Doxapram

Doxapram is a prescription medicine used to treat the symptoms of COPD associated with acute hypercapnia, respiratory depression postanesthesia, and drug-induced CNS depression.

• Doxapram is available under the following different brand names: Dopram

Adult and pediatric dosage

Injectable solution

• 20mg/mL

COPD Associated with Acute Hypercapnia

Adult dosage

• 1-2 mg/min IV infusion; not to exceed 3 mg/min or 2 hours; monitor arterial blood gases before initiation of infusion and at 30 min intervals during the infusion to identify possible development of acidosis/CO2 retention

Pediatric dosage

• Children below 12 years: Safety and efficacy not established
• Children above 12 years: 1-2 mg/min IV infusion; not to exceed 3 mg/min or 2 hours; monitor arterial blood gases before initiation of infusion and at 30 min intervals during the infusion to identify possible development of acidosis/CO2 retention

Respiratory Depression Postanesthesia

Adult dosage

• 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

Pediatric dosage

• Children below 12 years: Safety and efficacy not established
• Children above 12 years:
• 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 for 1-2 hours and repeat priming dose; if some stimulation is noted, initiate infusion at 1-3 mg/min IV infusion not to exceed 2 hours; suspend infusion if the 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

Adult dosage

• Intermittent injection: 1-2 mg/kg IV injection priming dose, repeat in 1-2 hours priming dose; not to exceed 3 g/day; may repeat in 24 hours if necessary OR  
• IV infusion: 1-2 mg/kg IV injection, repeat in 5 min, if no response, wait for 1-2 hours and repeat priming dose; if some stimulation is noted, initiate infusion at 1-3 mg/min IV infusion not to exceed 2 hours; suspend infusion if the patient begins to awaken; may repeat after a rest of 30-120 minutes, total dose not to exceed 3 g/day

Pediatric dosage

• Children below 12 years: Safety and efficacy not established
• Children above 12 years:
• Intermittent injection: 1-2 mg/kg IV injection priming dose, repeat in 1-2 hours priming dose; not to exceed 3 g/day; may repeat in 24 hours if necessary OR  
• IV infusion: 1-2 mg/kg IV injection, repeat in 5 min, if no response, wait for 1-2 hours and repeat priming dose; if some stimulation is noted, initiate infusion at 1-3 mg/min IV infusion not to exceed 2 hours; suspend infusion if the patient begins to awaken; may repeat after a rest of 30-120 minutes, total dose not to exceed 3 g/day

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

Common side effects of Doxapram include:

• pain and redness at the injection site,
• a feeling of warmth,
• flushing,
• sweating,
• headache,
• dizziness,
• nausea,
• diarrhea, and
• enlarged pupils.

Serious side effects of Doxapram include:

• hives,
• difficulty breathing,
• swelling of the face, lips, tongue, or throat,
• chest pain,
• rapid or irregular heartbeat,
• fever,
• mood changes,
• increased muscle activity or spasms,
• seizures,
• urination problems,
• itching, and
• rapid or slow breathing.

Rare side effects of Doxapram include:

• none 

This is not a complete list of side effects and other serious side effects or health problems that may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Doxapram has severe interactions with no other drugs.
• Doxapram has serious interactions with at least 35 other drugs.
• Doxapram has moderate interactions with the following drugs:
  • atracurium
  • cisatracurium
  • onabotulinumtoxinA
  • pancuronium
  • procarbazine
  • rapacuronium
  • rocuronium
  • solriamfetol
  • succinylcholine
  • theophylline
  • vecuronium
• Doxapram has minor interactions with no other drugs. 

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns.

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)

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Doxapram?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Doxapram?”

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 the same injection site over a long period & 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

• May be acceptable during pregnancy.
• Lactation
  • Excretion in milk is unknown; use with caution.