Drug interactions- summary-

Doxapram +

Anesthestics-
in patients who received general anesthersia utilizing a volatile agent, known to sensitize
doxapram .,delay administration of doxapram until  the volatile agent has been excreted   

MAOIs -
administer cautiously to patients receiving these drugs because additive pressor can occur

Neuromuscular blocking agents-
doxapram may mask the residual efects of neuromuscular blocking agents

Sympthomimetics-
administer cautious to patients receiving these drugs becuase of additive effects.

Aminophylline /thophylline + Doxapram-
admmnister cautiously as increased skeletal muscle activity , agitation may occur

Postanesthesia
Drug induced CNS depression

Adverse reactions-

Cardiovascular- arrhyhthmias ( ventricular tachycardia, and ventricular fibrilation) chest pain,
                            lowered T -wave, tightness in chest, variations in heart rate

CNS -                  apphrensions, clonus, convulsions, disoreientation, dizziness, hallucinations,
                            headache, hyperacidity, involuntry movements,

GI -                      desire to defecate, diarrhea, nausea, vomiting,

GU -                    albuminuria, elevation of BUN,  stimulation of urinary bladder, with spontaneous
                             voiding, urinary retention

Hematologic /lymphatic -  decrease in hemoglobin, hemotocrit, or red blood count, has occurred
                          in postoperative patients

Respiratory -     broncospasm, cough, dyspnea, hiccoughs, hyperventilation,laryngo spasm,
                          rebound hypoventilation, tachypnea

Miscellaneous- flushing, increased deep tendon reflexus muscle fistulization, muscle spasticity.
                           puplilary dilation, pyrexia, sweating

Hypersensitivity to the drug

Special Precaution-
Postanesthetic use - narcosis may occurafter simulation with  doxapram , take care
to maintain close observation unitil the patient has been fully alert for 0.5 to 1 hour

COPD- do not use in conjunction with mechanical ventilation

Administration- avoid vascular extravasation or use of single injection site over an extended
period

Cardiovascular -monitor blood pressure , pulse rate, and deep tendon reflexes to prevent
overdosage

Renal/hapatic function- administer with caution with significant renal or hepatic impairment
as reduction of metabolism or excretion of metabolites may alter response.

Pregnancy-  use during prergnancy only when clearly needed

Lactation- excercisecaution when administering to a nursing mother.

Children- excercise caution when asministering to a nursing mother

Monitor- monitor blood pressure, pulse rate, and deep tendon reflexes to prevent
overdosage. Monitor for disturbances in cardiac rhythym

Indication-
Postanesthesia
Drug induced CNS depression

Dosage-
Postanesthesia-
                                   Recom. dose   Max dose per single inj   Max total dose
                                           mg/kg                        mg/kg                       mg/kg  
by IV administration        0.5 to 1                         1.5                            1.5

Repeat injection-            0.5 to 1                         1.5                              2

Infusion-                           0.5 to 1                                                            4
0.5  to 1mg/kg 
Maximum dose - 4mg/kg

Drug induced CNS depression-
Mild -                         single /repeat IV infusion         intermittant IV infusion 
 Mild                                    1mg/kg                                            1mg/kg/hr
Moderate -                          2mg/kg                                             2 to 3 mg.kg/hr

CNS Stimulants - Analeptics include-

Caffeine citrate, Doxapram Hcl, Modanafinil, Armodafinil

1. Do not exceed the recommended dosage

2. Discontinue use if increased or abnormal heart rate, dizziness, or palpitations occur

3. If fatigue persists or recurs.consult physician

4. Not intended for use as a substitute for normal sleep.

Pregnancy- 
Use during prergnancy only when clearly needed

Lactation-
Excercisecaution when administering to a nursing mother.

Children-
Excecise caution when asministering to a nursing mother