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Pharmacologic class: CNS and respiratory stimulant
Therapeutic class: Analeptic
Pregnancy risk category B
Activates peripheral carotid, aortic, and other chemoreceptors to stimulate respiration. Increases tidal volume and respiratory rate by directly stimulating respiratory center in medulla oblongata.
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.
• Laryngospasm secondary to postoperative tracheal extubation
• Apnea of prematurity
• Postoperative shivering
• Hypersensitivity to drug
• Cardiovascular disorders, severe hypertension
• Cerebrovascular accident
• Head injury, seizures
• Respiratory failure, restrictive respiratory disease
Use cautiously in:
• bronchial asthma, arrhythmias, increased intracranial pressure, hyperthyroidism, pheochromocytoma, metabolic disorders
• concurrent use of mechanical ventilation
• pregnant or breastfeeding patients.
• 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.
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
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
• 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.
• 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.
ClassificationTherapeutic: central nervous system stimulants
Time/action profile (increases in minute volume)
|IV||20–40 sec||1–2 min||5–12 min|
Adverse Reactions/Side Effects
Central nervous system
- seizures (life-threatening)
Ear, Eye, Nose, Throat
- laryngospasm (life-threatening)
- rebound hypoventilation
- changes in heart rate
- chest pain
- T-wave inversion
- perineal/genital burning sensation
- spontaneous voiding
- urinary retention
- involuntary movement
- muscle spasticity
- skeletal muscle hyperactivity
- generalized clonus
- positive bilateral Babinski’s sign
Drug-Drug interactionPressor 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/DosageRespiratory Depression following Anesthesia
- 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.
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.
- May cause ↑ BUN and proteinuria.
Potential Nursing DiagnosesIneffective breathing pattern (Indications)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
- 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
- Instruct patient to notify health care professional immediately if shortness of breath worsens.
- 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.