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DOPRAM
Asthma/COPD
Respiratory stimulants
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Drug Name:

DOPRAM Rx

Generic Name and Formulations:
Doxapram HCl 20mg/mL; soln for IV inj after dilution; contains benzyl alcohol.

Company:
West-Ward Pharmaceutical Corp.

Therapeutic Use:

Indications for DOPRAM:

As a temporary measure in hospitalized patients with acute respiratory insufficiency superimposed on chronic obstructive pulmonary disease, to be used for a short period of time as an aid in the prevention of elevation of arterial CO2 tension during the administration of oxygen.

Adult:

Give by IV infusion. Mix doxapram 400mg with 180mL of dextrose 5% or 10% or normal saline soln (concentration 2mg/mL). Initial rate: 1–2mg/minute, may increase to max 3mg/minute. Obtain arterial blood gases prior to treating and at least every half hour during the two hours of infusion to insure against the insidious development of CO2-retention and acidosis. If the blood gases show evidence of deterioration, the infusion of doxapram should be discontinued. Additional infusions beyond single max two hour administration period are not recommended.

Children:

Not recommended.

Contraindications:

Epilepsy or other convulsive disorders. Pulmonary embolism. Mechanical disorders of ventilation (eg, mechanical obstruction, muscle paresis [including neuromuscular blockade], flail chest, pneumothorax, acute bronchial asthma, pulmonary fibrosis, other conditions resulting in restriction of the chest wall, muscles of respiration, or alveolar expansion). Head injury. Cerebral vascular accident. Cerebral edema. Signficant cardiovascular impairment. Uncompensated heart failure. Severe coronary artery disease. Severe hypertension (including that associated with hyperthyroidism or pheochromocytoma).

Warnings/Precautions:

Do not use in conjunction with mechanical ventilation. Monitor BP, pulse rate, deep tendon reflexes, blood gas measurements, cardiac rhythm disturbances. Severely ill: do not increase the rate of infusion. Acute respiratory failure. Discontinue if sudden hypotension or dyspnea develops. Significant renal or hepatic impairment. Avoid extravasation. Pregnancy (Cat.B). Nursing mothers.

Interactions:

Delay doxapram administration until volatile anesthetic agent has been excreted to lessen the potential for arrhythmias. Additive pressor effect with MAOIs, sympathomimetics. May temporarily mask residual effects of neuromuscular blocking agents. Caution with aminophylline, theophylline.

Pharmacological Class:

Respiratory stimulant.

Adverse Reactions:

Pyrexia, flushing, sweating; pruritus and paresthesia, such as a feeling of warmth, burning, or hot sensation, especially in the area of genitalia and perineum; apprehension, disorientation, pupillary dilatation, hallucinations, headache, dizziness, hyperactivity, involuntary movements, muscle spasticity, muscle fasciculations, increased deep tendon reflexes, clonus, bilateral Babinski, convulsions (have anticonvulsants, oxygen, and resusciative equipment available), dyspnea, cough, hyperventilation, tachypnea, laryngospasm, bronchospasm, hiccough, rebound hypoventilation, phlebitis, variations in heart rate, lowered T-waves, arrhythmias (including ventricular tachycardia and ventricular fibrillation), chest pain, tightness in chest, increased BP, GI upset, stimulation of urinary bladder with spontaneous voiding; urinary retention, elevation of BUN and albuminuria, hemolysis (w/ rapid infusion), blood dyscrasias.

How Supplied:

Multi-dose vials (20mL)—6

Indications for DOPRAM:

To stimulate respiration in patients with drug-induced postanesthesia respiratory depression or apnea other than that due to muscle relaxant drugs. To pharmacologically stimulate deep breathing in the postoperative patient. To stimulate respiration, hasten arousal, and to encourage the return of laryngopharyngeal reflexes in patients with mild to moderate respiratory and CNS depression due to drug overdosage.

Adult:

Postanesthetic use: 0.5–1mg/kg for a single injection and at 5-minute intervals; max total dose: 2mg/kg. Or, may give as IV infusion at a rate of 5mg/minute until satisfactory response, then maintain at 1–3mg/minute; max total dose: 4mg/kg or approx. 300mg. Management of drug-induced CNS depression: Method One: Give priming dose of 1mg/kg (for mild depression) or 2mg/kg (for moderate depression) and repeat in 5 minutes. Repeat same dose every 1–2 hours until patient wakens. If relapse occurs, resume injections every 1–2 hours until arousal sustained, or total max (3g) is given. After max dose has been given, allow patient to sleep until 24 hours have elapsed from first inj using assisted or automatic respiration if necessary. Repeat following day until patient breathes spontaneously and sustains desired level of consciousness, or until max (3g) is given. Failure to response may indicate the need for neurologic evaluation. Method Two: Give priming dose as in Method One. If patient wakens, watch for relapse; if no response, continue general supportive treatment for 1–2 hours and repeat priming dose. If some respiratory stimulation occurs, give 1–2mg/kg/hr (for mild depression) or 2–3mg/kg/hr (for moderate depression) as an IV infusion. Discontinue if patient begins to waken or at end of 2 hours. Continue supportive treatment for ½–2 hours and repeat the second step. For both indications: Do not exceed 3g/day.

Children:

Not recommended.

Contraindications:

Epilepsy or other convulsive disorders. Pulmonary embolism. Mechanical disorders of ventilation (eg, mechanical obstruction, muscle paresis [including neuromuscular blockade], flail chest, pneumothorax, acute bronchial asthma, pulmonary fibrosis, other conditions resulting in restriction of the chest wall, muscles of respiration, or alveolar expansion). Head injury. Cerebral vascular accident. Cerebral edema. Signficant cardiovascular impairment. Uncompensated heart failure. Severe coronary artery disease. Severe hypertension (including that associated with hyperthyroidism or pheochromocytoma).

Warnings/Precautions:

Do not use in conjunction with mechanical ventilation. For postanesthetic use: observe patient for ½–1 hour after stimulation with doxapram. Monitor BP, pulse rate, deep tendon reflexes, blood gas measurements, cardiac rhythm disturbances. Discontinue if sudden hypotension or dyspnea develops. Significant renal or hepatic impairment. Avoid extravasation. Pregnancy (Cat.B). Nursing mothers.

Interactions:

Delay doxapram administration until volatile anesthetic agent has been excreted to lessen the potential for arrhythmias. Additive pressor effect with MAOIs, sympathomimetics. May temporarily mask residual effects of neuromuscular blocking agents. Caution with aminophylline, theophylline.

Pharmacological Class:

Respiratory stimulant.

Adverse Reactions:

Pyrexia, flushing, sweating; pruritus and paresthesia, such as a feeling of warmth, burning, or hot sensation, especially in the area of genitalia and perineum; apprehension, disorientation, pupillary dilatation, hallucinations, headache, dizziness, hyperactivity, involuntary movements, muscle spasticity, muscle fasciculations, increased deep tendon reflexes, clonus, bilateral Babinski, convulsions (have anticonvulsants, oxygen, and resusciative equipment available), dyspnea, cough, hyperventilation, tachypnea, laryngospasm, bronchospasm, hiccough, rebound hypoventilation, phlebitis, variations in heart rate, lowered T-waves, arrhythmias (including ventricular tachycardia and ventricular fibrillation), chest pain, tightness in chest, increased BP, GI upset, stimulation of urinary bladder with spontaneous voiding; urinary retention, elevation of BUN and albuminuria, hemolysis (w/ rapid infusion), blood dyscrasias.

How Supplied:

Multi-dose vials (20mL)—6

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