Drug Detail:Doxapram (monograph) (Dopram)
Drug Class:
Usual Adult Dose for Respiratory Depression
Postanesthesia Respiratory Depression or Apnea:
IV Injection:
- Recommended Dose: 0.5 to 1 mg/kg for a single injection and for repeat injections at 5-minute intervals.
- Maximum Dose Per Injection: 1.5 mg/kg
- Maximum Total Dose: 2 mg/kg; not to exceed 3 grams in 24 hours.
IV Infusion:
- Initial Dose: 0.5 to 1 mg/kg at a rate of approximately 5 mg/minute until a satisfactory respiratory response is observed.
- Maintenance Dose: 0.5 to 1 mg/kg at a rate of 1 to 3 mg/minute.
- Maximum Total Dose: 4 mg/kg; not to exceed 3 grams in 24 hours.
Drug Overdosage Respiratory or CNS Depression:
IV Injection:
Initial Dose:
- Administer dose (1 mg/kg in patients with mild depression; 2 mg/kg in patients with moderate depression) and then repeat in 5 minutes.
- Repeat the same dose every 1 to 2 hours until the patient awakens.
Maintenance Dose:
- If the patient relapses into unconsciousness or respiratory depression develops, resume injections every 1 to 2 hours until arousal is sustained or the total maximum daily dose is given.
- After the total maximum daily dose is reached, allow the patient to sleep until 24 hours have elapsed from the first injection; use assisted or automatic respiration if necessary.
- Repeat the procedure the following day until the patient breathes spontaneously and sustains a desired level of consciousness or until the total maximum daily dose is reached.
Intermittent IV Infusion:
Initial Dose:
- Administer dose (1 to 2 mg/kg/hr in patients with mild depression; 2 to 3 mg/kg/hr in patients with moderate depression) and then repeat in 5 minutes.
- Repeat same dose every 1 to 2 hours until the patient awakens.
Maintenance Dose:
- If the patient shows some respiratory stimulation, administer 1 to 3 mg/minute according to patient size and coma depth.
- If the patient shows no response, repeat the initial dose and continue general supportive treatment for 1 to 2 hours.
- If the patient begins to waken or at the end of 2 hours, discontinue this drug.
- Continue supportive treatment for 30 minutes to 2 hours and then repeat the maintenance dose.
- Maximum Total Dose for IV Injection and IV Infusion: 3 grams in 24 hours.
Comments:
- Adjust the infusion rate to sustain the desired level of respiratory stimulation with a minimum of side effects.
- Consult the manufacturer product information for instructions on creating the infusion solution.
- Administer repetitive IV injection doses only if the patient has shown response to the initial dose.
- If the patient fails to respond appropriately, conduct a neurologic evaluation for a possible CNS source of sustained coma.
Uses: Stimulate respiration in patients with drug-induced postanesthesia respiratory depression or apnea other than that due to muscle relaxant drugs, and stimulate deep breathing in the postoperative patient; stimulate respiration, hasten arousal, and encourage the return of laryngopharyngeal reflexes in patients with mild to moderate respiratory and CNS depression due to drug overdosage.
Usual Adult Dose for Chronic Obstructive Pulmonary Disease
- Initial Dose: 1 to 2 mg/minute IV infusion
- Maximum Dose: 3 mg/minute IV infusion
- Maximum Single Administration Period: 2 hours; additional infusions beyond this period are not recommended.
Comments:
- Consult the manufacturer product information on instructions for mixing this drug to create the infusion solution.
- Determine arterial blood gases prior to the onset of drug administration and at least every 30 minutes during the infusion period to insure against the development of carbon dioxide-retention and acidosis.
- May need to adjust the infusion rate due to alterations of oxygen concentration or flow rate.
Use: Short-term aid in the prevention of elevation of arterial carbon dioxide tension during oxygen administration for hospitalized patients with acute respiratory insufficiency superimposed on COPD.
Usual Pediatric Dose for Respiratory Depression
Age 12 Years and Older:
Postanesthesia Respiratory Depression or Apnea:
IV Injection:
- Recommended Dose: 0.5 to 1 mg/kg for a single injection and for repeat injections at 5-minute intervals.
- Maximum Dose Per Injection: 1.5 mg/kg
- Maximum Total Dose: 2 mg/kg; not to exceed 3 grams in 24 hours.
IV Infusion:
- Initial Dose: 0.5 to 1 mg/kg at a rate of approximately 5 mg/minute until a satisfactory respiratory response is observed.
- Maintenance Dose: 0.5 to 1 mg/kg at a rate of 1 to 3 mg/minute.
- Maximum Total Dose: 4 mg/kg; not to exceed 3 grams in 24 hours.
Drug Overdosage Respiratory or CNS Depression:
IV Injection:
Initial Dose:
- Administer dose (1 mg/kg in patients with mild depression; 2 mg/kg in patients with moderate depression) and then repeat in 5 minutes.
- Repeat the same dose every 1 to 2 hours until the patient awakens.
Maintenance Dose:
- If the patient relapses into unconsciousness or respiratory depression develops, resume injections every 1 to 2 hours until arousal is sustained or the total maximum daily dose is given.
- After the total maximum daily dose is reached, allow the patient to sleep until 24 hours have elapsed from the first injection; use assisted or automatic respiration if necessary.
- Repeat the procedure the following day until the patient breathes spontaneously and sustains a desired level of consciousness or until the total maximum daily dose is reached.
Intermittent IV Infusion:
Initial Dose:
- Administer dose (1 to 2 mg/kg/hr in patients with mild depression; 2 to 3 mg/kg/hr in patients with moderate depression) and then repeat in 5 minutes.
- Repeat same dose every 1 to 2 hours until the patient awakens.
Maintenance Dose:
- If the patient shows some respiratory stimulation, administer 1 to 3 mg/minute according to patient size and coma depth.
- If the patient shows no response, repeat the initial dose and continue general supportive treatment for 1 to 2 hours.
- If the patient begins to waken or at the end of 2 hours, discontinue this drug.
- Continue supportive treatment for 30 minutes to 2 hours and then repeat the maintenance dose.
- Maximum Total Dose for IV Injection and IV Infusion: 3 grams in 24 hours.
Comments:
- Adjust the infusion rate to sustain the desired level of respiratory stimulation with a minimum of side effects.
- Consult the manufacturer product information for instructions on creating the infusion solution.
- Administer repetitive IV injection doses only if the patient has shown response to the initial dose.
- If the patient fails to respond appropriately, conduct a neurologic evaluation for a possible CNS source of sustained coma.
Uses: Stimulate respiration in patients with drug-induced postanesthesia respiratory depression or apnea other than that due to muscle relaxant drugs, and stimulate deep breathing in the postoperative patient; stimulate respiration, hasten arousal, and encourage the return of laryngopharyngeal reflexes in patients with mild to moderate respiratory and CNS depression due to drug overdosage.
Usual Pediatric Dose for Chronic Obstructive Pulmonary Disease
Age 12 Years and Older:
- Initial Dose: 1 to 2 mg/minute IV infusion
- Maximum Dose: 3 mg/minute IV infusion
- Maximum Single Administration Period: 2 hours; additional infusions beyond this period are not recommended.
Comments:
- Consult the manufacturer product information on instructions for mixing this drug to create the infusion solution.
- Determine arterial blood gases prior to the onset of drug administration and at least every 30 minutes during the infusion period to insure against the development of carbon dioxide-retention and acidosis.
- May need to adjust the infusion rate due to alterations of oxygen concentration or flow rate.
Use: Short-term aid in the prevention of elevation of arterial carbon dioxide tension during oxygen administration for hospitalized patients with acute respiratory insufficiency superimposed on COPD.
Renal Dose Adjustments
Significantly Impaired Renal Function: Use with caution as there is a possibility of an altered response due to the reduced metabolism rate/metabolite excretion in this population.
Liver Dose Adjustments
Significantly Impaired Hepatic Function: Use with caution as there is a possibility of an altered response due to the reduced metabolism rate/metabolite excretion in this population.
Dose Adjustments
- If Sudden Hypotension or Dyspnea Develops: Stop this drug.
- If Arterial Blood Gases Deteriorate: Stop this drug and initiate mechanical ventilation.
Precautions
Safety and efficacy have not been established in patients younger than 12 years.
Consult WARNINGS section for additional precautions.
Dialysis
Data not available.
Other Comments
Administration Advice:
- An adequate airway is essential; consider airway protection as this drug may stimulate vomiting.
- Administer this drug concurrently with oxygen to patients with severe irreversible airway obstruction or severely decreased lung compliance; assess oxygenation using a quantitative method such as pulse oximetry.
- In patients presenting with bronchoconstriction, consider administering this drug in conjunction with beta-adrenoceptor bronchodilator agents.
- Avoid vascular extravasation and the use of a single injection site over an extended period.
- Use the minimum effective dosage to avoid side effects.
IV Compatibility and Incompatibility:
- Consult the manufacturer product information.
General:
- Mild drug-induced respiratory or CNS depression consists of Class 0 and 1. Class 0 is asleep, but can be aroused and can answer questions; Class 1 is comatose, will withdraw from painful stimuli, reflexes intact.
- Moderate drug-induced respiratory or CNS depression consists of Class 2 and 3. Class 2 is comatose, will not withdraw from painful stimuli, reflexes intact; Class 3 is comatose, reflexes absent, no depression of circulation or respiration.
- Overdosage: There is no specific antidote for this drug; it is unlikely dialysis would be helpful.
Monitoring:
- Peripheral nerve stimulation, airway pressures, head lift, pulse oximetry, and end-tidal carbon dioxide (before treatment initiation)
- Cardiac rhythm disturbances (during treatment)
- Blood pressure, pulse rate, deep tendon reflexes (during treatment)
