Doxapram 💊
⚠️ Ceiling of care: This refers to the agreed maximum level of intervention a patient will receive. Doxapram is not an alternative to intubation and ventilation where these are indicated. Always monitor SpO₂ and arterial blood gases (ABG) closely. 🩺
ℹ️ About
Always check the BNF link here 📖 for full prescribing details.
- Doxapram is a respiratory stimulant occasionally used as a short-term measure in patients with hypoventilation who are not candidates for NIV or ITU-level care.
⚙️ Mode of Action
- Acts as a CNS stimulant, directly activating the medullary respiratory centres.
- Stimulates peripheral chemoreceptors in the carotid bodies → ↑ respiratory rate & tidal volume.
- Result: improved alveolar ventilation and oxygenation in type 2 respiratory failure (hypercapnia) 🌬️.
💊 Indications & Dose
| Indication | Dose / Frequency | Route |
| Hypoventilatory type 2 respiratory failure (when not for NIV/ITU) |
1–4 mg/min IV infusion, titrated to response |
IV |
⏱️ Onset: rapid (within 20–40 sec).
💡 Duration: short (≈ 5–12 min after bolus; longer with infusion).
⚠️ Interactions
- See BNF. May interact with sympathomimetics, anaesthetics, and drugs lowering seizure threshold.
🔎 Cautions
- Avoid in cerebral oedema, recent stroke, ischaemic heart disease, epilepsy, or severe hypertension.
- Requires monitoring in a high-dependency or ICU setting 🏥.
🚫 Contraindications
- See BNF for details. Generally contraindicated if ventilatory support is required but feasible (e.g. ITU/NIV available).
❗ Side Effects
- Cardiac: tachycardia, arrhythmias, hypertension ❤️.
- Neuro: agitation, seizures, headache, confusion 🧠.
- Other: pyrexia, sweating, nausea 🤢.
📚 References
- BNF - Doxapram
- British Thoracic Society: Oxygen and ventilatory support guidelines
📝 Revisions
- Updated 2018 - added cautionary notes on ceiling of care, monitoring, and side effects.
