DOXAPRAM

Dopram

Reviewed by NICU and Dept. of Pharmacy
November 2011
Administration Newborn Drug Protocol Index Newborn Services Home Page

 

Dose and Administration

Continuous Intravenous Infusion

Indications

Contraindications and Precautions 1, 2, 3

  1. Seizures
  2. Recent periventricular haemorrhage
  3. Cerebral oedema
  4. Severe hypertension
  5. Cardiac failure
  6. Hyperthyroidism

Precautions

Clinical Pharmacology 1, 2, 3, 4

Doxapram is a respiratory stimulant, acting principally through the central respiratory centres in the medulla. Stimulation of peripheral carotid chemoreceptors may also contribute to the respiratory action. The resultant effect is an increase in tidal volume with an increase in respiratory rate. Doxapram has a quick onset and short duration of action. A release in catecholamines has been noted following the use of doxapram, leading to a pressor effect, attributed to an increase in cardiac output rather than a peripheral vasoconstriction.

Doxapram undergoes extensive hepatic metabolism, with very little free drug appearing in the urine.

Possible Adverse Effects 1, 2, 3, 7

  1. Hypertension is the most common adverse effect seen in preterm infants, and can even occur at low doses7.  Monitor blood pressure regularly.
  2. QTc prolongation, 2nd degree heart block, arrhythmias.
  3. Seizures (may be associated with high doses), irritability, flushing, sweating, involuntary movements, muscle spasm.
  4. Respiratory distress
  5. Vomiting, diarrhoea, urinary retention.
  6. Extravasation may cause thrombophlebitis or skin irritation.

Drug Interactions 1

  1. Caffeine Citrate, aminophylline  -  possible increase in CNS stimulation.

Special Considerations 3, 6

  1. Do not use in conjunction with mechanical ventilation.
  2. Monitor:
  3. Watch for accumulation if high doses are infused for more than 36 to 48 hours.
  4. Signs of overdose are: excessive pressor effect, tachycardia, skeletal muscle hyperactivity (tremors), enhanced deep tendon reflexes.
  5. Some preparations of doxapram contain benzyl alcohol as a preservative (e.g.Wyeth brand of DopramĀ®). Benzyl alcohol may cause significant metabolic and neurological disturbance in infants.
  6. Doxapram is not licensed for use in children. There are limited trials evaluating its use in neonates for the treatment of apnoea.