1. Name Of The Medicinal Product
Dopram Injection
Doxapram Hydrochloride 20mg/ml Solution for Injection
2. Qualitative And Quantitative Composition
Dopram Injection contains 20mg Doxapram Hydrochloride BP per ml.
3. Pharmaceutical Form
Sterile solution for intravenous injection.
4. Clinical Particulars
4.1 Therapeutic Indications
Doxapram acts as a ventilatory stimulant and Dopram Injection is used following anaesthesia to stimulate ventilation in the post-operative period as an aid to the reduction of post-operative pulmonary complications, and to permit the use of effective doses of narcotic analgesics without associated problems of ventilatory depression. Dopram Injection is also used to increase CNS arousal and spontaneous respiratory activity from inhalational anaesthesia when this would be beneficial.
4.2 Posology And Method Of Administration
Dopram Injection is recommended for intravenous use only.
Adults and older patients:
The recommended dosage is 1.0 to 1.5mg/kg body weight, administered over a period of 30 seconds or more, which may be repeated at one hour intervals, if necessary.
Children: Not recommended.
4.3 Contraindications
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4.4 Special Warnings And Precautions For Use
1. Dopram should be administered concurrently with oxygen to patients with severe irreversible airways obstruction or severely decreased lung compliance, due to the increased work of breathing in these patients.
2. In patients presenting with bronchoconstriction, Dopram should always be used in conjunction with β-adrenoceptor bronchodilator drugs in order to reduce the amount of respiratory effort.
3. As Dopram is metabolised primarily by the liver, use with care in patients with hepatic dysfunction.
4. Dopram should be administered cautiously to patients receiving sympathomimetic agents since an additive pressor effect may occur.
5. Dopram should be used with great care in patients who are being treated concurrently with monoamine oxidase inhibiting drugs. Animal studies have shown that the action of doxapram is potentiated after pre-treatment with a MAOI.
6. In patients who have received anaesthetics known to sensitize the myocardium to catecholamines, such as halothane, cyclopropane, and enflurane, initiation of Dopram therapy should be delayed for at least 10 minutes following discontinuance of anaesthesia, since an increase in adrenaline release has been noted with Dopram administration.
7. The respiratory stimulant effect of Dopram may not outlast the residual effects of the depressant drugs. Since respiratory depression may recur after stimulation with Dopram, the patient should be closely monitored until fully alert for ½ to 1 hour. Dopram may temporarily mask the residual effects of curare-type muscle relaxant drugs.
8. Dopram should be administered with caution in patients with hypermetabolic states such as phaeochromocytoma.
9. If sudden hypotension or dyspnoea develops, Doxapram should be stopped.
10. Monitoring of the blood pressure and deep tendon reflexes is recommended to prevent overdosage.
11. To avoid side effects, it is advisable to use the minimum effective dosage.
12. Doxapram should not be used in conjunction with mechanical ventilation.
13. An adequate airway is essential and airway protection should be considered since Doxapram way stimulate vomiting.
4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction
Clinical data suggest that concurrent use of aminophylline and Dopram may be associated with agitation, muscle fasciculation and hyperactivity. Care should thus be taken when these two drugs are used concomitantly.
Dopram should also be administered with great care to patients being treated concurrently with monoamine oxidase inhibitors (MAOIs). Animal studies have shown that the action of Dopram may be potentiated after pretreatment with a MAOI.
Dopram may potentiate the effects of sympathomimetic agents.
4.6 Pregnancy And Lactation
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 the benefit to the risk.
It is not known whether this drug is excreted in human milk. Therefore, caution should be exercised when Dopram is administered to a lactating mother.
4.7 Effects On Ability To Drive And Use Machines
Not applicable.
4.8 Undesirable Effects
Dopram may produce adverse effects due to general stimulation of the central, peripheral and autonomic nervous systems: pyrexia, sweating, flushing, headache, dizziness, hyperactivity, confusion, hallucinations, perineal warmth, muscle fasciculation, muscle spasticity, clonus, bilateral babinski, increased deep tendon reflexes and convulsions have been reported.
Respiratory problems such as dyspnoea, cough, bronchospasm and laryngospasm may occur.
Cardiovascular effects have been observed and include a moderate increase in blood pressure, arrhythmias, sinus tachycardia, bradycardia and extrasystoles, chest pain or chest tightness.
Effects on the gastrointestinal tract such as nausea and vomiting may also occur.
Genitourinary:
Urinary retention, stimulation of urinary bladder with spontaneous voiding.
4.9 Overdose
Overdosage may result in hypertension, tachycardia and other arrhythmias; skeletal muscle hyperactivity including enhanced deep tendon reflexes, and dyspnoea. Serious symptoms of overdosage may include clonic and generalized seizures. Intravenous diazepam, phenytoin, and short-acting barbiturates, oxygen and resuscitative equipment should be readily available to manage overdoses.
5. Pharmacological Properties
5.1 Pharmacodynamic Properties
The principal pharmacological action of Dopram is an increase in minute volume produced primarily by an increase in tidal volume and to a lesser extent by changes in respiratory rate. Neuropharmacological studies have shown that the primary sites of action of Dopram are the peripheral carotid chemoreceptors. It is considered that this site of action of Dopram is responsible for its relative specificity of action; it is only following large doses of doxapram hydrochloride that non-specific central nervous system stimulation occurs.
5.2 Pharmacokinetic Properties
Following an I.V. bolus injection of 1.5mg/kg doxapram, the plasma concentration of doxapram declined in a multi-exponential manner. The mean half-life from 4 – 12 hours was 3.4 hours (range 2.4 – 4.1 hours). The mean apparent volume of distribution was 1.5 litres/kg and the whole body clearance was 370ml/min. Renal clearance was not related to urine flow or pH, but increased progressively with time over the first 12 hours. The mean 0 – 24 hour renal clearance values for individual volunteers ranged from 1.1 to 14.1ml/min. The rate of decline of plasma concentration appeared to decrease after 12 hours. Doxapram was extensively metabolised, and less than 5% of an I.V. dose was excreted unchanged in the urine in 24 hours.
5.3 Preclinical Safety Data
Reproduction studies have been performed in rats at doses up to 1.6 times the human dose and have revealed no evidence of impaired fertility or harm to the foetus associated with the use of doxapram. Acute toxicity studies in several animal species suggest impairment of the central nervous system at high doses.
6. Pharmaceutical Particulars
6.1 List Of Excipients
Water for Injections
6.2 Incompatibilities
Dopram is incompatible with alkaline solutions such as aminophylline, frusemide and thiopentone sodium.
6.3 Shelf Life
4 years.
6.4 Special Precautions For Storage
Do not store above 25°C.
Do not refrigerate.
6.5 Nature And Contents Of Container
Primary container: Clear type I one point-cut (OPC) glass ampoules
Secondary container: Cardboard carton
Presentation: Each ampoule contains 5ml
6.6 Special Precautions For Disposal And Other Handling
Not applicable
Administrative Data
7. Marketing Authorisation Holder
Anpharm Limited
Roscrea
Co. Tipperary
Ireland
8. Marketing Authorisation Number(S)
PL 15372/0001
9. Date Of First Authorisation/Renewal Of The Authorisation
20/03/2006
10. Date Of Revision Of The Text
March 2009
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