Drug information of Doxapram

Doxapram

Drug group:

A central respiratory stimulant with a brief duration of action.

Mechanism of effect

Doxapram produces respiratory stimulation mediated through the peripheral carotid chemoreceptors. It is thought to stimulate the carotid body by inhibiting certain potassium channels.

Pharmacodynamic

Doxapram is an analeptic agent (a stimulant of the central nervous system). The respiratory stimulant action is manifested by an increase in tidal volume associated with a slight increase in respiratory rate. A pressor response may result following doxapram administration.

Provided there is no impairment of cardiac function, the pressor effect is more marked in hypovolemic than in normovolemic states. The pressor response is due to the improved cardiac output rather than peripheral vasoconstriction. Following doxapram administration, an increased release of catecholamines has been noted.

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)

Dosage

Adult

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

<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

Alerts

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 when used concurrently with MAO inhibitors, volatile anesthetics, or sympathomimetics

Avoid extravasation

Pregnancy level

B

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