Drugs List

Therapeutic Indications

Uses

Cardiac failure - especially if output reduced & filling pressure increased

Unlicensed Uses

Heart failure associated with cardiac surgery

Administration

For intravenous administration after dilution.

Enoximone may be administered by slow intravenous injection or intravenous infusion.

Contraindications

None known

Precautions and Warnings

Children under 18 years
Aortic stenosis
Breastfeeding
Cardiac arrhythmias
Hepatic impairment
Hypertrophic cardiomyopathy
Left ventricular outflow obstruction
Mitral stenosis
Obstructive valvular heart disease
Pregnancy
Renal impairment

Reduce dose in patients with hepatic impairment
Reduce dose in patients with renal impairment
Contains alcohol
Contains propylene glycol: may cause irritation
Dilute injection before use - avoid glass containers or syringes
If extravasation occurs follow local policy & seek expert help immediately
Monitor platelets before starting and during treatment
Monitor serum potassium levels before treatment
Monitor blood pressure
Monitor central venous pressure
Monitor ECG
Monitor fluid and electrolyte status
Monitor heart rate
Monitor hepatic enzymes
Monitor renal function
Monitor serum potassium regularly
Discontinue if hepatic enzymes (AST or ALT) become persistently raised
Discontinue treatment if arrhythmias occur
Interrupt or reduce dose if significant gastrointestinal disturbances occur

If the patient develops severe supraventricular and ventricular arrhythmias during treatment, enoximone should be immediately discontinued and appropriate anti-arrhythmic therapy should be instituted.

Pregnancy and Lactation

Pregnancy

Use enoximone with caution in pregnancy.

Enoximone should not be used during pregnancy unless clearly necessary

The manufacturer reports that no animal teratogenicity was reported following oral therapy. Reproduction studies performed in rats at doses up to 300 mg/kg/day and 100 mg/kg/day have revealed reductions in maternal food consumption, maternal body weight gain and in pup weight at weaning and sexual maturity when enoximone was administered throughout pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use enoximone with caution in breastfeeding.

It is not known whether enoximone is excreted into human breast milk. At the time of writing, there is no published experience concerning the use of enoximone during breastfeeding.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Altered liver enzymes values
Chills
Decrease in haemoglobin and haematocrit
Diarrhoea
Dizziness
Ectopic beats
Fever
Fluid retention
Headache
Hypotension
Increase in blood urea or creatinine
Increase in serum glucose
Increased uric acid level
Insomnia
Leucocytosis
Lower limb pain
Nausea
Oliguria
Painful extremities
Phlebitis (injection site)
Supraventricular arrhythmias
Thrombocytopenia
Upper limb pain
Urinary retention
Ventricular fibrillation
Ventricular tachycardia
Vomiting

Presentation

Injection containing enoximone

Drugs List

Therapeutic Indications

Uses

Cardiac failure - especially if output reduced & filling pressure increased

Unlicensed Uses

Heart failure associated with cardiac surgery

Dosage

Adults

Children

Neonates

Administration

For intravenous administration after dilution.

Enoximone may be administered by slow intravenous injection or intravenous infusion.

Contraindications

None known

Precautions and Warnings

Children under 18 years
Aortic stenosis
Breastfeeding
Cardiac arrhythmias
Hepatic impairment
Hypertrophic cardiomyopathy
Left ventricular outflow obstruction
Mitral stenosis
Obstructive valvular heart disease
Pregnancy
Renal impairment

Reduce dose in patients with hepatic impairment
Reduce dose in patients with renal impairment
Contains alcohol
Contains propylene glycol: may cause irritation
Dilute injection before use - avoid glass containers or syringes
If extravasation occurs follow local policy & seek expert help immediately
Monitor platelets before starting and during treatment
Monitor serum potassium levels before treatment
Monitor blood pressure
Monitor central venous pressure
Monitor ECG
Monitor fluid and electrolyte status
Monitor heart rate
Monitor hepatic enzymes
Monitor renal function
Monitor serum potassium regularly
Discontinue if hepatic enzymes (AST or ALT) become persistently raised
Discontinue treatment if arrhythmias occur
Interrupt or reduce dose if significant gastrointestinal disturbances occur

If the patient develops severe supraventricular and ventricular arrhythmias during treatment, enoximone should be immediately discontinued and appropriate anti-arrhythmic therapy should be instituted.

Pregnancy and Lactation

Pregnancy

Use enoximone with caution in pregnancy.

Enoximone should not be used during pregnancy unless clearly necessary

The manufacturer reports that no animal teratogenicity was reported following oral therapy. Reproduction studies performed in rats at doses up to 300 mg/kg/day and 100 mg/kg/day have revealed reductions in maternal food consumption, maternal body weight gain and in pup weight at weaning and sexual maturity when enoximone was administered throughout pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use enoximone with caution in breastfeeding.

It is not known whether enoximone is excreted into human breast milk. At the time of writing, there is no published experience concerning the use of enoximone during breastfeeding.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Altered liver enzymes values
Chills
Decrease in haemoglobin and haematocrit
Diarrhoea
Dizziness
Ectopic beats
Fever
Fluid retention
Headache
Hypotension
Increase in blood urea or creatinine
Increase in serum glucose
Increased uric acid level
Insomnia
Leucocytosis
Lower limb pain
Nausea
Oliguria
Painful extremities
Phlebitis (injection site)
Supraventricular arrhythmias
Thrombocytopenia
Upper limb pain
Urinary retention
Ventricular fibrillation
Ventricular tachycardia
Vomiting

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: July 2014

Reference Sources

Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

Summary of Product Characteristics: Perfan injection 100mg/20ml concentration for solution for injection. Myogen GmbH. Revised May 2012.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 28 June 2017