Aminophylline/Theophylline : Loading and maintenance dose

Intravenous Note: Aminophylline is the soluble form of theophylline used for injectable preparations. Doses are calculated based on measured or (as required theophylline serum levels, and therefore dosing needs to be converted to aminophylline . Aminophylline) Theophylline 1mg is equivalent to Aminophylline 1.25mg for dosing Patients NOT already receiving xanthines (theophylline or aminophylline) Loading dose: 5mg/kg aminophylline (using ideal body weight) slow bolus intravenous injection (20-30minutes) Using 10mg/mL diluted solution centrally or peripherally Using 25mg/mL undiluted solution centrally for patients with fluid restriction
Volume of 25mg/mL (undiluted) containing required dose (mL) 8 9 10 11 12 13 14 15 Loading dose infusion rate for 20 minutes only (mL/hr) Centrally only 24 27 30 33 36 39 42 45

Ideal bodyweight (kg)

Dose (mg)

Volume of 10mg/mL containing required dose (mL)

Loading dose infusion rate for 20 minutes only (mL/hr)

40 45 50 55 60 65 70 75 80 85 90

200 20 60 225 22.5 67.5 250 25 75 275 27.5 82.5 300 30 90 325 32.5 97.5 350 35 105 375 37.5 112.5 400 40 120 16 425 42.5 127.5 17 450 45 135 18 Ideal body weight- For men: 50kg + 2.3 for each inch over 5 ft (for each 2.5cm over 1.52m) For women: 49kg + 1.7 for each inch over 5ft (for each 2.5cm over 1.52m)

48 51 54

Patient already receiving xanthine (theophylline or aminophylline) Note: Common practice at ELHT is to omit the loading dose step and give the maintenance infusion Loading dose: Use the current serum level to calculate a loading dose based on the expectation that each 0.5mg/kg of theophylline administered will result in a 1 microgram/mL increase in serum theophylline concentration. e.g.if the current theophylline serum level is 9 micrograms/mL and a target level of 15 micrograms/mL is desired , a loading dose of 3.75mg/kg aminophylline is needed (6 x 0.5mg/kg = 3mg/kg theophylline = 3.75mg/kg aminophylline). Prepared by N Fong, ELHT Pharmacy Date: 12/09/2011 V1 Approved by ELHE Medicines Management Board Review Date:12/09/2013

Aminophylline/Theophylline : Loading and maintenance dose

Maintenance dose of aminophylline (i.e. after loading dose) Maintenance dose infusion rate: (using 1mg/mL diluted solution) Ideal body weight (kg) Dose in mg/hr Infusion rate (mL/hr) (500micrograms/kg/hr) 40 20 20 50 25 25 60 30 30 70 35 35 80 40 40 90 45 45 The serum theophylline level should be check before any further clinical intervention (see monitor section)
Note: Young adult smoker, healthy non-smoker and older patients will need higher infusion rate. Please refer to the summary of product characteristic

Oral maintenance

Aminophylline: Adults - The usual dose is two PHYLLOCONTIN CONTINUS tablets 225 mg, or one or two PHYLLOCONTIN Forte CONTINUS tablets 350mg twice-daily following an initial week of therapy on one tablet twice-daily. Slo-phyllin: Adults- 125-250mg twice daily

Uniphyllin: The usual maintenance dose for adults and elderly patients is 200 mg 12 hourly. This may be titrated to either 300 mg or 400 mg dependent on the therapeutic response. Intravenous Infuse in sodium chloride 0.9%, glucose 5%, glucose 4% and sodium chloride 0.18% or compound sodium lactate (Hartmanns) Administration Dilution: maximum concentration 25mg in 1mL Monitoring For intravenous administration: Take samples from the opposite arm to that which the infusion is running. If patient was on oral theophylline or aminophylline then a serum theophylline level should be taken prior to starting infusion. After loading, the serum concentration should be at steady state; serum theophylline level should be taken six hours after starting the maintenance infusion. Levels should subsequently be taken on a daily basis. As the patient is at steady state on a continuous infusion, timing of levels is not critical. The therapeutic range should be between 55-110 micromol/L (or 10-20 mg/L or micrograms/mL) Infusion rate should be adjusted to maintain plasma level between these levels. Monitor heart rate, BP and potassium level; signs of toxicity: nausea, trachycardia, irritability, arrhythmias and convulsions Prepared by N Fong, ELHT Pharmacy Approved by ELHE Medicines Management Board Date: 12/09/2011 V1 Review Date:12/09/2013

Aminophylline/Theophylline : Loading and maintenance dose

For oral: Steady state theophylline levels are generally attained 3-4 days after dose adjustment. If a satisfactory clinical response is not achieved, serum theophylline should be measured 4 6 hours after the last dose. References: BNF 61 March 2011 Aminophyllin 250mg/mL Injection (Goldshield Plc) Summary of Product Characteristic Apr 2011 Phyllocontin Continus Tablets (Napp Pharmaceuticals Ltd) Summary of Product Characteristic Sep 2009 Slo-Phyllin Capsules (Merck Serono) Summary of Product Characteristic Jan 2010 Uniphyllin Tablets (Napp Pharmaceuticals Ltd) Summary of Product Characteristic Feb 2011 Injectable Medicines Guide (Medusa) accessed June 2011 Injectable Drugs Guide Pharmaceutical Press 2011 Injectable Medicines Administration Guide UCL 3rd Edition

Prepared by N Fong, ELHT Pharmacy Date: 12/09/2011

V1

Approved by ELHE Medicines Management Board Review Date:12/09/2013