Doxepram?

jwk · Jan 25, 2006

I did a presentation yesterday on sleep apnea/hypoventilation. One of my instructors is after me to find out more about doxepram in this setting. Morgan & Mikhail and Stoelting basically say it's a dinosaur. There is literally no clinical information to be found on a Google search. What IS this stuff, and do I care??

Doxepram (Dopram), as I recall from my ancient anesthesia pharmacology trivia section of my brain, is some sort of "CNS stimulant". Sorry, I don't remember why exactly it works. We used it years ago, before SSEP monitoring, to do "wakeup tests" in the middle of Harrington rod spinal fusions - we reversed the muscle relaxants, turned off the gases, turned up the O2 and then gave doxepram - they woke up fairly quickly, we'd yell at them to move their feet (hopefully they did) and then put them back to sleep. We also used it occasionally for patients who were very slow waking up at the end of a procedure. I think it's pretty much fallen out of favor - it's not even on our hospital formulary any more.

fergus51 · Jan 25, 2006

That's funny. My NICU recently started giving it again for apnea of prematurity when caffeine has failed. It isn't even in the neofax.

athomas91 · Jan 25, 2006

i can't remember exactly - know i encountered it studying for boards - i know it is a central respiratory stimulant - can't remember right now where it works - maybe the apneustic center...i will try to find the question in valley later...

no-pain · Jan 25, 2006

We use this medication in the nicu as well when caffine doesnt work but here is what I found for the adult population if this helps at all. :uhoh3: from Lexi Drugs.

U.S. Brand Names Dopram®

Pharmacologic Category Respiratory Stimulant; Stimulant

Use Respiratory and CNS stimulant for respiratory depression secondary to anesthesia, drug-induced CNS depression; acute hypercapnia secondary to COPD

Drug InteractionsInhaled anesthetics: Halothane, cyclopropane, and enflurane may sensitize the myocardium to catecholamine and epinephrine which is released at the initiation of doxapram, hence, separate discontinuation of anesthetics and start of doxapram until the volatile agent has been excreted.

Mechanism of Action Stimulates respiration through action on respiratory center in medulla or indirectly on peripheral carotid

chemoreceptors

Pharmacodynamics/Kinetics Onset of action: Respiratory stimulation: I.V.: 20-40 seconds; Peak effect: 1-2 minutes;Duration: 5-12 minutes; Half-life elimination, serum: Adults: Mean: 3.4 hours

Dosage

Respiratory depression following anesthesia:

Intermittent injection: Initial: 0.5-1 mg/kg; may repeat at 5-minute intervals (only in patients who demonstrate initial response); maximum total dose: 2 mg/kg

I.V. infusion: Initial: 5 mg/minute until adequate response or adverse effects seen; decrease to 1-3 mg/minute; maximum total dose: 4 mg/kg

Drug-induced CNS depression:

Intermittent injection: Initial: Priming dose of 1-2 mg/kg, repeat after 5 minutes; may repeat at 1-2 hour intervals (until sustained consciousness); maximum: 3 g/day. May repeat in 24 hours if necessary.

Monitoring Parameters Monitor heart rate, blood pressure, reflexes, CNS status, ECG, arterial blood gases (COPD)

Anesthesia and Critical Care Concerns/Other Considerations Because of doxapram's transient effect, doxapram should not be used as a drug of choice to treat anesthesia-induced respiratory depression. Initial studies suggest a therapeutic range of at least 1.5 mg/L. Toxicity becomes frequent at serum levels >5 mg/L.

Dosage Forms Injection, solution, as hydrochloride: 20 mg/mL (20 mL) [contains benzyl alcohol]

66F · Jan 25, 2006

that's funny. my nicu recently started giving it again for apnea of prematurity when caffeine has failed. it isn't even in the neofax.

i'd be careful with it. here are a couple of sites with some info, it is a dirty drug with a history. if you use it and something goes wrong............. sky would be the limit for your checkbook.

"caution:

doxapram hydrochloride injection that contains benzyl alcohol (in canada, chlorobutanol) as a preservative must not be used in newborns and immature infants. {03} the use of benzyl alcohol in neonates has been associated with a fatal toxic syndrome consisting of metabolic acidosis and central nervous system (cns), respiratory, circulatory, and renal function impairment"

http://www.drugs.com/mmx/doxapram_hydrochloride.html

"a preservative-free preparation currently is not commercially available in the us. "

http://www.medscape.com/druginfo/monograph?cid=med&drugid=9144&drugname=dopram+intravenous&monotype=monograph&secid=4

fergus51 · Jan 25, 2006

i'd be careful with it.
"caution:
doxapram hydrochloride injection that contains benzyl alcohol (in canada, chlorobutanol) as a preservative must not be used in newborns and immature infants. {03} the use of benzyl alcohol in neonates has been associated with a fatal toxic syndrome consisting of metabolic acidosis and central nervous system (cns), respiratory, circulatory, and renal function impairment"
http://www.drugs.com/mmx/doxapram_hydrochloride.html

that's why most places stopped using it decades ago i believe. most of our drugs unfortunately have some nasty potential side effects. i know some docs won't use surfactant prophylactically because of that despite the fact that is the norm in most hospitals. my personal least favorite drug is indocin, but that's another story...

66F · Jan 25, 2006

I did a presentation yesterday on sleep apnea/hypoventilation. One of my instructors is after me to find out more about doxepram in this setting. Morgan & Mikhail and Stoelting basically say it's a dinosaur. There is literally no clinical information to be found on a Google search. What IS this stuff, and do I care??

Use the term "Dopram" in your search and you'll get hits.

66F

apaisRN, RN, CRNA · Jan 26, 2006

Use the term "Dopram" in your search and you'll get hits.
66F

Thanks, I'll give it a shot.

I didn't think to look it up for NICU use.