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Doxapram Hydrochloride

Pronouncation: (DOX-uh-pram HIGH-droe-KLOR-ide)
Class: Analeptic

Trade Names:
Dopram
- Injection 20 mg/mL

Pharmacology

Increases depth of respirations (tidal volume) by stimulating respiratory center in CNS; respiratory rate may increase slightly. May elevate BP by increasing cardiac output. Respiratory depression from opiates is reversed without affecting pain relief.

Pharmacokinetics

Metabolism

Extensively metabolized.

Elimination

Metabolites and a small amount of unchanged drug excreted in urine. The t _½ is 2.4 to 4.1 h.

Onset

20 to 40 sec.

Peak

1 to 2 min.

Duration

5 to 12 min.

Indications and Usage

Stimulate deep breathing in postoperative patients; reversal of respiratory depression caused by anesthesia (other than muscle relaxants) or drug overdose; temporary measure for acute respiratory failure in patients with COPD who are not undergoing mechanical ventilation.

Contraindications

Use in newborns (contains benzyl alcohol); seizures; muscle paresis; epilepsy or other convulsive states; flail chest; head injury; pneumothorax; acute asthma; pulmonary fibrosis; other conditions that restrict chest wall, respiratory muscles or alveolar expansion; severe hypertension; cerebrovascular accident; proven or suspected pulmonary embolism; mechanical obstruction; cerebral edema; CV impairment; uncompensated heart failure; severe coronary artery disease; hypersensitivity to any component of the product.

Dosage and Administration

Anesthesia-induced Respiratory Depression
Adults

Max daily dose is 3 g. Bolus IV injection 0.5 to 1ߙmg/kg (single dose not to exceed 1.5ߙmg/kg). Can be given as multiple IV injections every 5 min (not to exceed total dose of 2 mg/kg).

IV infusion Initial rate 5 mg/min until satisfactory respiratory response is noted. Maintenance rate: 1 to 3 mg/min. Max total infusion dose is 4ߙmg/kg.

Drug-induced CNS Depression
Adults

Max daily dose is 3 g. Bolus IV injection Priming dose is 1 to 2 mg/kg (mild to moderate). Repeat in 5 min. Depending on response, may give every 1 to 2 h until patient awakens. Intermittent IV infusion Priming dose is 1 to 2ߙmg/kg (mild to moderate). If respirations improve, give by IV infusion at 1 to 3 mg/min. Discontinue after 2 h or if patient awakens.

Acute Hypercapnia from COPD
Adults

IV infusion 2 mg/mL with initial rate of 1 to 2 mg/min; may increase to max 3ߙmg/min; discontinue after 2 h.

Storage/Stability

Store vials at controlled room temperature (59° to 86°F).

Drug Interactions

Aminophylline, theophylline

May increase skeletal muscle activity, agitation, and hyperactivity.

Cyclopropane, enflurane, halothane

To prevent arrhythmias, wait at least 10ߙmin after stopping these anesthetics before giving doxapram.

MAOIs, sympathomimetics

Increased risk of hypertension.

Muscle relaxants

Residual effects may be temporarily masked by doxapram.

Incompatibility

Do not add to or give with alkaline solutions such as aminophylline, furosemide, thiopental, or sodium bicarbonate.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Arrhythmias; chest pain; increased BP; lowered T-waves; phlebitis; tachycardia; tightness in chest; variations in heart rate.

CNS

Apprehension; bilateral Babinski; clonus; disorientation; dizziness; hallucination; headache; hyperactivity; increased reflexes; involuntary movements; muscle spasticity and fasciculations; paresthesia; pyrexia; seizures.

EENT

Pupillary dilation.

GI

Desire to defecate; diarrhea; nausea; vomiting.

Genitourinary

Elevation of BUN; urinary incontinence and retention.

Hematologic

Hemolysis (with rapid infusion).

Respiratory

Bronchospasm; cough; dyspnea; hiccoughs; hyperventilation; laryngospasm; rebound hypoventilation; tachypnea.

Miscellaneous

Feelings of warmth; flushing; pruritus; sweating.

Precautions

Pregnancy

Category B .

Lactation

Undetermined.

Children

Safety and efficacy not established in children younger than 12ߙyr of age. Doxapram contains benzyl alcohol, which has been associated with fatal gasping syndrome in premature infants.

COPD patients

Do not increase infusion rate in severely ill patients; drug may increase work of breathing.

Drug-induced CNS and respiratory depression

Used as adjunct to supportive care.

Postanesthesia

Do not use as antidote for opiates or neuromuscular blockers.

Overdosage

Symptoms

Severe hypertension, tachycardia, hyperactive reflexes, seizures.

Patient Information

Advise patient or caregiver that medication will be prepared and administered by health care professionals in a intensive care setting with close monitoring.