Dopram


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doxapram hydrochloride

Dopram

Pharmacologic class: CNS and respiratory stimulant

Therapeutic class: Analeptic

Pregnancy risk category B

Action

Activates peripheral carotid, aortic, and other chemoreceptors to stimulate respiration. Increases tidal volume and respiratory rate by directly stimulating respiratory center in medulla oblongata.

Availability

Injection: 20 mg/ml

Indications and dosages

Respiratory depression after anesthesia

Adults and adolescents: 5 mg/minute by I.V. infusion until desired response occurs; then reduce to 1 to 3 mg/minute, to a maximum cumulative dosage of 4 mg/kg (or 300 mg). Or 0.5 to 1 mg/kg I.V. injection, repeated q 5 minutes, if needed, to a maximum total dosage of 1.5 mg/kg.

Chronic pulmonary disease related to acute hypercapnia

Adults: 1 to 2 mg/minute by I.V. infusion, using a concentration of 2 mg/ml, to a maximum of 3 mg/minute. Infusion shouldn't exceed 2 hours.

Drug-induced CNS depression

Adults: Initially, 2 mg/kg I.V., repeated in 5 minutes and then q 1 to 2 hours until patient awakens, to a maximum daily dosage of 3 g. For infusion, priming dose of 2 mg/kg I.V.; if no response occurs, continue for 1 to 2 hours as needed; if some response occurs, give I.V. infusion of 250 mg in 250 ml of saline solution or dextrose 5% in water at 1 to 3 mg/minute until patient awakens. Don't infuse longer than 2 hours or give more than 3 g/day.

Off-label uses

• Laryngospasm secondary to postoperative tracheal extubation
• Apnea of prematurity
• Postoperative shivering

Contraindications

• Hypersensitivity to drug
• Cardiovascular disorders, severe hypertension
• Cerebrovascular accident
• Head injury, seizures
• Respiratory failure, restrictive respiratory disease
• Neonates

Precautions

Use cautiously in:
• bronchial asthma, arrhythmias, increased intracranial pressure, hyperthyroidism, pheochromocytoma, metabolic disorders
• concurrent use of mechanical ventilation
• pregnant or breastfeeding patients.

Administration

• Ensure adequate airway and oxygenation before administering.
• Give I.V. slowly to avoid hemolysis.
• Know that doxapram is compatible with 5% and 10% dextrose in water and with normal saline solution.

Don't mix with thiopental sodium, bicarbonate, or aminophylline, because precipitates or gas may form.

Adverse reactions

CNS: weakness, dizziness, drowsiness, headache, dysarthria, dysphonia, disorientation, hyperactivity, paresthesia, loss of consciousness,seizures

CV: hypotension, bradycardia, chest pain or tightness, heart rate changes, thrombophlebitis, atrioventricular block, arrhythmias, cardiac arrest

EENT: lacrimation, diplopia, miosis, conjunctival hyperemia, sneezing, laryngospasm

GI: nausea, vomiting, diarrhea, abdominal cramps, increased salivation, dysphagia

GU: urinary frequency or incontinence, albuminuria

Musculoskeletal: muscle cramps, fasciculations

Respiratory: dyspnea, increased secretions, cough, hyperventilation, tachypnea, rebound hypoventilation bronchospasm

Skin: rash, diaphoresis, flushing

Other: burning or hot sensation in genitalia and perineal areas, hiccups

Interactions

Drug-drug.General anesthetics: increased risk of self-limiting arrhythmias

MAO inhibitors, sympathomimetics: potentiation of adverse cardiovascular effects

Skeletal muscle relaxants: masking of residual effects of these drugs

Drug-diagnostic tests.Blood urea nitrogen: increased level

Erythrocytes, hematocrit, hemoglobin, red blood cells, white blood cells: decreased levels

Patient monitoring

• Assess blood pressure, pulse, deep tendon reflexes, airway, and arterial blood gas values before starting therapy and frequently during infusion.
• Monitor I.V. site frequently for irritation and thrombophlebitis.

Discontinue infusion immediately if hypotension or dyspnea suddenly develops.

Patient teaching

• Instruct patient to report adverse reactions promptly.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

doxapram

(dox-a-pram) ,

Dopram

(trade name)

Classification

Therapeutic: central nervous system stimulants
Pregnancy Category: B

Indications

Used in carefully selected short-term situations with other supportive measures to treat postoperative patients with respiratory depression secondary to anesthesia.Prevention of acute hypercapnea during administration of oxygen to patients with acute respiratory insufficiency due to COPD (short-term only—less than 2 hr).Treatment of mild-to-moderate respiratory and CNS depression due to drug overdosage.

Action

In low doses, stimulates breathing by activating carotid receptors.
Larger doses directly stimulate the respiratory center in medulla as well as produce generalized CNS stimulation.

Therapeutic effects

Transient increase in tidal volume, small increase in respiratory rate. Oxygenation is not increased.

Pharmacokinetics

Absorption: Administered IV only; results in complete bioavailability.
Distribution: Unknown.
Metabolism and Excretion: Rapidly metabolized; metabolites mostly excreted by the kidneys.
Half-life: 2.4–4 hr.

Time/action profile (increases in minute volume)

ROUTEONSETPEAKDURATION
IV20–40 sec1–2 min5–12 min

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Patients on mechanical ventilation; Head trauma; Seizures; Flail chest; Pulmonary embolism; Pneumothorax; Pulmonary fibrosis; Acute asthma; Extreme dyspnea; Cardiovascular or cerebrovascular disease; Pediatric: Newborns (contains benzyl alcohol).
Use Cautiously in: Patients with a history of asthma or arrhythmias; Hyperthyroidism; Pheochromocytoma; Serious uncorrected metabolic disorders; Hepatic or renal impairment; Obstetric / Lactation / Pediatric: Pregnancy, lactation, or children <12 yr (safety not established).

Adverse Reactions/Side Effects

Central nervous system

  • seizures (life-threatening)
  • apprehension
  • disorientation
  • dizziness
  • headache

Ear, Eye, Nose, Throat

  • gagging
  • mydriasis

Respiratory

  • laryngospasm (life-threatening)
  • bronchospasm
  • cough
  • dyspnea
  • hiccups
  • rebound hypoventilation
  • tachypnea

Cardiovascular

  • arrhythmias
  • changes in heart rate
  • chest pain
  • hypertension
  • T-wave inversion

Gastrointestinal

  • diarrhea
  • nausea
  • vomiting

Genitourinary

  • albuminuria
  • perineal/genital burning sensation
  • spontaneous voiding
  • urinary retention

Dermatologic

  • flushing
  • pruritus
  • sweating

Hematologic

  • hemolysis

Local

  • phlebitis

Musculoskeletal

  • involuntary movement
  • muscle spasticity
  • skeletal muscle hyperactivity

Neurologic

  • generalized clonus
  • paresthesia
  • positive bilateral Babinski’s sign

Miscellaneous

  • fever

Interactions

Drug-Drug interaction

Pressor effects may be ↑ by concurrent use of adrenergic amines (sympathomimetics) or MAO inhibitors.May mask residual effects of skeletal muscle relaxants. Initial release of epinephrine caused by doxapram may cause adverse reactions when given concurrently with anesthetics known to sensitize the myocardium to the effects of cathecholamines (wait 10 minutes following discontinuation of anthesthetic to administer doxapram).Concurrent use with aminophylline or theophylline may worsen skeletal muscle hyperactivity.

Route/Dosage

Respiratory Depression following Anesthesia
Intravenous (Adults) Intermittent injection–0.5–1 mg/kg (not to exceed 1.5 mg/kg) initially; may repeat every 5 min to a total of 2 mg/kg. Infusion—Initiate at 5 mg/min until response is obtained; then decrease infusion rate to 1–3 mg/min (total dose by infusion method should not exceed 4 mg/kg).
Drug-Induced CNS Depression
Intravenous (Adults) Intermittent injection– Give priming dose of 1–2 mg/kg; repeat in 5 min. May repeat at 1–2–hr intervals until sustained consciousness or total of 3 g/24 hr given. Infusion—Give priming dose of 1–2 mg/kg by direct injection; repeat in 5 min. If no response, continue supportive measures for 1–2 hr and repeat priming dose. If some respiratory stimulation occurs, initiate infusion at 1–3 mg/min. Discontinue infusion if patient begins to awaken or after 2 hr. Infusion may be restarted (along with priming dose) after rest interval of 30–120 min. Do not exceed 3 g/24 hr.
Acute Hypercapnea Secondary to COPD
Intravenous (Adults) Infusion– 1–2 mg/min (up to 3 mg/min). Should not be used for more than 2 hr.

Availability

Injection: 20 mg/mL

Nursing implications

Nursing assessment

  • Because of narrow margin of safety and indications for use, patient must be monitored constantly when receiving doxapram and until patient is fully alert for 30–60 min.
  • Monitor respiratory status (rate and depth of respirations) and ABGs. Ensure that patient has patent airway and is adequately oxygenated. Relapse of respiratory depression may occur if CNS depressant has long duration of action. Position patient on side, with head of bed elevated to encourage maximal chest expansion and to prevent aspiration.
  • Monitor neurologic status (level of consciousness and deep tendon reflexes). Notify health care professional if reflexes become hyperactive or if spasticity occurs.
  • Monitor vital signs, ECG, and hemodynamic parameters. May cause tachycardia, hypertension, increased cardiac output, or increased pulmonary artery pressure. Report significant change in hemodynamic parameters, arrhythmias, or chest pain. Patients with COPD may be at increased risk for arrhythmias because of hypoxia. Discontinue infusion if sudden hypotension, dyspnea, or arrhythmia occur.
  • Inspect infusion site. May cause thrombophlebitis (erythema, swelling, and pain or skin irritation).
  • Lab Test Considerations: Monitor ABGs prior to and every 30 min during therapy. Notify health care professional immediately if ABGs deteriorate. May order cessation of drug, intubation, and mechanical ventilation.
    • Monitor hemoglobin, hematocrit, and leukocyte count. Rapid infusion may cause hemolysis.
    • May cause ↑ BUN and proteinuria.
  • Toxicity is manifested by severe hypertension, tachycardia, and hyperactive reflexes or seizures. Infusion should be stopped immediately. Seizures may be controlled with diazepam or a short-acting barbiturate. Resuscitative equipment should be available at all times.

Potential Nursing Diagnoses

Ineffective breathing pattern (Indications)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Intravenous Administration
  • Diluent: Administer undiluted. Administer over 5 min.
  • Intermittent Infusion: Diluent: For patients with respiratory depression, following anesthesia or drug-induced CNS depression, dilute 250 mg in 250 mL of D5W, D10W, or 0.9% NaCl. Concentration: Concentration will be 1 mg/mL.
    • Diluent: For patients with acute hypercapnea secondary to COPD, dilute 400 mg in 180 mL of D5W, D10W, or 0.9% NaCl. Concentration: 2 mg/mL.
  • Rate: Doses vary with patient's condition (see Route and Dosage section).
    • Administer via infusion pump to ensure accurate dosage.
  • Y-Site Compatibility: ampicillin, caffiene citrate, caclium chloride, calcium gluconate, cefazolin, ceftazidime, erythromycin, fentanyl, gentamicin, heparin, insulin, metoclopramide, metronidazole, oxacillin, phenobarbital, ranitidine, vancomycin
  • Y-Site Incompatibility: clindamycin

Patient/Family Teaching

  • Instruct patient to notify health care professional immediately if shortness of breath worsens.

Evaluation/Desired Outcomes

  • Treatment of postoperative respiratory depression not associated with skeletal muscle relaxants.
  • Treatment of respiratory and CNS depression due to drug overdosage.
  • Prevention of acute respiratory insufficiency in patients with COPD. Doxapram is not used often because of its narrow margin of safety.

Dopram

A brand name for DOXAPRAM.
References in periodicals archive ?
Once a sea lion was immobilized, intramuscular injection of 3-10 cc of Dopram was administered to stimulate respiration and facilitate recovery.