doxapram (Rx)

Brand and Other Names:Dopram
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 20mg/mL
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COPD Associated with Acute Hypercapnia

1-2 mg/min IV infusion; not to exceed 3 mg/min or 2 hours; monitor arterial blood gases prior to initiation of infusion and at 30 min interval during the infusion to identify possible development of acidosis/CO2 retention

Respiratory Depression Postanesthesia

0.5-1 mg/kg IV injection; repeat at 5-min intervals in patients that show an initial response; not to exceed 2 mg/kg OR 

Initial: 5 mg/min IV infusion (with 1 mg/mL solution) until adequate response or adverse effects occur; may reduce to 1-3 mg/min; total IV infusion not to exceed 4 mg/kg

Drug-Induced CNS Depression

Intermittent injection: 1-2 mg/kg IV injection priming dose, repeat in 1-2 hr priming dose; not to exceed 3 g/day; may repeat in 24 hr if necessary OR 

IV infusion: 1-2 mg/kg IV injection, repeat in 5 min, if no response, wait 1-2 hr and repeat priming dose; if some stimulation noted, initiate infusion at 1-3 mg/min IV infusion not to exceed 2 hours; suspend infusion if patient begins to awaken; may repeat after a rest of 30-120 minutes, total dose not to exceed 3 g/day

Dosage Forms & Strengths

injectable solution

  • 20mg/mL
more...

<12 years

Safety & efficacy not established

>12 years

COPD Associated with Acute Hypercapnia

  • 1-2 mg/min IV infusion; not to exceed 3 mg/min or 2 hours; monitor arterial blood gases prior to initiation of infusion and at 30 min interval during the infusion to identify possible development of acidosis/CO2 retention

Respiratory Depression Postanesthesia

  • 0.5-1 mg/kg IV injection; repeat at 5-min intervals in patients that show an initial response; not to exceed 2 mg/kg OR 
  • IV infusion: 1-2 mg/kg IV injection, repeat in 5 min, if no response, wait 1-2 hr and repeat priming dose; if some stimulation noted, initiate infusion at 1-3 mg/min IV infusion not to exceed 2 hours; suspend infusion if patient begins to awaken; may repeat after a rest of 30-120 minutes, total dose not to exceed 3 g/day

Drug-Induced CNS Depression

  • Intermittent injection: 1-2 mg/kg IV injection priming dose, repeat  in 1-2 hr priming dose; not to exceed 3 g/day; may repeat in 24 hr if necessary OR 
  • IV infusion: 1-2 mg/kg IV injection, repeat in 5 min, if no response, wait 1-2 hr and repeat priming dose; if some stimulation noted, initiate infusion at 1-3 mg/min IV infusion not to exceed 2 hours; suspend infusion if patient begins to awaken; may repeat after a rest of 30-120 minutes, total dose not to exceed 3 g/day
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Interactions

Interaction Checker

and doxapram

No Results

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Pyrexia

            Flushing

            Sweating

            Pruritus & paresthesia, burning/hot sensation especially in genitalia & perineum

            Disorientation

            Pupillary dilatation

            Hallucinations

            Involuntary movements

            Muscle spasticity, muscle fasciculations, increased deep tendon reflexes, clonus, bilateral Babinski, convulsions

            Dyspnea

            Cough

            Hyperventilation/ rebound hypoventilation

            Tachypnea

            Laryngospasm

            Bronchospasm

            Hiccough

            Phlebitis

            Variations in heart rate

            Lowered T-waves, arrhythmias

            Chest pain, tightness in chest

            Increase in blood pressure

            Stimulation of urinary bladder with spontaneous voiding, urinary retention

            Elevation of BUN, albuminuria

            Hemolysis (with rapid infusion)

            Decrease in Hgb, Hct, or RBC count

            Decrease in WBC (pts with leukopenia)

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            Warnings

            Contraindications

            Hypersensitivity

            Epilepsy, convulsive disorder

            Existing/suspected pulmonary embolism

            Mechanical obstruction, muscle paresis, flail chest, pneumothorax, acute bronchial asthma, pulmonary fibrosis

            Head injury, CVA, cerebral edema

            Disorders of ventilation including mechanical obstruction, neuromuscular blockade, muscle paresis

            Cerebral vascular accident, head injury

            Significant cardiovascular impairment, uncompensated heart failure, severe coronary artery disease, severe HTN including hypertension associated with hyperthyroidism or pheochromocytoma)

            Cautions

            Narrow margin of safety

            Do not use concurrently with mechanical ventilation

            Contains benzyl alcohol (associated with potentially fatal "Gasping Syndrome" in neonates)

            Avoid using same injection site over long period of time & avoid rapid infusion

            Concurrency with sympathomimetic or MAOIs

            Hepatic/renal impairment

            May cause severe CNS stimulation resulting in seizures; anticonvulsants should be available

            May cause dysrhythmias; monitor

            If sudden hypotension develops discontinue therapy

            Use caution in patients with cerebrovascular disease

            Use caution in hepatic and renal impairment

            Use caution when used concurrently with MAO inhibitors, volatile anesthetics, or sympathomimetics

            Avoid extravasation

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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: Excretion in milk unknown; use with caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Produces respiratory stimulation in medulla (which propagates stimulation to other parts of brain & spinal cord) through peripheral carotid chemoreceptors

            Pharmacokinetics

            Onset: 20-40 sec

            Duration: 5-12 min (single IV injection)

            Peak Plasma Time: 1-2 min

            Half-life: 3.4 hr (2.4-4.1 hr)

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            Administration

            IV Incompatibilities

            Additive: aminophylline, thiopental, sodium bicarbonate, furosemide, minocycline, ticarcillin

            Syringe: aminophylline, ascorbic acid, cefoperazone, cefotaxime, cefotetan, cefuroxime, dexamethasone sodium phosphate, diazepam, folic acid, furosemide, hydrocortisone sodium succinate, methylprednisolone sodium succinate, minocycline, thiopental, ticarcillin

            Y-site: clindamycin

            IV Preparation

            Add 250 mg doxapram to 250 mL D5W, D10W or NS to obtain a 1 mg/mL soln

            For COPD: add 400 mg doxapram to 180 mL D5W, D10W or NS to a final concentration of 2 mg/mL

            IV Administration

            COPD

            • Initial infusion at 1-2 mg/min; may incr to NMT 3 mg/min
            • No more than 2 hr
            • ABG should be determined before administering doxapram & q30min during 2 hr of infusion
            • Discontinue if ABG show evidence of deterioration

            Anesthesia

            • If infusing, use 1 mg/mL at an initial rate of 5 mg/min
            • When the desired response is obtained or if adverse effects appear, may be reduce to 1-3 mg/min
            • Do not increase infusion rate in debilitated patients in an attempt to lower pCO2 because of associated increased work in breathing

            CNS Depression

            • If infusing, infuse at 1-3 mg/min until patient begins to awaken, but NMT 2 hr
            • May repeat after a 30 min-2 hr rest period, provided max daily dose of 3 g has not been exceeded

            Storage

            Store at 20-25°C

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            Images

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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