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Doxapram Intravenous for Adults
Who can administer
Administration RESTRICTED - see Appendix 1
Important information
- Monitoring requirements - see below
- Doxapram infusion is listed as a licensed preparation - however, it is not marketed in Ireland. We are therefore suggesting preparing an infusion using the ampoules, as recommended in ref 1 if an infusion is required
Available preparations
Doxapram 100mg per 5ml ampoule
Reconstitution
Already in solution
Draw up using a 5 micron filter needle
Infusion fluids
Ampoules: Usually not required - product ready for injection
Infusion required: prepare using Glucose 5% (ref 1)
Methods of intravenous administration
Bolus intravenous injection
- Administer required dose over at least 30 seconds
- May be repeated at one hour intervals if needed
Intermittent intravenous infusion
- Prepare an infusion containing 2mg/ml as follows:
- Add 5 ampoules of 100mg/5ml (=500mg/25ml) to 225ml infusion fluid (unlicensed method of preparation)
- Administer as per 'Dose below'
- Administer concurrently with oxygen
Dose in adults
Post-operative use (using intravenous injection)
- Administer 1 to 1.5mg/kg by intravenous bolus administration over at least 30 seconds
- May be repeated at one hour intervals if needed
Post-operative use (using intravenous infusion)
- Recommended dosage is 2 to 3 mg per minute (=60 to 90ml/hour of a 2mg/ml solution)
- Adjust dose according to the response of the patient
- Maximum dose 4mg/minute
Acute respiratory failure (using intravenous infusion)
- Administer 1.5 to 4mg per minute, depending on the condition and response of the patient
- Administer concurrently with oxygen
- The following dosage schedule has been shown to result in the rapid production of a steady state plasma concentration of doxapram
Respiratory stimulant | Dose | Rate in ml/hour using infusion containing 500mg/250ml (2mg/ml) |
---|---|---|
0-15 minutes | Give 4mg per minute | 120ml per hour |
15 to 30 minutes | Give 3mg per minute | 90ml per hour |
30 to 60 minutes | Give 2mg per minute | 60ml per hour |
60 minutes onwards | Give 1.5mg per minute | 45 ml per hour |
Maximum dose | 4mg per minute |
Liver impairment
- As doxapram is primarily metabolised by the liver, use with care in patients with hepatic dysfunction
Monitoring
- Frequent arterial blood gas and pH measurements are necessary
- Blood pressure, and deep tendon reflexes should be monitored
Further information
- Doxapram should be administered concurrently with oxygen to patients with severe irreversible airways obstruction or severely decreased lung compliance, due to the increased work of breathing in these patients
- Doxapram should be used in conjunction with a beta-2 agonist in patients presenting with bronchoconstriction, to reduce the amount of respiratory effort
- Respiratory stimulant effect of doxapram may not outlast the residual effects of the depressant drugs- patients will need to be closely monitored until fully alert for 30 to 60 minutes. Doxapram may temporarily mask the residual effects of curare-type muscle relaxants
- Should be used with caution for patients who receiving sympathomimetic agents since an additive pressor effect may occur
- Do not use with mechanical ventilation
- The infusion may also be prepared in sodium chloride 0.9% if required - but consider sodium load in patients with impaired cardiac function
- Refer to SPC for other precautions
Storage
- Store below 25° C
- Do not refrigerate
References
SPC Doxapram injection October 2016
SPC Doxapram infusion July 2015
1: Injectable Medicines guide, downloaded from Medusa 25th August 2020
Therapeutic classification
Repiratory stimulant