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Indications and Dosage
Intravenous
Postoperative respiratory depression Adult: 1-1.5 mg/kg via inj over at least 30 seconds, repeated at hrly intervals, as necessary. Alternatively, an initial dose of 2-5 mg/min via infusion, reduced to 1-3 mg/min according to response. Max total: 4 mg/kg. Intravenous Acute respiratory failure Adult: 1.5-4 mg/min via infusion, adjusted according to response.
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Incompatibility
Incompatible w/ ascorbic acid, cefoperazone, cefotaxime, cefotetan, cefuroxime, clindamycin, folic acid, dexamethasone, diazepam, hydrocortisone, methylprednisolone. May form precipitate or gas w/ alkaline soln (e.g. thiopental Na, Na bicarbonate, furosemide, or aminophylline.
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Contraindications
Severe HTN, status asthmaticus, coronary artery disease, epilepsy and other convulsive disorders, cerebral oedema, CVA, hyperthyroidism/thyrotoxicosis, physical obstruction of the resp tract, head injury, known or suspected pulmonary embolism. Patients on mechanical ventilation.
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Special Precautions
Patient w/ cerebrovascular disease, hypermetabolic states (e.g. phaeochromocytoma), HTN. Hepatic or renal impairment.
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Adverse Reactions
Significant: Dysrrhythmias, seizure, HTN or hypotension, dyspnoea.
Nervous: Confusion, convulsions, dizziness, hallucinations, headache, hyperactivity. GI: Diarrhoea, nausea, vomiting. Resp: Bronchospasm, cough, hiccup, laryngospasm, hyperventilation, rebound hypoventilation. Genitourinary: Urinary retention, urinary bladder stimulation w/ spontaneous voiding. Musculoskeletal: Muscle fasciculation or spasticity. Dermatologic: Flushing, sweating, warm sensation. Others: Fever. |
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IV/Parenteral: B
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Monitoring Parameters
Monitor heart rate, BP, deep tendon reflexes, CNS status, ECG. Measure arterial blood gas and pH frequently during treatment.
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Overdosage
Symptoms: HTN, tachycardia and other arrhythmias, skeletal muscle hyperactivity including enhanced deep tendon reflexes, dyspnoea, cough, confusion, agitation, sweating; clonic and generalised seizure may occur. Management: Symptomatic treatment. IV diazepam, phenytoin, and short-acting barbiturates may be given, along w/ oxygen and resuscitative equipment.
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Drug Interactions
Additive pressor effect when concurrently used w/ MAOIs or sympathomimetics. May temporarily mask the residual effect when used w/ neuromuscular blocking agents. May cause increased CNS stimulation, agitation, muscle fasciculation and hyperactivity w/ concurrent use of aminophylline/theophylline. Cardiac arrhythmias may occur when given w/ anaesthetics that are known to sensitise the myocardium to catecholamines (e.g. enflurane, halothane, isoflurane), delay initiation of doxapram for at least 10 min after discontinuance of anaesthesia.
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Action
Description: Doxapram stimulates respiration through action on peripheral carotid chemoreceptors. It also directly stimulates the central respiratory center in medulla w/ progressive stimulation of other parts of the brain and spinal cord at higher doses.
Onset: Resp stimulation: 20-40 seconds. Duration: 5-12 min. Pharmacokinetics: Distribution: Rapidly distributed into the tissues. Metabolism: Extensively metabolised in the liver via ring hydroxylation to active metabolite, keto-doxapram. Excretion: Mainly via faeces (as unchanged drug and metabolites) and also via urine (<60>5%). Elimination half-life: 3.4 hr (mean); 2.4-4.1hr (range). |
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Chemical Structure
 Source: National Center for Biotechnology Information. PubChem Database. Doxapram, CID=3156, https://pubchem.ncbi.nlm.nih.gov/compound/Doxapram (accessed on Jan. 21, 2020) |
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Storage
Store between 20-25°C.
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MIMS Class
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ATC Classification
R07AB01 - doxapram ; Belongs to the class of respiratory stimulants. Used in treatment of respiratory diseases.
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References
Anon. Doxapram. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 17/11/2016. Buckingham R (ed). Doxapram Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com . Accessed 17/11/2016. Dopram Injection (West-ward Pharmaceutical Corp.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 17/11/2016. Joint Formulary Committee. Doxapram Hydrochloride . British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 17/11/2016. McEvoy GK, Snow EK, Miller J et al (eds). Doxapram Hydrochloride. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 17/11/2016.
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