Doxapram

Doxapram
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alberto Plate [2]

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Overview

Doxapram is a respiratory stimulant that is FDA approved for the treatment of Postanesthesia, Drug-Induced Central Nervous System Depression and Chronic Pulmonary Disease Associated with Acute Hypercapnia. Common adverse reactions include {{{adverseReactions}}}.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

There is limited information regarding Doxapram FDA-Labeled Indications and Dosage (Adult) in the drug label.

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Doxapram in adult patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Doxapram in adult patients.

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

There is limited information regarding Doxapram FDA-Labeled Indications and Dosage (Pediatric) in the drug label.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Doxapram in pediatric patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Doxapram in pediatric patients.

Contraindications

• Doxapram is contraindicated in patients with known hypersensitivity to the drug or any of the injection components.
• Doxapram should not be used in patients with epilepsy or other convulsive disorders.
• Doxapram is contraindicated in patients with proven or suspected pulmonary embolism.
• Doxapram is contraindicated in patients with mechanical disorders of ventilation such as mechanical obstruction, muscle paresis (including neuromuscular blockade), flail chest, pneumothorax, acute bronchial asthma, pulmonary fibrosis, or other conditions resulting in restriction of the chest wall, muscles of respiration, or alveolar expansion.
• Doxapram is contraindicated in patients with evidence of head injury, cerebral vascular accident, or cerebral edema, and in those with significant cardiovascular impairment, uncompensated heart failure, severe coronary artery disease, or severe hypertension, including that associated with hyperthyroidism or pheochromocytoma.

Warnings

Doxapram should not be used in conjunction with mechanical ventilation. Exposure to excessive amounts of benzyl alcohol has been associated with toxicity (hypotension, metabolic acidosis), particularly in neonates, and an increased incidence of kernicterus, particularly in small preterm infants. There have been rare reports of deaths, primarily in preterm infants, associated with exposure to excessive amounts of benzyl alcohol. The amount of benzyl alcohol from medications is usually considered negligible compared to that received in flush solutions containing benzyl alcohol. Administration of high dosages of medications containing this preservative must take into account the total amount of benzyl alcohol administered. The amount of benzyl alcohol at which toxicity may occur is not known. If the patient requires more than the recommended dosages or other medications containing this preservative, the practitioner must consider the daily metabolic load of benzyl alcohol from these combined sources (see PRECAUTIONS, PEDIATRIC USE).

In Postanesthetic Use

Doxapram is neither an antagonist to muscle relaxant drugs nor a specific narcotic antagonist. More specific tests (eg, peripheral nerve stimulation, airway pressures, head lift, pulse oximetry, and end-tidal carbon dioxide) to assess adequacy of ventilation are recommended before administering doxapram. Doxapram should be administered with great care and only under careful supervision to patients with hypermetabolic states such as hyperthyroidism or pheochromocytoma. Since narcosis may recur after stimulation with doxapram, care should be taken to maintain close observation until the patient has been fully alert for ½ to 1 hour. In patients who have received general anesthesia utilizing a volatile agent known to sensitize the myocardium to catecholamines, administration of doxapram should be delayed until the volatile agent has been excreted in order to lessen the potential for arrhythmias, including ventricular tachycardia and ventricular fibrillation.

In Drug-Induced CNS and Respiratory Depression

Doxapram alone may not stimulate adequate spontaneous breathing or provide sufficient arousal in patients who are severely depressed either due to respiratory failure or to CNS depressant drugs, but may be used as an adjunct to established supportive measures and resuscitative techniques.

In Chronic Obstructive Pulmonary Disease

Because of the associated increased work of breathing, do not increase the rate of infusion of doxapram in severely ill patients in an attempt to lower pCO2.

Adverse Reactions

Clinical Trials Experience

There is limited information regarding Doxapram Clinical Trials Experience in the drug label.

Postmarketing Experience

There is limited information regarding Doxapram Postmarketing Experience in the drug label.

Drug Interactions

There is limited information regarding Doxapram Drug Interactions in the drug label.

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): There is no FDA guidance on usage of Doxapram in women who are pregnant.
Pregnancy Category (AUS): There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Doxapram in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Doxapram during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Doxapram in women who are nursing.

Pediatric Use

There is no FDA guidance on the use of Doxapram in pediatric settings.

Geriatic Use

There is no FDA guidance on the use of Doxapram in geriatric settings.

Gender

There is no FDA guidance on the use of Doxapram with respect to specific gender populations.

Race

There is no FDA guidance on the use of Doxapram with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Doxapram in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Doxapram in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Doxapram in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Doxapram in patients who are immunocompromised.

Administration and Monitoring

Administration

There is limited information regarding Doxapram Administration in the drug label.

Monitoring

There is limited information regarding Doxapram Monitoring in the drug label.

IV Compatibility

There is limited information regarding the compatibility of Doxapram and IV administrations.

Overdosage

There is limited information regarding Doxapram overdosage. If you suspect drug poisoning or overdose, please contact the National Poison Help hotline (1-800-222-1222) immediately.

Pharmacology

There is limited information regarding Doxapram Pharmacology in the drug label.

Mechanism of Action

There is limited information regarding Doxapram Mechanism of Action in the drug label.

Structure

There is limited information regarding Doxapram Structure in the drug label.

Pharmacodynamics

There is limited information regarding Doxapram Pharmacodynamics in the drug label.

Pharmacokinetics

There is limited information regarding Doxapram Pharmacokinetics in the drug label.

Nonclinical Toxicology

There is limited information regarding Doxapram Nonclinical Toxicology in the drug label.

Clinical Studies

There is limited information regarding Doxapram Clinical Studies in the drug label.

How Supplied

There is limited information regarding Doxapram How Supplied in the drug label.

Storage

There is limited information regarding Doxapram Storage in the drug label.

Images

Drug Images

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Package and Label Display Panel

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Patient Counseling Information

There is limited information regarding Doxapram Patient Counseling Information in the drug label.

Precautions with Alcohol

Alcohol-Doxapram interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

There is limited information regarding Doxapram Brand Names in the drug label.

Look-Alike Drug Names

There is limited information regarding Doxapram Look-Alike Drug Names in the drug label.

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

Doxapram

Clinical data
Routes of administration	Intravenous
ATC code	R07AB01 (WHO)
Identifiers
IUPAC name 1-ethyl-4- (2-morpholin-4-ylethyl)- 3,3-diphenyl-pyrrolidin-2-one
CAS Number	309-29-5
PubChem CID	3156
DrugBank	APRD00935
E number	{{#property:P628}}
ECHA InfoCard	{{#property:P2566}}
Chemical and physical data
Formula	C24H30N2O2
Molar mass	378.507 g/mol

Doxapram hydrochloride (marketed as Dopram®) is a respiratory stimulant. Administered intravenously, doxapram stimulates the respiratory rate, leading to an increase in tidal volume.

Mode of action

Doxapram stimulates chemoreceptors in the carotid arteries, which in turn, stimulates the respiratory centre in the brain stem.

Presentation

Doxapram is a white to off-white, odorless, crystalline powder that is stable in light and air. It is soluble in water, sparingly soluble in alcohol and practically insoluble in ether. Injectable products have a pH from 3.5-5. Benzyl alcohol or chlorobutanol is added as a preservative agent in the commercially available injections.

Uses

Doxapram is used in intensive care settings to stimulate the respiratory rate in patients with respiratory failure.

It is equally effective as pethidine in suppressing shivering after surgery.

Side effects

High blood pressure, panic attacks, tachycardia (rapid heart rate), tremor, sweating and vomiting may occur. Convulsions have been reported. It cannot be used in patients with coronary heart disease, epilepsy and high blood pressure. It is also contraindicated in newborns and small children, mainly due to the presence of benzyl alcohol.