Doxapram
Doxapram hydrochloride
Also known as: Dopram-V · Respiram · Docatone · Doxapril · AHR-619 · doxaprami hydrochloridum
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Audited v13 dosing evidence
Reviewed non-calculator evidenceReviewed non-calculator evidence (4)
Evidence only — not for automatic calculation
Most species/respiratory stimulant
TABLE 127.5. Agent: Doxapram. Dosage: 20 mg/kg IM, IV, IO232. Species/Comments: Most species/respiratory stimulant.
Evidence only — not for automatic calculation
American alligators/immediate dose-dependent increase in breathing frequency
TABLE 127.5. Agent: Doxapram. Dosage: 5–10 mg/kg IV303. Species/Comments: American alligators/immediate dose-dependent increase in breathing frequency.
Evidence only — not for automatic calculation
Most species/respiratory stimulant
TABLE 127.5. Agent: Doxapram. Dosage: 4–12 mg/kg IM, IV295. Species/Comments: Most species/respiratory stimulant.
Evidence only — not for automatic calculation
Most species/respiratory stimulant; reduces recovery time; reported to partially “reverse” effects of dissociatives183
TABLE 127.5. Agent: Doxapram. Dosage: 5 mg/kg IM, IV22 q10min prn. Species/Comments: Most species/respiratory stimulant; reduces recovery time; reported to partially “reverse” effects of dissociatives183.
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Doxapram is a centrally acting analeptic agent (CNS and respiratory stimulant). In veterinary medicine, it is primarily utilized to stimulate respiration during or after general anesthesia and to speed awakening. It is also uniquely valuable for the assessment of laryngeal function (e.g., diagnosing laryngeal paralysis) under light anesthesia, as it stimulates deep inspiratory efforts that make arytenoid cartilage movement easier to evaluate.
Clinical Pearl: Historically, doxapram was routinely administered (often sublingually or via the umbilical vein) to stimulate breathing in neonates following dystocia or C-section. This use is now highly controversial. Doxapram significantly increases myocardial and cerebral oxygen demand. In an already hypoxic neonate, this can be detrimental. Current neonatal resuscitation guidelines strongly emphasize clearing the airway, providing oxygen, and utilizing positive pressure ventilation (mechanical support) over the use of analeptic drugs.
Mechanism of action
Doxapram is a generalized CNS stimulant. Its respiratory effects are primarily driven by:
- Direct stimulation of the medullary respiratory centers.
- Reflex activation of peripheral carotid and aortic chemoreceptors.
This dual action leads to transient increases in tidal volume and respiratory rate.
Mechanistic Note: While doxapram increases respiratory effort, it simultaneously increases the overall work of breathing, metabolic rate, and carbon dioxide production. Consequently, it does not reliably improve arterial oxygenation, which is why it cannot replace mechanical ventilation in severely hypoxic patients.
Safety & warnings
Contraindications
- Patients receiving mechanical ventilation
- Hypersensitivity to doxapram
- Seizure disorders
- Head trauma or cerebrovascular accidents (CVA)
- Uncompensated heart failure
- Severe hypertension
- Respiratory failure secondary to neuromuscular disorders
- Airway obstruction
- Pulmonary embolism
- Pneumothorax
- Acute asthma
- Dyspnea
- Hypoxia not associated with hypercapnia
- Premature calves or patients with clinical signs of lung immaturity
Adverse effects
- Hypertension
- Arrhythmias
- Tachycardia
- Seizures (at high doses)
- Hyperventilation leading to respiratory alkalosis
- Increased myocardial oxygen demand
- Reduced cerebral blood flow
- Skeletal muscle hyperactivity
Precautions
Use with extreme caution in patients with a history of asthma, arrhythmias, tachycardias, cerebral edema, increased CSF pressure, pheochromocytoma, or hyperthyroidism. Doxapram is NOT a substitute for aggressive artificial (mechanical) respiratory support. Avoid IV extravasation or using a single injection site for a prolonged period. Repeated IV doses in neonates should be administered with caution because the commercial product contains benzyl alcohol as a preservative.
Drug interactions
Doxapram may increase epinephrine release and sensitize the myocardium to catecholamines. Use should be delayed for ~10 minutes after discontinuing these anesthetics.
Doxapram may mask the effects of muscle relaxant drugs.
Additive pressor (blood pressure increasing) effects may occur.
Monitoring
- Respiratory rate and effort
- Cardiac rate and rhythm
- Blood gases (if available and indicated)
- CNS level of excitation and reflexes
- Blood pressure (if indicated)
Pharmacokinetics
Absorption
Onset of effect after IV injection usually occurs rapidly, within 2 minutes.
Distribution
The drug is well distributed into tissues.
Metabolism
In dogs, doxapram is rapidly metabolized.
Elimination
Most is excreted as metabolites in the urine within 24-48 hours after administration. Small quantities of metabolites may be excreted up to 120 hours after dosing.
Overdose
The reported LD50 for IV administration in neonatal dogs and cats is approximately 75 mg/kg.
Clinical signs of overdosage include:
- Respiratory alkalosis
- Hypertension
- Skeletal muscle hyperactivity
- Tachycardia
- Generalized CNS excitation, including seizures
Treatment: Treatment is primarily supportive. Drugs such as short-acting IV barbiturates may be used to help decrease CNS hyperactivity. Oxygen therapy may be necessary.
Available products
Formulations
- Injection: 20 mg/mL
Veterinary
- Doxapram HCl for Injection: 20 mg/mL in 20 mL multi-dose vials (Dopram-V, Respiram)
Human-labeled
- Doxapram HCl for Injection: 20 mg/mL in 20 mL multi-dose vials (Dopram, generic)
Regulatory status
No regulatory data for: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Store at room temperature and avoid freezing the solution. Do not mix with alkaline solutions (e.g., thiopental, aminophylline, sodium bicarbonate). Doxapram is physically compatible with D5W or normal saline.
Client information
Doxapram is an emergency and anesthetic adjunct medication used exclusively in a hospital setting under direct professional supervision.
- Your veterinarian may use this medication to help stimulate your pet's breathing as they wake up from anesthesia.
- It is also frequently used during specific diagnostic procedures, such as evaluating the function of the larynx (voice box) in dogs suspected of having laryngeal paralysis.
- Because it stimulates the central nervous system, your pet will be closely monitored for changes in heart rate, breathing rate, and neurological status while receiving this drug.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.