Respiratory stimulants like doxapram, caffeine, and theophylline work by stimulating the respiratory center in the brainstem and medulla, leading to increased breathing. They can also cause bronchodilation by inhibiting phosphodiesterase enzymes. These drugs are used to treat conditions involving respiratory depression, asthma, and apnea of prematurity. Common side effects include muscle tremors, agitation, gastrointestinal issues, and cardiovascular effects like hypertension and arrhythmias. Therapeutic monitoring of vital signs and drug levels is important when using respiratory stimulants.

1. By
Dr. Dinesh Kumar G
Pharm. D

11. RESPIRATORY STIMULANTS
DRUG NAME doxapram, caffeine, theophylline, aminophylline
CLASS Respiratory stimulants
MECHANISM of ACTION
•Stimulate respiratory center in the brainstem and medulla → respiratory
stimulation
•Phosphodiesterase enzyme inhibitors → bronchodilation
INDICATIONS
•Asthma
•Respiratory depression
•Apnea of prematurity
ROA PO, IV
SIDE EFFECTS
•Muscle tremors
•Agitation, anxiety, irritability, insomnia
•Hypertension, heart palpitations, tachycardia, ECG abnormalities
•Gastrointestinal disturbances: nausea, vomiting, diarrhea
•Theophylline overdose: arrhythmias, seizures
•Caffeine (high doses to premature infants): intracranial hemorrhage
CONTRAINDICATIONS
and CAUTIONS
•Arteriosclerosis, cardiovascular disease, hypertension
• Pregnancy and breastfeeding
•History of seizures
•Hepatic or renal disease
•Theophylline: drug interactions with beta blockers, phenytoin, beta adrenergic
agonists, antidepressants, cimetidine, ciprofloxacin, tobacco smoke, and marijuana

12. CONSIDERATIONS FOR
RESPIRATORY STIMULANTS
Assessment and monitoring
•Assessment
Vital signs, especially respiratory rate; SpO2, lung sounds
•Laboratory test results: renal and hepatic function
•Monitoring
Vital signs
•Serum drug concentration levels; not to exceed 20 mcg/mL
•Side effects
•Evaluate therapeutic response: improved airflow and decreased respiratory effort
Client education
Purpose of medication: help them to breathe easier
•Take medication in the morning, with or without food
• Avoid taking at bedtime
•Avoid smoking, alcohol, and dietary sources of caffeine, like coffee, tea, soda, and
chocolate
•Side effects to report
• Nausea, irritability, anxiety, tachycardia, palpitations, insomnia, nausea
• If side effects are persistent or severe
• Symptoms of toxicity: dizziness, lightheadedness, fatigue, weakness, shortness
of breath