Dose:   2.5 to 3.0 mg/kg/ as a loading dose  
              1.0 to 1.5 mg/kg/hour as a continuous infusion

Frequency:    Continuous infusion

Comments:   Doxapram is a potent respiratory stimulant. It contains benzyl alcohol. Use of this drug in infants is generally limited to reports outside of the United States (chlorobutanol used instead of benzyl alcohol as a preservative). Doxapram is a potent respiratory stimulant (via activation of the peripheral carotid chemoreceptors) that has been used in adults. Following IV administration, effects are seen within twenty to forty seconds with peak effects in one to two minutes. The effectiveness of the drug ranges from 5 to 12 minutes so that a continuous infusion is required to maintain the therapeutic effect. Henderson-Smart and Steer reported on a meta-analysis of published reviews of doxapram versus methylxanthines for the treatment of apnea in preterm infants. They noted that were a number of methodological flaws in the studies. And though there was no differences noted between the drugs in short-term treatment (48 hours), the number of infants that have been reported is too small to make meaningful conclusions about infants most likely to respond to treatment with doxapram as well as potential side effects and long-term clinical outcomes. Infants who have been treated with doxapram have shown an increase in minute ventilation, tidal volume, and inspiratory flow rates, and a decrease in apnea and mean PaCO₂. A meta-analysis by Henderson-Smart and Davis of studies also found that current studies do not support the routine use of doxapram to assist endotracheal extubation in preterm infants who are eligible to receive methylxanthine and/or CPAP. There are no data on the effects of doxapram in the absence of use of methylxanthine or CPAP. The results should be interpreted with caution because the small number of infants studied does not allow reliable assessment of the benefits and harms of doxapram. The drug is contraindicated in infants with epilepsy or convulsive disorders, pneumothorax, reversible airways disease, and hypertension. For further information,  see Comments on doxapram.

Toxicity:  Use of doxapram in infants has been associated with irritability. Mild to moderate elevations in blood pressure have also been noted in many infants who have been treated with doxapram. Vomiting, diarrhea, and urinary retention have also been described. In adults headache, dizziness, hyperactivity, convulsions, spasticity, pyrexia, and flushing are reported adverse effects. Tachypnea, laryngospasm, bronchospasm, rebound hypotension, and arrhythmias have also been described in adults.

Preparation: Doxapram (Dopram) is available in 20 mg/ml concentrations in 20 ml vials (0.9% benzyl alcohol).

Compatibility: Doxapram is compatible D5W, D10W, and normal saline as well as amikacin, bumetanide, dopamine, epinephrine, pyridoxine, and tobramycin.  It is incompatible with aminophylline, cefotaxime, dexamethasone, diazepam, digoxin, dobutamine, furosemide, hydrocortisone,  ketamine, and ticarcillin.