NICU and Dept. of Pharmacy
Continuous Intravenous Infusion
- Start at 0.5mg/kg/hour and, if necessary, titrate upwards at increments
of 0.5 mg/kg/hour to a usual maximum of 1.5 mg/kg/hour
- Review continuing use on a daily basis. There is some evidence that the
effect may not be sustained.
- Apnoea of prematurity unresponsive to caffeine citrate (or aminophylline).
Contraindications and Precautions
1, 2, 3
- Recent periventricular haemorrhage
- Cerebral oedema
- Severe hypertension
- Cardiac failure
- Impaired renal or hepatic function
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
Doxapram undergoes extensive hepatic metabolism, with very little free drug
appearing in the urine.
Possible Adverse Effects
1, 2, 3,
- Hypertension is the most common adverse effect seen in preterm infants,
and can even occur at low doses7. Monitor blood pressure regularly.
- QTc prolongation, 2nd degree heart block, arrhythmias.
- Seizures (may be associated with high doses), irritability, flushing,
sweating, involuntary movements, muscle spasm.
- Respiratory distress
- Vomiting, diarrhoea, urinary retention.
- Extravasation may cause thrombophlebitis or skin irritation.
- Caffeine Citrate, aminophylline - possible increase in CNS stimulation.
- Do not use in conjunction with mechanical ventilation.
- B.P. & pulse rate (sudden onset of hypotension or dyspnoea suggests
that doxapram should be stopped)
- Blood gases: consider ventilation if there is a deterioration in
blood gas parameters without clinical improvement
- Watch for accumulation if high doses are infused for more than 36 to 48
- Signs of overdose are: excessive pressor effect, tachycardia, skeletal
muscle hyperactivity (tremors), enhanced deep tendon reflexes.
- Some preparations of doxapram contain benzyl alcohol as a preservative (e.g.Wyeth
brand of Dopram®). Benzyl alcohol may cause significant metabolic and
neurological disturbance in infants.
- Doxapram is not licensed for use in children. There are limited trials
evaluating its use in neonates for the treatment of apnoea.