Dosing and uses of Dopram (doxapram)
Adult dosage forms and strengths
injectable solution
- 20mg/mL
COPD Associated with Acute Hypercapnia
1-2 mg/min IV infusion; not to exceed 3 mg/min or 2 hours; monitor arterial blood gases prior to initiation of infusion and at 30 min interval during the infusion to identify possible development of acidosis/CO2 retention
Respiratory Depression Postanesthesia
0.5-1 mg/kg IV injection; repeat at 5-min intervals in patients that show an initial response; not to exceed 2 mg/kg Or
Initial: 5 mg/min IV infusion (with 1 mg/mL solution) until adequate response or adverse effects occur; may reduce to 1-3 mg/min; total IV infusion not to exceed 4 mg/kg
Drug-Induced CNS Depression
Intermittent injection: 1-2 mg/kg IV injection priming dose, repeat in 1-2 hr priming dose; not to exceed 3 g/day; may repeat in 24 hr if necessary Or
IV infusion: 1-2 mg/kg IV injection, repeat in 5 min, if no response, wait 1-2 hr and repeat priming dose; if some stimulation noted, initiate infusion at 1-3 mg/min IV infusion not to exceed 2 hours; suspend infusion if patient begins to awaken; may repeat after a rest of 30-120 minutes, total dose not to exceed 3 g/day
Pediatric dosage forms and strengths
injectable solution
- 20mg/mL
<12 years
Safety & efficacy not established
>12 years
COPD Associated with Acute Hypercapnia
- 1-2 mg/min IV infusion; not to exceed 3 mg/min or 2 hours; monitor arterial blood gases prior to initiation of infusion and at 30 min interval during the infusion to identify possible development of acidosis/CO2 retention
Respiratory Depression Postanesthesia
- 0.5-1 mg/kg IV injection; repeat at 5-min intervals in patients that show an initial response; not to exceed 2 mg/kg OR
- IV infusion: 1-2 mg/kg IV injection, repeat in 5 min, if no response, wait 1-2 hr and repeat priming dose; if some stimulation noted, initiate infusion at 1-3 mg/min IV infusion not to exceed 2 hours; suspend infusion if patient begins to awaken; may repeat after a rest of 30-120 minutes, total dose not to exceed 3 g/day
Drug-Induced CNS Depression
- Intermittent injection: 1-2 mg/kg IV injection priming dose, repeat in 1-2 hr priming dose; not to exceed 3 g/day; may repeat in 24 hr if necessary OR
- IV infusion: 1-2 mg/kg IV injection, repeat in 5 min, if no response, wait 1-2 hr and repeat priming dose; if some stimulation noted, initiate infusion at 1-3 mg/min IV infusion not to exceed 2 hours; suspend infusion if patient begins to awaken; may repeat after a rest of 30-120 minutes, total dose not to exceed 3 g/day
Dopram (doxapram) adverse (side) effects
Frequency not defined
Pyrexia
Flushing
Sweating
Pruritus & paresthesia, burning/hot sensation especially in genitalia & perineum
Disorientation
Pupillary dilatation
Hallucinations
Involuntary movements
Muscle spasticity, muscle fasciculations, increased deep tendon reflexes, clonus, bilateral Babinski, convulsions
Dyspnea
Cough
Hyperventilation/ rebound hypoventilation
Tachypnea
Laryngospasm
Bronchospasm
Hiccough
Phlebitis
Variations in heart rate
Lowered T-waves, arrhythmias
Chest pain, tightness in chest
Increase in blood pressure
Stimulation of urinary bladder with spontaneous voiding, urinary retention
Elevation of BUN, albuminuria
Hemolysis (with rapid infusion)
Decrease in Hgb, Hct, or RBC count
Decrease in WBC (pts with leukopenia)
Warnings
Contraindications
Hypersensitivity
Epilepsy, convulsive disorder
Existing/suspected pulmonary embolism
Mechanical obstruction, muscle paresis, flail chest, pneumothorax, acute bronchial asthma, pulmonary fibrosis
Head injury, CVA, cerebral edema
Disorders of ventilation including mechanical obstruction, neuromuscular blockade, muscle paresis
Cerebral vascular accident, head injury
Significant cardiovascular impairment, uncompensated heart failure, severe coronary artery disease, severe HTN including hypertension associated with hyperthyroidism or pheochromocytoma)
Cautions
Narrow margin of safety
Do not use concurrently with mechanical ventilation
Contains benzyl alcohol (associated with potentially fatal "Gasping Syndrome" in neonates)
Avoid using same injection site over long period of time & avoid rapid infusion
Concurrency with sympathomimetic or MAOIs
Hepatic/renal impairment
May cause severe CNS stimulation resulting in seizures; anticonvulsants should be available
May cause dysrhythmias; monitor
If sudden hypotension develops discontinue therapy
Use caution in patients with cerebrovascular disease
Use caution in hepatic and renal impairment
Use caution when used concurrently with MAO inhibitors, volatile anesthetics, or sympathomimetics
Avoid extravasation
Pregnancy and lactation
Pregnancy category: B
Lactation: Excretion in milk unknown; use with caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Dopram (doxapram)
Mechanism of action
Produces respiratory stimulation in medulla (which propagates stimulation to other parts of brain & spinal cord) through peripheral carotid chemoreceptors
Pharmacokinetics
Onset: 20-40 sec
Duration: 5-12 min (single IV injection)
Peak Plasma Time: 1-2 min
Half-life: 3.4 hr (2.4-4.1 hr)
Administration
IV Incompatibilities
Additive: aminophylline, thiopental, sodium bicarbonate, furosemide, minocycline, ticarcillin
Syringe: aminophylline, ascorbic acid, cefoperazone, cefotaxime, cefotetan, cefuroxime, dexamethasone sodium phosphate, diazepam, folic acid, furosemide, hydrocortisone sodium succinate, methylprednisolone sodium succinate, minocycline, thiopental, ticarcillin
Y-site: clindamycin
IV Preparation
Add 250 mg doxapram to 250 mL D5W, D10W or NS to obtain a 1 mg/mL soln
For COPD: add 400 mg doxapram to 180 mL D5W, D10W or NS to a final concentration of 2 mg/mL
IV Administration
COPd
- Initial infusion at 1-2 mg/min; may incr to NMT 3 mg/min
- No more than 2 hr
- ABG should be determined before administering doxapram & q30min during 2 hr of infusion
- Discontinue if ABG show evidence of deterioration
Anesthesia
- If infusing, use 1 mg/mL at an initial rate of 5 mg/min
- When the desired response is obtained or if adverse effects appear, may be reduce to 1-3 mg/min
- Do not increase infusion rate in debilitated patients in an attempt to lower pCO2 because of associated increased work in breathing
CNS Depression
- If infusing, infuse at 1-3 mg/min until patient begins to awaken, but NMT 2 hr
- May repeat after a 30 min-2 hr rest period, provided max daily dose of 3 g has not been exceeded
Storage
Store at 20-25°C
