Adult Dosing
Drug-induced postanesthesia respiratory depression or apnea
- Intermittent IV injection
- Start with 0.5-1 mg/kg (Max: 1.5 mg/kg) IV; may repeat at 5-minute intervals
- Max total dose: 2 mg/kg
- IV infusion
- Start with 5 mg/minute IV infusion, until a satisfactory respiratory response is observed; then maintain at a rate of 1-3 mg/minute
- Max total dose: 4 mg/kg
Management of drug-induced CNS depression
- Single or intermittent IV injection
- Start 1-2 mg/kg (mild-moderate CNS depression) IV; repeat in 5 minutes; may repeat same dose q1-2 hrs until patient wakens, or a maximum dose of 3 g/day is reached
- IV infusion
- Priming dose of 1-2 mg/kg (mild-moderate CNS depression) by direct IV injection; repeat in 5 minutes; if no response, continue supportive measures for 1-2 hrs and repeat the priming dose; if respiration improves, start infusion at 1-3 mg/minute (as per the patient's size and the depth of coma)
- Discontinue treatment if patient begins to waken or at the end of 2 hours
- Continue supportive treatment for 30 minutes to 2 hrs interval and infusion may be restarted (along with the priming dose)
- Max: 3 g/day
COPD associated with acute hypercapnia
- IV infusion
- Start the infusion at 1-2 mg/min (max: 3 mg/min); duration of infusion not to exceed 2 hrs
- Monitor arterial blood gases prior to initiation of infusion and at least every half hour during the 2 hrs of infusion to insure against the insidious development of carbon-dioxide retention and acidosis
Pediatric Dosing
- Safety and effectiveness in pediatric patients <12 yrs of age have not been established
>12 yrs
Drug-induced postanesthesia respiratory depression or apnea
- Intermittent IV injection
- Start with 0.5-1 mg/kg (Max: 1.5 mg/kg) IV; may repeat at 5-minute intervals
- Max total dose: 2 mg/kg
- IV infusion
- Start with 5 mg/minute IV infusion, until a satisfactory respiratory response is observed; then maintain at a rate of 1-3 mg/minute
- Max total dose: 4 mg/kg
Management of drug-induced CNS depression
- Single or intermittent IV injection
- Start 1-2 mg/kg (mild-moderate CNS depression) IV; repeat in 5 minutes; may repeat same dose q1-2 hrs until patient wakens, or a maximum dose of 3 g/day is reached
- IV infusion
- Priming dose of 1-2 mg/kg (mild-moderate CNS depression) by direct IV injection; repeat in 5 minutes; if no response, continue supportive measures for 1-2 hrs and repeat the priming dose; if respiration improves, start infusion at 1-3 mg/minute (as per the patient's size and the depth of coma)
- Discontinue treatment if patient begins to waken or at the end of 2 hours
- Continue supportive treatment for 30 minutes to 2 hrs interval and infusion may be restarted (along with the priming dose)
- Max: 3 g/day
COPD associated with acute hypercapnia
- IV infusion
- Start the infusion at 1-2 mg/min (max: 3 mg/min): duration of infusion not to exceed 2 hrs
- Monitor arterial blood gases prior to initiation of infusion and at least every half hour during the 2 hrs of infusion to insure against the insidious development of carbon-dioxide retention and acidosis
- Do not use in conjunction with mechanical ventilation
- Doxapram solution contains benzyl alcohol, exposure to excessive amounts of which is associated with toxicity (hypotension, metabolic acidosis), especially in neonates. An increased incidence of kernicterus and sometimes deaths have been reported in small preterm infants
- Excessive amounts of benzyl alcohol is associated with [gasping syndrome’ (CNS depression, metabolic acidosis, gasping respiration, and high levels of benzyl alcohol and its metabolites in blood and urine) in neonates and low-birth-weight neonates
- Prior to initiation of therapy specific tests, including peripheral nerve stimulation, airway pressures, head lift, pulse oximetry, and end-tidal carbon dioxide, must be done to assess adequacy of ventilation
- Administer with extreme caution and under careful observation to patients with hypermetabolic states including hyperthyroidism or pheochromocytoma
- Since narcosis may recur after stimulation with the drug, consider careful observation until the patient has been fully alert for half to 1 hr
- Delay use in patients who have received volatile general anesthetic agent until it has been excreted in order to decrease the potential for arrhythmias, including ventricular tachycardia and ventricular fibrillation
- In severely depressed patients either due to respiratory failure or to CNS depressant drugs, doxapram may be used as an adjunct to established supportive measures and resuscitative techniques
- Do not increase the rate of infusion of doxapram in severely ill patients in an attempt to lower pCO2 because of the associated increased work of breathing
- Provide an adequate airway and airway protection during therapy as doxapram may stimulate vomiting
- Use minimum effective dose to avoid side effects; monitor blood pressure, pulse rate, and deep tendon reflexes to prevent overdose
- Avoid vascular extravasation or injecting at a single site over an extended period as either may lead to thrombophlebitis or local skin irritation
- Hemolysis may occur during rapid infusion
- Lowered pCO2 induced by hyperventilation produces cerebral vasoconstriction and slowing of cerebral circulation
- In patients with COPD with acute hypercapnia, arterial blood gases should be performed prior to initiation of therapy and during oxygen administration, and then at least every 30 minutes during the infusion period to prevent development of CO2 retention and acidosis
- The need for careful monitoring of the patient or the need for supplemental oxygen in patients with acute respiratory failure is not diminished with the administration of doxapram. Stop doxapram if the arterial blood gases deteriorate and start mechanical ventilation
- Therapy may cause adverse effects such as seizures due to general CNS stimulation; anticonvulsants in addition with oxygen and resuscitative equipment should be readily available to manage overdosage manifested by excessive CNS stimulation
- Monitor cardiac rhythm to determine any cardiovascular effects including dysrhythmias; discontinue therapy if sudden hypotension or dyspnea develops
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Patients receiving sympathomimetics
- Concomitant use of MAO inhibitors
Pregnancy Category:B
Breastfeeding: Safety unknown, manufacturer advises caution.
