Monograph: |
ENOXIMONE
Enoximone and milrinone are selective phosphodiesterase inhibitors which exert most of their effect on the myocardium. Sustained haemodynamic benefit has been observed after administration, but there is no evidence of any beneficial effect on survival.
Indications
acute heart failure, including low output states, following heart surgery
short-term treatment of severe congestive heart failure unresponsive to conventional maintenance therapy (not immediately after myocardial infarction)
congestive heart failure where cardiac output reduced and filling pressures increased
Cautions
heart failure associated with hypertrophic cardiomyopathy, stenotic or obstructive valvular disease or other outlet obstruction; monitor blood pressure, heart rate, ECG, central venous pressure, fluid and electrolyte status, renal function, platelet count, hepatic enzymes; avoid extravasation; renal impairment; pregnancy; breast-feeding
Side-effects
ectopic beats; less frequently ventricular tachycardia or supraventricular arrhythmias (more likely in patients with pre-existing arrhythmias); hypotension; also headache, insomnia, nausea and vomiting, diarrhoea; occasionally, chills, oliguria, fever, urinary retention; upper and lower limb pain
Dose
By slow intravenous injection (rate not exceeding 12.5 mg/minute), diluted before use, initially 0.5-1 mg/kg, then 500 micrograms/kg every 30 minutes until satisfactory response or total of 3 mg/kg given; maintenance, initial dose of up to 3 mg/kg may be repeated every 3-6 hours as required
By intravenous infusion, initially 90 micrograms/kg/minute over 10-30 minutes, followed by continuous or intermittent infusion of 5-20 micrograms/kg/minute
Total dose over 24 hours should not usually exceed 24 mg/kg
HOW TO USE:
Continuous or intermittent in Sodium chloride 0.9% or Water for injections
Dilute to a concentration of 2.5 mg/mL; incompatible with glucose solutions; use only plastic containers or syringes
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