Respiratory stimulant

Doxapram hydrochloride

Brand names: Dopram

Doxapram is an intravenous respiratory stimulant (analeptic) used in specialist and critical-care settings for acute respiratory failure or post-operative respiratory depression. It has a narrow role and is short-acting.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Postanaesthetic use: 0.5–1 mg/kg by IV injection as a single injection, repeatable at 5-minute intervals (maximum total by IV injection 2 mg/kg)

Route: IV injection or IV infusion

Frequency: Single IV injection repeatable at 5-minute intervals; or continuous IV infusion

Max: IV injection 2 mg/kg; IV infusion 4 mg/kg (~300 mg for the average adult); overall not to exceed 3 grams/24 hours

By infusion (postanaesthetic): add 250 mg (12.5 mL) to 250 mL of 5%/10% dextrose or normal saline; initiate at ~5 mg/minute until satisfactory respiratory response, then maintain at 1–3 mg/minute. Drug-induced CNS depression: priming dose 2 mg/kg (mild depression 1 mg/kg), repeat in 5 minutes, then same dose every 1–2 hours until the patient wakens (maximum 3 grams/day); repetitive doses only for patients who responded to the initial dose. COPD with acute hypercapnia: 400 mg in 180 mL (2 mg/mL), start 1–2 mg/minute, increase to a maximum of 3 mg/minute, single 2-hour administration only (additional infusions beyond 2 hours not recommended); check arterial blood gases before and at least every half hour. Contains benzyl alcohol. Incompatible with alkaline solutions (e.g. thiopental sodium, sodium bicarbonate), furosemide, aminophylline and others.

Dose auto-extracted from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

DOSAGE & ADMINISTRATION NOTE: CONTAINS BENZYL ALCOHOL (see PRECAUTIONS ) In Postanesthetic Use Table I. Dosage for postanesthetic use-I.V. and infusion. * Dose not to exceed 3 grams/24 hours. BY I.V. INJECTION (See Table I. Dosage for postanesthetic use—I.V.) The recommended dose for I.V. administration is 0.5 – 1 mg/kg for a single injection and at 5-minute intervals. Careful observation of the patient during administration and for some time subsequently are advisable. The maximum total dosage by I.V. injection is 2 mg/kg. BY INFUSION The solution is prepared by adding 250 mg of doxapram (12.5 mL) to 250 mL of dextrose 5% or 10% in water or normal saline solution. The infusion is initiated …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2025-01-08. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Known hypersensitivity to the drug or any injection component
Epilepsy or other convulsive disorders
Proven or suspected pulmonary embolism
Mechanical disorders of ventilation — mechanical obstruction, muscle paresis (including neuromuscular blockade), flail chest, pneumothorax, acute bronchial asthma, pulmonary fibrosis, or other restriction of the chest wall, muscles of respiration or alveolar expansion
Head injury, cerebrovascular accident or cerebral oedema; significant cardiovascular impairment, uncompensated heart failure, severe coronary artery disease, or severe hypertension (including that associated with hyperthyroidism or phaeochromocytoma)

Side effects

CNS: pyrexia, flushing, sweating, dizziness, headache, hyperactivity, involuntary movements, muscle spasticity/fasciculations, convulsions
Respiratory: dyspnoea, cough, hyperventilation, tachypnoea, laryngospasm, bronchospasm, hiccough, rebound hypoventilation
Cardiovascular: variations in heart rate, arrhythmias (including ventricular tachycardia/fibrillation), chest pain; mild-to-moderate rise in blood pressure
Gastrointestinal: nausea, vomiting, diarrhoea
Genitourinary/haematological: urinary urgency or retention; haemolysis with rapid infusion

Clinical monograph

How it works

At low doses it stimulates respiration through peripheral chemoreceptors, and at higher doses acts on the central respiratory centres in the brainstem, increasing respiratory rate and tidal volume.

Prescribing in practice

It is contraindicated in severe hypertension, epilepsy and severe asthma, and requires close monitoring in a setting equipped to support ventilation.
It can cause agitation, tachycardia and hypertension, and may provoke arrhythmias or convulsions.
Its short duration of action means it is a temporising measure and not a substitute for assisted ventilation where that is indicated.

Monitoring

Continuous monitoring of respiratory rate, oxygenation, blood pressure, heart rate and conscious level is required during administration, with arterial blood gas measurement to guide therapy and avoid worsening carbon dioxide retention.

Counselling the patient

This medicine is given under close supervision in hospital; staff will monitor you continuously.
Tell staff if you feel agitated, develop palpitations or have any unusual sensations.

Evidence & guidelines

A specialist respiratory stimulant with a limited, closely monitored role in acute respiratory failure and post-operative respiratory depression.

Reference: BTS NIV guideline; NICE NG115; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Doxapram · Respiratory Stimulant

Pathways