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