Aminophylline

Note: All dosages expressed as aminophylline; use ideal body weight (theophylline distributes poorly into body fat) to calculate dose; individualize dose based on steady-state serum concentrations. Theophylline dose is ~79% of aminophylline dose. The treatment of asthma exacerbations with aminophylline is not supported or recommended by current clinical practice guidelines (GINA 2016; NAEPP 2007). The treatment of acute COPD exacerbations with aminophylline is not recommended by current clinical practice guidelines (Global Initiative for COPD Guidelines 2017). Reversible airflow obstruction, acute symptoms: Loading dose: IV: Patients who have not received aminophylline or theophylline in the previous 24 hours: 5.7 mg/kg. Patients who have received aminophylline or 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: Loading dose = (desired serum theophylline concentration - measured serum theophylline concentration) (Vd) Maintenance dose: IV: Note: Dosing presented is to achieve a target theophylline concentration of 10 mcg/mL. Lower initial doses may be required in patients with reduced theophylline clearance. Dosage should be adjusted according to serum level measurements. Adults ≤60 years: 0.51 mg/kg/hour; maximum dose: 1,139 mg/day unless serum levels indicate need for larger dose. Adults >60 years: 0.38 mg/kg/hour; maximum dose: 507 mg/day unless serum levels indicate need for larger dose. Cardiac decompensation, cor pulmonale, sepsis with multiorgan failure, and shock: 0.25 mg/kg/hour; maximum dose: 507 mg/day unless serum levels indicate need for larger dose. Dosage adjustment based on serum theophylline concentrations: Note: Recheck serum theophylline concentration 24 hours after dosage adjustment. 10 to 14.9 mcg/mL: Maintain infusion rate if dosage is tolerated and symptoms controlled. Recheck serum concentrations at 24-hour intervals. If symptoms are not controlled and dosage is tolerated, consider adding additional medications to treatment regimen. 15 to 19.9 mcg/mL: Consider 10% dose reduction in infusion rate to improve safety margin even if dose is tolerated. 20 to 24.9 mcg/mL: Decrease infusion rate by 25% even if no adverse effects present. 25 to 30 mcg/mL: Stop infusion for 24 hours and decrease subsequent infusion rate at least 25%. If symptomatic, stop infusion and consider whether overdose treatment is indicated. >30 mcg/mL: Stop infusion and treat overdose; if resumed, decrease subsequent infusion rate at least 50%. Reversal of adenosine-, dipyridamole-, or regadenoson-induced adverse reactions (eg, angina, hypotension) during nuclear cardiac stress testing (off-label use): IV: 50 to 250 mg administered over 30 to 60 seconds, repeat as necessary. Note: Since adenosine-induced side effects are short lived after discontinuation of the infusion, aminophylline administration is only very rarely required (ASN