Doxapram Hcl

Drug overview for DOXAPRAM HCL (doxapram hcl):

Generic name: DOXAPRAM HCL
Drug class: Amphetamines/Anorexiants/Stimulants
Therapeutic class: Central Nervous System Agents

Doxapram hydrochloride is a monohydrated pyrrolidinone-derivative CNS stimulant.

Doxapram hydrochloride has been used in conjunction with supportive measures to hasten arousal and to treat respiratory depression associated with overdosage of CNS depressant drugs (e.g., barbiturates, opiate analgesics, general anesthetics); acute respiratory insufficiency associated with chronic obstructive pulmonary disease; or respiratory depression in the postoperative recovery period that is not caused by skeletal muscle relaxants. However, because of its questionable benefit, transient action, and high potential for toxicity, doxapram has a limited role in the contemporary management of these conditions. In the management of respiratory depression associated with overdosage of CNS depressant drugs, doxapram and other analeptic drugs have largely been abandoned in favor of intensive supportive care (e.g., mechanical ventilation, oxygenation, cardiovascular support) and treatment with specific antidotes (e.g., pure opiate antagonists).

Use of doxapram in the management of postoperative respiratory depression has declined because of the availability of safer and shorter-acting anesthetic agents. Most experts state that respiratory stimulants such as doxapram should not be used for the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease unless other supportive measures (e.g., noninvasive ventilation using either negative- or positive-pressure devices) are unavailable or not indicated. Doxapram hydrochloride also has been used for the treatment of neonatal apnea+, principally in combination with theophylline or caffeine when the response to therapy with one of the latter drugs alone was inadequate; however, further evaluation is needed to determine the efficacy, safety, and optimum dosage of doxapram in the treatment of this condition.

Limited evidence suggests that doxapram may improve apnea in preterm infants within the first 48 hours of treatment; however, no firm conclusions regarding efficacy for this indication can be made because of the relatively small number of patients included in the studies. Furthermore, no apparent therapeutic advantage for doxapram over IV methylxanthines has been observed. In addition, because the commercially available doxapram hydrochloride injection is preserved with benzyl alcohol, the manufacturers state that this preparation should not be used in neonates. (See Cautions: Pediatric Precautions.)

DRUG IMAGES

DOXAPRAM HCL 20 MG/ML VIAL

The following indications for DOXAPRAM HCL (doxapram hcl) have been approved by the FDA:

Indications:
Post-anesthesia respiratory depression

Professional Synonyms:
Post-anesthesia respiratory failure
Post-anesthesia respiratory insufficiency

The following dosing information is available for DOXAPRAM HCL (doxapram hcl):

Dosing
Administration
Dosing Information
Generic

Because doxapram has a narrow margin of safety, the minimum effective dosage should be used and maximum recommended dosages should not be exceeded. Analeptic use of doxapram hydrochloride is strongly discouraged by most clinicians.

Doxapram hydrochloride may be administered by IV injection or infusion. An adequate airway and oxygenation should be established before administering the drug, and care should be taken to prevent vomiting and aspiration of vomitus. Monitoring of blood pressure, heart rate, and deep tendon reflexes is recommended to prevent overdosage; dosage or rate of infusion should be adjusted on the basis of these parameters.

Arterial blood gases should be monitored prior to and at 30-minute intervals during administration of doxapram to guard against the development of respiratory acidosis; the drug should be discontinued if arterial carbon dioxide tension increases, oxygen tension decreases, or mechanical ventilation is initiated. The drug also should be discontinued if sudden hypotension or dyspnea occurs. Because narcosis may recur after administration of doxapram, close observation of the patient should be continued until the patient has been fully alert for 30 minutes to 1 hour.

If recurrence of unconsciousness or respiratory depression occurs, supportive care should be provided as required. Doxapram is not an antagonist to muscle relaxant drugs nor a specific opiate antagonist. When doxapram is used to manage respiratory depression following anesthesia, adequacy of ventilation should be assessed with specific tests (e.g., peripheral nerve stimulation, airway pressures, head lift, pulse oximetry, end-tidal carbon dioxide) prior to administration.

For IV infusion, a doxapram hydrochloride solution containing approximately 1 mg/mL can be prepared by adding 250 mg of doxapram hydrochloride (12.5 mL of the commercially available injection) to 250 mL of 5 or 10% dextrose or 0.9% sodium chloride injection. A solution containing a final concentration of 2 mg/mL can be prepared by adding 400 mg of doxapram hydrochloride (20 mL of the commercially available injection) to 180 mL of 5 or 10% dextrose or 0.9% sodium chloride injection.

No dosing information available.

No generic dosing information available.

The following contraindication information is available for DOXAPRAM HCL (doxapram hcl):

Overview
Contraindicated
Severe
Moderate

Drug contraindication overview.

No enhanced Contraindications information available for this drug.

There are 15 contraindications. Absolute contraindication.

Contraindication List
Acute asthma attack
Acute decompensated heart failure
Cerebral edema
Cerebrovascular accident
Flail chest
Lower seizure threshold
Neuromuscular blockade
Pheochromocytoma
Pneumothorax
Pulmonary fibrosis
Pulmonary thromboembolism
Respiratory obstruction
Seizure disorder
Severe coronary artery disease
Severe uncontrolled hypertension

There are 3 severe contraindications. Adequate patient monitoring is recommended for safer drug use.

Severe List
Hyperthyroidism
Hypotension
Mechanical ventilation

There are 4 moderate contraindications. Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.

Moderate List
Cardiac arrhythmia
Disease of liver
Kidney disease with reduction in glomerular filtration rate (GFr)
Leukopenia

The following adverse reaction information is available for DOXAPRAM HCL (doxapram hcl):

Overview
Severe
Less Severe

Adverse reaction overview.

No enhanced Common Adverse Effects information available for this drug.

There are 10 severe adverse reactions.

More Frequent	Less Frequent
None.	None.

Rare/Very Rare
Cardiac arrhythmia Chest pain Chest tightness Dyspnea Hemolysis Hypertension Tachycardia Tachypnea Thrombophlebitis Wheezing

There are 11 less severe adverse reactions.

More Frequent	Less Frequent
None.	Acute cognitive impairment Cough Diarrhea Dizziness Dysuria Flushing Headache disorder Hiccups Hyperhidrosis Nausea Vomiting

Rare/Very Rare
None.

The following precautions are available for DOXAPRAM HCL (doxapram hcl):

Pediatric
Pregnant
Lactation
Geriatric

No enhanced Pediatric Use information available for this drug.

Contraindicated

None

Severe Precaution

None

Management or Monitoring Precaution

None

The safety of doxapram in pregnant women has not been established. The manufacturer recommends that the drug be used during pregnancy only when clearly needed.

No enhanced Lactation information available for this drug.

No enhanced Geriatric Use information available for this drug.

Post-anesthesia respiratory depression
J95.1	Acute pulmonary insufficiency following thoracic surgery
J95.2	Acute pulmonary insufficiency following nonthoracic surgery
J95.82	Postprocedural respiratory failure
J95.821	Acute postprocedural respiratory failure
J95.822	Acute and chronic postprocedural respiratory failure