Adult: Initially, 0.5-1.5 mg/kg via IV inj over at least 30 seconds; may repeat dose at hourly intervals if necessary. Alternatively, may be given at an initial rate of 2-5 mg/minute via IV infusion, then decrease to 1-3 mg/minute according to response (Max total dose: 4 mg/kg). Dosing and treatment recommendations may vary among individual products and between countries (refer to specific product guidelines).
Intravenous Acute respiratory failure
Adult: 1.5-4 mg/minute via IV infusion; adjust dose according to patient response. Dosing and treatment recommendations may vary among individual products and between countries (refer to specific product guidelines).
Incompatibility
Incompatible with ticarcillin, ascorbic acid, cefoperazone, cefotaxime, cefotetan, cefuroxime, dexamethasone, diazepam, folic acid, hydrocortisone and methylprednisolone. May form gas or precipitate with Na bicarbonate or other strongly alkaline drugs (e.g. aminophylline, furosemide, thiopental Na).
Contraindications
Significant CV impairment (e.g. uncompensated heart failure, CAD), severe hypertension, hyperthyroidism or thyrotoxicosis, head injury, cerebral oedema, CVA, epilepsy and other convulsive disorders, mechanical disorders of ventilation (e.g. mechanical obstruction, muscle paresis, neuromuscular blockade, flail chest, pneumothorax, pulmonary fibrosis, acute bronchial asthma), status asthmaticus, proven or suspected pulmonary embolism.
Special Precautions
Patient with cerebrovascular disease, pulmonary disease, hypermetabolic states (e.g. phaeochromocytoma). Ensure adequate airway and airway protection before administration. Not recommended to be used in conjunction with mechanical ventilation. Renal and hepatic impairment. Pregnancy and lactation.
Adverse Reactions
Significant: Dysrhythmias, severe CNS stimulation (e.g. seizures). Cardiac disorders: Sinus tachycardia, bradycardia, extrasystoles, chest pain, chest tightness. Gastrointestinal disorders: Nausea, vomiting, salivation, diarrhoea, hiccups. General disorders and administration site conditions: Fever. Musculoskeletal and connective tissue disorders: Fasciculations. Nervous system disorders: Headache, dizziness, convulsions, bilateral Babinski. Psychiatric disorders: Hallucination, confusion, hyperactivity. Renal and urinary disorders: Urinary retention. Reproductive system and breast disorders: Perineal warmth. Respiratory, thoracic and mediastinal disorders: Cough, bronchospasm, laryngospasm, hyperventilation, rebound hypoventilation, dyspnoea. Skin and subcutaneous tissue disorders: Sweating. Vascular disorders: Flushing, phlebitis.
Monitor heart rate, blood pressure, deep tendon reflexes, CNS status and ECG. Obtain ABG before treatment initiation and at 30-minute intervals during administration.
Overdosage
Symptoms: Hypertension, tachycardia, other arrhythmias, skeletal muscle hyperactivity, enhanced deep tendon reflexes, dyspnoea, agitation, confusion, sweating and clonic or generalised seizures. Management: Symptomatic treatment. IV diazepam, phenytoin and short-acting barbiturate may be administered alongside oxygen and resuscitative equipment.
Drug Interactions
May cause additive pressor effects with sympathomimetic agents and MAOIs. May temporarily mask the residual effects of neuromuscular blockers. May enhance CNS stimulation, agitation, skeletal muscle activity and hyperactivity with theophylline or aminophylline. Concurrent use with anaesthetics known to sensitise the myocardium to catecholamines (e.g. cyclopropane, enflurane, halothane) may increase the risk of arrhythmias.
Action
Description: Mechanism of Action: Doxapram, a monohydrated pyrrolidinone derivative, is a central and respiratory stimulant. It stimulates respiration through reflex activation of aortic, carotid or other peripheral chemoreceptors. At higher doses, doxapram also stimulates other areas of the brain and spinal cord. Additionally, it has a pressor action that may increase the release of catecholamines. Onset: 20-40 seconds (respiratory stimulation). Duration: 5-12 minutes. Pharmacokinetics: Distribution: Rapidly distributed into the tissues. Metabolism: Extensively metabolised in the liver via hydroxylation into keto-doxapram (active metabolite). Excretion: Via urine and faeces. Elimination half-life: Mean: 3.4 hours (range: 2.4-4.1 hours).
Chemical Structure
Doxapram Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 3156, Doxapram. https://pubchem.ncbi.nlm.nih.gov/compound/Doxapram. Accessed Mar. 26, 2025.
R07AB01 - doxapram ; Belongs to the class of respiratory stimulants. Used in treatment of respiratory diseases.
References
Anon. Doxapram. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 13/01/2025.Brayfield A, Cadart C (eds). Doxapram Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 13/01/2025.Dopram 2 mg/mL Solution for Infusion (Mercury Pharmaceuticals Limited). MHRA. https://products.mhra.gov.uk. Accessed 13/01/2025.Dopram 20 mg/mL Solution for Injection (Mercury Pharmaceuticals Limited). MHRA. https://products.mhra.gov.uk. Accessed 13/01/2025.Dopram Injection (Hikma Pharmaceuticals USA Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 14/02/2025.Doxapram. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 13/01/2025.Joint Formulary Committee. Doxapram Hydrochloride. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 13/01/2025.
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