Nurses Compass
Drug Guide
Doxapram Hydrochloride
Classification
Therapeutic: Respiratory Stimulant
Pharmacological: Central Nervous System Stimulant
FDA Approved Indications
- Management of respiratory depression due to respiratory failure, especially in cases of apnea, postoperative respiratory depression, or drug overdose with respiratory depression.
Mechanism of Action
Doxapram stimulates the carotid chemoreceptors and the respiratory center in the medulla oblongata, resulting in increased respiratory drive and ventilatory rate.
Dosage and Administration
Adult: Initial dose: 5-10 mg administered intravenously over 20-30 seconds. Repeat at 30-second intervals if necessary, up to a maximum of 15 mg. Maintain as needed, not exceeding total dose of 20 mg per 24 hours.
Pediatric: The dosage varies based on age and weight; typically, 0.5 mg/kg IV as a single dose, repeated as necessary. Specific pediatric dosing should be guided by clinical judgment and age/weight.
Geriatric: Use with caution; dosage adjustments are often necessary due to increased sensitivity and comorbidities.
Renal Impairment: No specific adjustment; monitor closely for effectiveness and adverse effects.
Hepatic Impairment: No specific adjustment suggested, but caution is advised.
Pharmacokinetics
Absorption: Given IV directly into circulation, so absorption not a concern.
Distribution: Widely distributed, crosses the blood-brain barrier.
Metabolism: Metabolized hepatically, though specific pathways are not well characterized.
Excretion: Excreted primarily in urine as metabolites.
Half Life: Approximately 3-8 hours, depending on renal function.
Contraindications
- Known hypersensitivity to doxapram or related compounds.
- Uncontrolled hypertension or severe coronary artery disease.
Precautions
- Use cautiously in patients with increased intracranial pressure, unstable cardiac conditions, or severe hypertension. Monitor blood pressure and cardiac status closely. Pregnant and lactating women: consult specific guidelines; use only if clearly needed.
Adverse Reactions - Common
- Hypertension (Less common)
- Tachycardia (Less common)
- Nausea or vomiting (Common)
- Anxiety or restlessness (Common)
Adverse Reactions - Serious
- Seizures (Rare)
- Arrhythmias (Rare)
- Elevated blood pressure or hypertensive crisis (Rare)
Drug-Drug Interactions
- Amphetamines or other CNS stimulants (risk of additive effects).
- Sympathomimetic agents (potential for increased cardiovascular effects).
Drug-Food Interactions
- No significant interactions identified.
Drug-Herb Interactions
- Limited data; caution advised with herbal stimulants or adrenergic agents.
Nursing Implications
Assessment: Assess respiratory status before and during administration. Monitor blood pressure, heart rate, and neurologic status.
Diagnoses:
- Impaired gas exchange related to respiratory depression.
- Risk for hypertension or arrhythmias.
Implementation: Administer IV as prescribed; ensure resuscitation equipment is available. Monitor vital signs and respiratory function continuously.
Evaluation: Evaluate effectiveness by improvement in respiratory rate and blood gases; monitor for adverse reactions.
Patient/Family Teaching
- Inform patient and family about the purpose of the drug, potential side effects, and importance of monitoring vital signs.
- Advise them to report chest pain, irregular heartbeat, severe headache, or neurological changes immediately.
Special Considerations
Black Box Warnings: N/A
Genetic Factors: None specific.
Lab Test Interference: No known interference with laboratory tests.
Overdose Management
Signs/Symptoms: Severe hypertension, seizures, arrhythmias, or agitation.
Treatment: Supportive care, seizure management with anticonvulsants if necessary, and control of blood pressure. Hemodialysis is not effective for overdose removal.
Storage and Handling
Storage: Store at controlled room temperature (20°C to 25°C). Keep in a protected environment away from light.
Stability: Stable under recommended storage conditions for the shelf life as indicated in the product labeling.