doxapram (Rx)

Brand and Other Names:Dopram
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 20mg/mL

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

<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

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     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (34)

              • benzphetamine

                doxapram increases effects of benzphetamine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • desflurane

                doxapram, desflurane. Mechanism: unspecified interaction mechanism. Contraindicated. May result in V tach or V fib. Delay doxapram until anesthesia has been excreted.

              • dexfenfluramine

                doxapram increases effects of dexfenfluramine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • dexmethylphenidate

                doxapram increases effects of dexmethylphenidate by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • dextroamphetamine

                doxapram increases effects of dextroamphetamine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • diethylpropion

                doxapram increases effects of diethylpropion by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • dobutamine

                doxapram increases effects of dobutamine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • dopamine

                doxapram increases effects of dopamine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • ephedrine

                doxapram increases effects of ephedrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • epinephrine

                doxapram increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • etomidate

                doxapram, etomidate. Mechanism: unspecified interaction mechanism. Contraindicated. May result in V tach or V fib. Delay doxapram until anesthesia has been excreted.

              • fenfluramine

                doxapram increases effects of fenfluramine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • isocarboxazid

                doxapram increases effects of isocarboxazid by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • isoproterenol

                doxapram increases effects of isoproterenol by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • ketamine

                doxapram, ketamine. Mechanism: unspecified interaction mechanism. Contraindicated. May result in V tach or V fib. Delay doxapram until anesthesia has been excreted.

              • linezolid

                doxapram increases effects of linezolid by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • lisdexamfetamine

                doxapram increases effects of lisdexamfetamine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • methamphetamine

                doxapram increases effects of methamphetamine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • methylenedioxymethamphetamine

                doxapram increases effects of methylenedioxymethamphetamine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • methylphenidate

                doxapram increases effects of methylphenidate by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • midodrine

                doxapram increases effects of midodrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • norepinephrine

                doxapram increases effects of norepinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • phendimetrazine

                doxapram increases effects of phendimetrazine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • phenelzine

                doxapram increases effects of phenelzine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • phentermine

                doxapram increases effects of phentermine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • phenylephrine

                doxapram increases effects of phenylephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • phenylephrine PO

                doxapram increases effects of phenylephrine PO by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • propofol

                doxapram, propofol. Mechanism: unspecified interaction mechanism. Contraindicated. May result in V tach or V fib. Delay doxapram until anesthesia has been excreted.

              • propylhexedrine

                doxapram increases effects of propylhexedrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • pseudoephedrine

                doxapram increases effects of pseudoephedrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • sevoflurane

                doxapram, sevoflurane. Mechanism: unspecified interaction mechanism. Contraindicated. May result in V tach or V fib. Delay doxapram until anesthesia has been excreted.

              • tranylcypromine

                doxapram increases effects of tranylcypromine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • xylometazoline

                doxapram increases effects of xylometazoline by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              • yohimbine

                doxapram increases effects of yohimbine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive pressor effect.

              Monitor Closely (11)

              • atracurium

                doxapram decreases effects of atracurium by pharmacodynamic antagonism. Use Caution/Monitor.

              • cisatracurium

                doxapram decreases effects of cisatracurium by pharmacodynamic antagonism. Use Caution/Monitor.

              • onabotulinumtoxinA

                doxapram decreases effects of onabotulinumtoxinA by pharmacodynamic antagonism. Use Caution/Monitor.

              • pancuronium

                doxapram decreases effects of pancuronium by pharmacodynamic antagonism. Use Caution/Monitor.

              • procarbazine

                doxapram increases effects of procarbazine by pharmacodynamic synergism. Use Caution/Monitor. Additive pressor effect.

              • rapacuronium

                doxapram decreases effects of rapacuronium by pharmacodynamic antagonism. Use Caution/Monitor.

              • rocuronium

                doxapram decreases effects of rocuronium by pharmacodynamic antagonism. Use Caution/Monitor.

              • solriamfetol

                doxapram and solriamfetol both increase sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor.

              • succinylcholine

                doxapram decreases effects of succinylcholine by pharmacodynamic antagonism. Use Caution/Monitor.

              • theophylline

                doxapram, theophylline. Mechanism: unspecified interaction mechanism. Use Caution/Monitor. Increased skeletal muscle activity, agitation, hyperactivity.

              • vecuronium

                doxapram decreases effects of vecuronium by pharmacodynamic antagonism. Use Caution/Monitor.

              Minor (0)

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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

                BRAND FORM. UNIT PRICE PILL IMAGE
                doxapram intravenous
                -
                20 mg/mL vial
                Dopram intravenous
                -
                20 mg/mL vial
                Dopram intravenous
                -
                20 mg/mL vial

                Copyright © 2010 First DataBank, Inc.

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                Patient Handout

                Patient Education
                doxapram intravenous

                NO MONOGRAPH AVAILABLE AT THIS TIME

                USES: Consult your pharmacist.

                HOW TO USE: Consult your pharmacist.

                SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

                PRECAUTIONS: Consult your pharmacist.

                DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

                OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

                NOTES: No monograph available at this time.

                MISSED DOSE: Consult your pharmacist.

                STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

                Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

                IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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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.

                Adding plans allows you to:

                • View the formulary and any restrictions for each plan.
                • Manage and view all your plans together – even plans in different states.
                • 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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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.