Respiratory Stimulant Pregnancy: Although there is no recognised hazard, this product is not recommended for use in pregnancy unless there are compelling clinical reasons to do so - the physician must weigh benefit against risk. Breast-feeding: it is not known whether doxapram is excreted in human milk, so caution should be exercised in a lactating mother. No human fertility data available.

Doxapram

Brand names: Dopram

Doxapram is an intravenous central respiratory stimulant used under close supervision in selected cases of acute respiratory failure, such as ventilatory failure where assisted ventilation is not appropriate. It is a short-term measure given in a monitored setting.

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: 1.0 to 1.5 mg/kg body weight

Route: Intravenous use only (doxapram hydrochloride 20 mg/ml solution for injection)

Frequency: Administered over a period of 30 seconds or more, which may be repeated at one-hour intervals if necessary

Same dose stated for adults and elderly. To avoid side effects it is advisable to use the minimum effective dosage; monitoring of blood pressure and deep tendon reflexes is recommended to prevent overdosage, together with continuous monitoring of all aspects of patient response including frequent arterial blood gas analysis. Administer concurrently with oxygen in patients with severe irreversible airways obstruction or severely decreased lung compliance; in patients with bronchoconstriction always use in conjunction with beta-adrenoceptor bronchodilator drugs. Doxapram should NOT be used in conjunction with mechanical ventilation. An adequate airway is essential and airway protection should be considered as doxapram may stimulate vomiting. Respiratory depression may recur after stimulation, so monitor the patient closely until fully alert for half an hour to one hour; doxapram may temporarily mask the residual effects of curare-type muscle relaxants. Stop if sudden hypertension or dyspnoea develops. Delay initiation for at least 10 minutes after discontinuing anaesthetics known to sensitise the myocardium to catecholamines (halothane, cyclopropane, enflurane). Hepatic impairment: no studies support dosage recommendations; use with care as doxapram is metabolised primarily by the liver. Paediatric population: NOT recommended (section 4.2); no per-kg paediatric dose is given. Adverse reactions reported in off-licence use in preterm neonates and infants include neurodevelopmental delay, significant QT prolongation sometimes with atrioventricular block, bleeding in stools, abdominal distension, necrotising enterocolitis, multiple gastric perforations and early teeth eruption. The UK SPC states NO maximum dose. US labelling (DailyMed, cross-check only - not the UK SPC, and dosing conventions differ) gives for postanaesthetic use 0.5-1 mg/kg per single IV injection at 5-minute intervals with a maximum total by IV injection of 2 mg/kg, or by infusion initiated at approximately 5 mg/minute until satisfactory respiratory response then maintained at 1 to 3 mg/minute with a maximum total by infusion of 4 mg/kg (approximately 300 mg for the average adult), and a stated ceiling of 3 grams in 24 hours; do not transfer these figures to the UK regimen without clinician verification.

Dose adjustments

Renal

There are no studies to support dosage recommendations in patients with renal impairment (section 4.2).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; 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.

Contraindications

Hypersensitivity to the active substance or to any of the excipients listed in section 6.1
Severe hypertension; coronary artery disease
Status asthmaticus; physical obstruction of the respiratory tract, or conditions resulting in restriction of the chest wall, muscles of respiration or alveolar expansion
Epilepsy and other convulsive disorders; cerebral oedema; cerebrovascular accident; head injury
Hyperthyroidism/thyrotoxicosis; proven or suspected pulmonary embolism

Side effects

Nervous system: pyrexia, sweating, flushing, salivation, headache, dizziness, hyperactivity, confusion, hallucinations, perineal warmth, muscle fasciculation, muscle spasticity, clonus, bilateral Babinski, increased deep tendon reflexes and convulsions; doxapram can induce a significant decrease in maximal cerebral blood flow velocity
Cardiac: moderate increase in blood pressure, arrhythmias, sinus tachycardia, bradycardia and extrasystoles, chest pain or chest tightness
Respiratory: dyspnoea, cough, bronchospasm, laryngospasm
Gastrointestinal: nausea and vomiting
Renal and urinary: urinary retention; stimulation of urinary bladder with spontaneous voiding

Interactions

Aminophylline/theophylline - concurrent use may be associated with increased CNS stimulation, agitation, muscle fasciculation and hyperactivity (section 4.5; the remainder of section 4.5 was truncated at the source-fetch limit)
Sympathomimetic agents - administer doxapram cautiously as an additive pressor effect may occur (section 4.4)
Monoamine oxidase inhibitors - use with great care; animal studies show the action of doxapram is potentiated after pre-treatment with an MAOI (section 4.4)
Anaesthetics that sensitise the myocardium to catecholamines (halothane, cyclopropane, enflurane) - delay starting doxapram for at least 10 minutes after discontinuing anaesthesia, since increased adrenaline release has been noted with doxapram (section 4.4)

Clinical monograph

How it works

It stimulates respiration through an action on peripheral chemoreceptors and, at higher doses, the central respiratory centres, increasing tidal volume and respiratory rate. The effect is brief, reflecting its short duration of action.

Prescribing in practice

It has a narrow margin of safety and can cause agitation, hypertension, arrhythmias, and convulsions, so it must be given with continuous cardiorespiratory monitoring and is contraindicated in severe hypertension, epilepsy, and obstructive airways disease with severe airflow limitation.
It is unsuitable where the increased work of breathing cannot be sustained, such as severe airflow obstruction or exhaustion.
Use with great caution alongside other CNS stimulants and where coronary artery disease is present.

Monitoring

Maintain continuous monitoring of blood pressure, heart rhythm, oxygenation, and blood gases during the infusion.

Counselling the patient

This is a hospital-only treatment given by drip under close observation.
Staff will watch your breathing, heart, and blood pressure throughout.
Tell staff at once if you feel agitated, breathless, or have palpitations.

Evidence & guidelines

Doxapram retains a limited specialist role as a respiratory stimulant in acute ventilatory failure when ventilatory support is not appropriate, used with intensive monitoring.

Reference: NICE; BTS/SIGN COPD Guidelines; 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 hydrochloride · Respiratory stimulant

Pathways