• 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.

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
• Pedi: 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
• OB: Lactation: Pedi: Pregnancy, lactation, or children <12 yr (safety not established).

CNS: SEIZURES, apprehension, disorientation, dizziness, headache.

EENT: gagging, mydriasis.

Resp: LARYNGOSPASM, bronchospasm, cough, dyspnea, hiccups, rebound hypoventilation, tachypnea.

CV: arrhythmias, changes in heart rate, chest pain, hypertension, T-wave inversion.

GI: diarrhea, nausea, vomiting.

GU: albuminuria, perineal/genital burning sensation, spontaneous voiding, urinary retention.

Derm: flushing, pruritus, sweating.

Hemat: hemolysis.

Local: phlebitis.

MS: involuntary movement, muscle spasticity, skeletal muscle hyperactivity.

Neuro: generalized clonus, paresthesia, positive bilateral Babinski’s sign.
Misc: fever.

Drug-Drug:

• 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.

• Injection: 20 mg/mL;

Respiratory Depression following Anesthesia

• IV (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

• IV (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

• IV (Adults): Infusion– 1–2 mg/min (up to 3 mg/min). Should not be used for more than 2 hr.

Dopram

• 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.

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

Therapeutic Classification: central nervous system stimulants

Absorption: Administered IV only; results in complete bioavailability.

Distribution: Unknown.

Metabolism/Excretion: Rapidly metabolized; metabolites mostly excreted by the kidneys.

Half-life: 2.4–4 hr.

(increases in minute volume)

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

DOX-a-pram