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Respiratory Stimulant Pregnancy: D — avoid

Doxapram

Brand names: Dopram

Adult dose

Dose: 1.5–4mg/min IV infusion (titrate to RR and ABG)
Route: IV infusion
Frequency: Continuous infusion — maximum 4h
Max: 3g in 24h
COPD acute exacerbation (Type 2 respiratory failure): use only when NIV unavailable or failed/refused. Initial rate 1.5mg/min, adjust every 15–30 min based on ABG. Most effective when used early. NOT a substitute for NIV.

Clinical pearls

  • Role greatly diminished since NIV became gold standard for Type 2 respiratory failure in COPD (BIPAP). Doxapram is a bridge or alternative when NIV not tolerated.
  • SIGN/BTS: NIV first-line for COPD + Type 2 RF. Doxapram only if NIV contraindicated, refused, or failed.
  • Respiratory alkalosis from over-stimulation can worsen: target pCO₂ reduction 1–2 kPa over first hour. Check ABG every 30 min initially.
  • IV infusion formulation: dilute 500mg in 500ml glucose 5% or NS (1mg/ml). Must use IV infusion pump.

Contraindications

  • Epilepsy or history of convulsions
  • Severe hypertension
  • Coronary artery disease
  • Thyrotoxicosis
  • Physical obstruction of airway

Side effects

  • Agitation, anxiety, confusion
  • Tachycardia, hypertension
  • Nausea and vomiting
  • Seizures (at high doses)
  • Laryngospasm

Interactions

  • MAO inhibitors: severe hypertension
  • Sympathomimetics: enhanced pressor response
  • Volatile anaesthetics: arrhythmia risk

Monitoring

  • ABG every 30–60 min
  • RR
  • HR
  • BP
  • SpO₂
  • level of consciousness

Reference: NICE BNF 84; BTS/SIGN COPD Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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