Enoximone Intravenous for Adults

Who can administer

Administration RESTRICTED- see Appendix 1 

Important information

• Unlicensed preparation
• Serum potassium levels should be corrected before and monitored throughout treatment with enoximone. Abnormal levels can predispose patients to arrhythmias
• See under 'Dose' for adjustments required in renal impairment'

Available preparations

Enoximone 100mg per 20ml ampoule (Perfan)

Reconstitution

Already in solution

• Draw up using a 5 micron filter needle
• Dilute further prior to administration

Infusion fluids

Sodium chloride 0.9% ONLY

Methods of intravenous administration

If a central venous access device is unavailable, administer via a large peripheral vein monitoring insertion site closely using a recognised phlebitis scoring tool ^{(ref 1)}

Slow intravenous injection

• Add required dose to equal volume of infusion fluid (to produce a 2.5mg/mL solution) 
• Do not use more dilute solutions as crystal formation may occur

Intermittent intravenous infusion (using an electronically controlled infusion device)

• Add required dose to equal volume of infusion fluid (to produce a 2.5mg/mL solution)
• Administer as per 'Dose' overleaf

Continuous intravenous infusion (using an electronically controlled infusion device)

• Add 100mg (20mL) to 20mL infusion fluid ^{(ref 1,2)} i.e. final infusion contains 100mg in 40mL (2.5mg/mL solution)
• Do not use more dilute solutions as crystal formation may occur
• Rate adjusted according to response - see 'Dose'

 

Dose in adults

Congestive Heart failure

Initial therapy

• Slow intravenous injection
  • Give 0.5 to 1 mg /kg at a rate not greater than 12.5mg per minute
  • Further doses of 0.5mg/kg may be given every 30 minutes until a satisfactory response is achieved or a total initial dose of 3mg/kg is achieved
  • OR
• Intermittent infusion
  • Give at a rate of 90micrograms/kg/minute administered over 10 to 30 minutes until the required haemodynamic response is achieved

Maintenance dose

• Slow intravenous injection
  • The initial dose (up to a max of 3mg/kg) may be repeated every three to six hours as required - adjusted according to the patient response
  • This should be administered at rate not greater than 12.5mg per minute
  • Normal maximum daily dose is 24mg/kg/day (i.e. 1,680mg/day in 70kg patient)
  • OR
• Continuous infusion
  • Give 5 - 20 micrograms/kg/minute following loading dose, according to haemodynamic response.
  • Normal maximum daily dose is 24mg/kg/day (i.e. 1,680mg/day in 70kg patient)

Renal impairment

• In patients with renal impairment, the dose or dosage frequency may need to be reduced

Monitoring

• Enoximone has a high pH and may cause venous irritation and tissue damage in cases of extravasation
• Monitor potassium levels: See under Important Information above
• Platelet count to be assessed before and during therapy.
• Severe gastrointestinal symptoms may occur; can be managed by reducing dose/temporarily interrupting the regime.
• Liver function tests; if clinically significant increases in hepatic enzymes therapy should be discontinued.
• Contains ethanol (10.4%); caution for use in those with a history of alcohol excess, pregnant or breast-feeding women and high-risk groups such as liver disease or epilepsy.
• Contains propylene glycol -monitor for adverse events e.g. hyperosmolality, lactic acidosis, renal dysfunction, cardiotoxicity, CNS disorders, respiratory depression, dyspnoea, liver dysfunction, haemolytic and haemoglobinuria.

Further information

• Occasionally, enoximone has produced 'furring of the lines'. In practice a dedicated line is recommended for its administration ^{(ref 1)}

Storage

Store below 25⁰C

Do not freeze.

References

Summary of Product Characteristics Perfan July 1st 2022
1: Medusa NHS guide - downloaded June 2023
2: Standard Medication Concentrations for Continuous Infusions in Adult Critical Care. Intensive Care Society December 2020 version 4.1. 

Therapeutic classification

Phosphodiesterase enzyme inhibitor