopathy. Anesth Analg. 2004 Mar;98(3):822-4, table of contents. Abstract

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