Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland.
Scand Cardiovasc J. 2012 Dec;46(6):330-8. doi: 10.3109/14017431.2012.725206. Epub 2012 Sep 25.
Levosimendan is an inodilator indicated for acute heart failure (AHF). Its vasodilatory and anti-ischemic effects are mediated by the opening of ATP-dependent potassium channels (K(ATP) channels). Diabetes mellitus is common in AHF patients and sulfonylureas are often prescribed. Sulfonylureas act by blocking the K(ATP) channels. An interaction between levosimendan and sulfonylureas has been shown in preclinical models and could be hypothesized in clinical practice.
We produced a pooled analysis of six randomized levosimendan trials (in total of 3004 patients of which 1700 were treated with levosimendan and 226 both with levosimendan and sulfonylureas) with the aim to study the influence of concurrent sulfonylurea treatment to the levosimendan effects. Invasive and non-invasive hemodynamics, biomarkers (BNP), adverse events related to myocardial ischemia, and survival were evaluated.
In our relatively small data set, we could not detect any clinically relevant interactions between the sulfonylureas and levosimendan. Similar decreases in systolic and diastolic blood pressure, pulmonary capillary wedge pressure and BNP, and similar survival and adverse event profiles were seen in sulfonylurea users and non-users exposed to levosimendan.
Concomitant use of sulfonylureas with levosimendan does not attenuate the hemodynamic or other effects of levosimendan.
左西孟旦是一种用于急性心力衰竭（AHF）的正性肌力药物和血管扩张剂。其血管扩张和抗缺血作用是通过开放三磷酸腺苷（ATP）依赖性钾通道（K（ATP）通道）介导的。糖尿病在 AHF 患者中很常见，通常会开磺酰脲类药物。磺酰脲类药物通过阻断 K（ATP）通道起作用。在临床实践中可以假设，左西孟旦和磺酰脲类药物之间存在相互作用。
我们对六项随机的左西孟旦试验进行了汇总分析（总共 3004 例患者，其中 1700 例接受左西孟旦治疗，226 例同时接受左西孟旦和磺酰脲类药物治疗），目的是研究同时接受磺酰脲类药物治疗对左西孟旦作用的影响。评估了有创和无创血流动力学、生物标志物（BNP）、与心肌缺血相关的不良事件和生存率。
在我们相对较小的数据集，我们没有发现磺酰脲类药物和左西孟旦之间存在任何临床相关的相互作用。在接受左西孟旦治疗的磺酰脲类药物使用者和非使用者中，血压、肺动脉楔压和 BNP 均有相似的下降，生存率和不良事件谱也相似。
同时使用磺酰脲类药物和左西孟旦不会减弱左西孟旦的血液动力学或其他作用。
