Theophylline

Note: Individualize dose based on steady-state serum concentrations; use ideal body weight (theophylline distributes poorly into body fat) to calculate dose. Reversible airflow obstruction, acute symptoms: Loading dose: IV, Oral (immediate release solution): Asthma exacerbations: The treatment of asthma exacerbations with theophylline is not supported or recommended by current clinical practice guidelines (GINA 2017; NAEPP 2007). COPD treatment: The treatment of acute COPD with theophylline IV is not supported or recommended by current clinical practice guidelines due to significant side effects (Global Initiative for COPD Guidelines 2017). Patients who have not received theophylline in the previous 24 hours: 4.6 mg/kg/dose IV (preferred route) or 5 mg/kg orally (immediate release only [oral solution]). Note: Loading dose intended to achieve a serum level of ~10 mcg/mL (range: 5 to 16 mcg/mL). On the average, for every 1 mg/kg theophylline given, blood levels will rise 2 mcg/mL. Obtain theophylline serum concentration 30 minutes (IV) or 24 hours (oral) after loading dose (when distribution is complete) to assess the need for and size of subsequent loading doses (and for guidance of continuing therapy). Patients who have received theophylline in the previous 24 hours: A loading dose should not be given before obtaining a serum theophylline concentration. The loading dose should be calculated as follows: Dose = (desired serum theophylline concentration - measured serum theophylline concentration) (Vd) Maintenance: Continuous IV infusion: Note: Dosing presented is to achieve a target concentration of 10 mcg/mL unless otherwise noted. Lower initial doses may be required in patients with reduced theophylline clearance. Dosage should be adjusted according to serum level measurements during the first 12- to 24-hour period. Adults ≤60 years: 0.4 mg/kg/hour; maximum: 900 mg/day unless serum levels indicate need for larger dose. Adults >60 years: 0.3 mg/kg/hour; maximum: 400 mg/day unless serum levels indicate need for larger dose. Cardiac decompensation, cor pulmonale, sepsis with multiorgan failure, or shock: 0.2 mg/kg/hour; maximum: 400 mg/day, unless serum levels indicate need for larger dose. Reversible airflow obstruction, chronic conditions: Oral: Note: Increase dose only if tolerated and if needed. Consider lowering dose or using a slower titration if caffeine-like adverse events occur. May use smaller doses more frequently in patients requiring higher than average doses prevent breakthrough symptoms. If at risk for impaired theophylline clearance or not feasible to monitor serum theophylline concentrations, do not exceed maximum dose of 400 mg/day. Immediate release (oral solution) (without risk factors for impaired clearance): Initial: 300 mg/day in divided doses every 6 to 8 hours; if tolerated, after 3 days increase to 400 mg/day divided every 6 to 8 hours; if tolerated, after 3 more days increase to 600 mg/day divided every 6 to 8 hours. Exten