What is the use of Doxapram (Dopram, respiratory stimulant)?

From the Guidelines

Doxapram should be considered in patients with acidosis (pH <7.26) and/or hypercapnia as a temporary measure to stimulate respiration, but its use should be closely monitored and as part of a comprehensive management plan. The use of doxapram, a respiratory stimulant, is indicated in specific clinical scenarios where respiratory depression or failure is a concern, such as in chronic obstructive pulmonary disease (COPD) exacerbations with hypercapnia 1. It works by stimulating the respiratory center in the medulla oblongata and peripheral carotid chemoreceptors, thereby increasing respiratory rate and tidal volume.

Key Points to Consider:

• Doxapram may be used to tide the patient over for 24–36 hours until the underlying cause, such as an infection, is controlled 1.
• Its use should be part of a supportive therapy regimen aimed at avoiding the need for intubation and invasive intermittent positive pressure ventilation (IPPV) 1.
• Close monitoring of the patient's condition is necessary, as a significant proportion may still require intubation and IPPV despite doxapram therapy 1.
• The decision to use doxapram should be made by a senior person, taking into account the patient's premorbid state, wishes, and those of close relatives, as outlined in guidelines for managing respiratory failure 1.

Clinical Context:

In the context of COPD management, doxapram can be considered as an adjunctive treatment to help manage respiratory failure, particularly in cases where non-invasive ventilation (NIV) is not immediately available or suitable 1. However, its use should always be weighed against the potential risks and benefits, considering the patient's overall clinical condition and the availability of more definitive respiratory support measures.

From the FDA Drug Label

INDICATIONS & USAGE Postanesthesia When the possibility of airway obstruction and/or hypoxia have been eliminated, doxapram may be used to stimulate respiration in patients with drug-induced postanesthesia respiratory depression or apnea other than that due to muscle relaxant drugs. To pharmacologically stimulate deep breathing in the postoperative patient. Drug-Induced Central Nervous System Depression Exercising care to prevent vomiting and aspiration, doxapram may be used to stimulate respiration, hasten arousal, and to encourage the return of laryngopharyngeal reflexes in patients with mild to moderate respiratory and CNS depression due to drug overdosage Chronic Pulmonary Disease Associated with Acute Hypercapnia Doxapram is indicated as a temporary measure in hospitalized patients with acute respiratory insufficiency superimposed on chronic obstructive pulmonary disease.

The use of Doxapram is to:

• Stimulate respiration in patients with drug-induced postanesthesia respiratory depression or apnea
• Stimulate deep breathing in the postoperative patient
• Stimulate respiration, hasten arousal, and encourage the return of laryngopharyngeal reflexes in patients with mild to moderate respiratory and CNS depression due to drug overdosage
• As a temporary measure in hospitalized patients with acute respiratory insufficiency superimposed on chronic obstructive pulmonary disease 2

From the Research

Use of Doxapram

• Doxapram is a respiratory stimulant used to counteract respiratory depression induced by opioids, such as morphine 3.
• It has been used to treat various respiratory disorders, including acute respiratory failure, post-anesthetic respiratory depression, and apnea of prematurity 4.
• Doxapram has been shown to be effective in reducing the incidence of apnea in preterm infants, although the evidence is not conclusive 5.
• The drug has also been used to treat congenital central hypoventilation syndrome, with significant improvements in quiet-sleep tidal volume, minute ventilation, and alveolar PCO2 6.

Mechanism of Action

• Doxapram stimulates the central respiratory network, increasing respiratory drive and improving ventilation 3.
• It also affects peripheral chemoreceptors, which helps to stimulate respiration 6.
• The exact mechanism of action is not fully understood, but it is thought to involve the blockade of tandem pore K(+) (TASK-1/-3) channels 3.

Clinical Applications

• Doxapram has been used in various clinical settings, including intensive care units, post-anesthesia care units, and neonatal intensive care units 4.
• It has been used to prevent and treat apnea in preterm infants, as well as to prevent reintubation in these patients 5.
• The drug has also been used to treat respiratory depression induced by opioids, such as morphine, in patients undergoing surgery or receiving pain management 3, 7.

Side Effects and Interactions

• Doxapram can cause nonrespiratory effects, such as generalized neuromuscular stimulation, acute hepatotoxicity, and perforated duodenal ulcer 6.
• The drug can interact with other medications, such as opioids, and may enhance their respiratory depressant effects 7.
• The evidence for the use of doxapram in certain clinical settings is limited, and more studies are needed to fully understand its effects and potential interactions 5.