doxapram hydrochloride

doxapram hydrochloride

[dok′səpram]

a respiratory stimulant.

indications It is prescribed to improve respiratory function after anesthesia, in drug-induced central nervous system depression, and for chronic pulmonary disease associated with acute hypercapnia.

contraindications Seizure disorder, pulmonary disease, coronary artery disease, uncompensated heart failure, hypertension, or known hypersensitivity to this drug prohibits its use.

adverse effects Among the more serious adverse reactions are convulsions, bronchospasm, cardiovascular symptoms, and phlebitis.

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doxapram hydrochloride

a respiratory stimulant which acts upon peripheral chemoreceptors. It is commonly used to reverse sedation induced by xylazine, although the antagonism is not specific.

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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

Contraindications

• Hypersensitivity to drug
• Cardiovascular disorders
• 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
• 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.

Route	Onset	Peak	Duration
I.V.	20-40 sec	1-2 min	5-12 min

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, respiratory muscle paralysis, central respiratory paralysis, bronchospasm, respiratory depression, respiratory arrest

Skin: rash, diaphoresis, flushing

Other: burning or hot sensation in genitalia and perineal areas

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.