Interactions : אינטראקציות

4.5 Interaction with other medicinal products and other forms of interaction
Consistent with current medical practice, levosimendan should be used with caution when used with other intravenous vasoactive medicinal products due to a potentially increased risk of hypotension (see section 4.4).

No pharmacokinetic interactions have been observed in a population analysis of patients receiving digoxin and levosimendan infusion. Levosimendan infusion can be used in patients receiving beta-blocking agents without loss of efficacy. Co-administration of isosorbide mononitrate and levosimendan in healthy volunteers resulted in significant potentiation of the orthostatic hypotensive response.

Levosimendan has shown to be an inhibitor of CYP2C8 in vitro, and inhibition of metabolism of sensitive CYP2C8 substrates at the highest levosimendan infusion level (0.2 μg/min/kg), as well as with the higher loading-dose (12 μg/kg) cannot be excluded. Clinical drug-drug interaction study involving levosimendan and a representative substrate primarily metabolized by CYP2C8 has not been conducted. However, co-administration of levosimendan at highest recommended dose with sensitive CYP2C8 substrates should be avoided when possible. Co- administration of levosimendan may increase the plasma concentrations of concomitant CYP2C8 substrates such as loperamide, pioglitazone, repaglinide and enzalutamide. With the lower infusion rate of 0.1 μg/min/kg the drug drug interactions are unlikely.