Usual Adult Dose for Asthma - Acute

THESE RECOMMENDATIONS SHOULD SERVE AS THE UPPER LIMIT FOR DOSE ADJUSTMENTS
ADJUST DOSE BASED ON SERUM THEOPHYLLINE CONCENTRATIONS

Loading dose (to achieve a target serum concentration of 10 mcg/mL theophylline):
For patients with NO theophylline use in the previous 24 hours:

• 5.7 mg aminophylline/kg (ideal body weight) intravenously over 30 minutes

For patient who HAVE had theophylline in the past 24 hours, based on theophylline serum concentration measurements in mcg/mL:

• Loading dose = (Desired concentration - measured concentration) (volume of distribution)
• Mean volume of distribution can be assumed to be 0.5 L/kg (actual range 0.3 to 0.7).
• Desired serum concentration should be conservative (e.g. 10 mcg/mL) to allow for variability of volume of distribution.

Once a serum concentration of 10 to 15 mcg/mL theophylline is achieved by loading dose:
1 mg aminophylline/kg ideal body weight/hour as a constant infusion

• Obtain a second serum theophylline concentration about one half-life after starting the infusion; the manufacturer product information should be consulted.

Comments:

• Steady state serum theophylline concentrations are a function of the infusion rate and rate of theophylline clearance in the individual patient.
• The dose required to achieve a serum theophylline concentration in the 10 to 20 mcg/mL range varies fourfold because of different rates of theophylline clearance.
• There is no single dose that is safe and effective for all patients.
• Administering the median dose may result in subtherapeutic or toxic blood levels.
• The dose must be individualized based on serum theophylline concentrations to achieve maximum benefit with minimal risk.
• Do not give a loading dose until a serum theophylline concentration has been obtained if the patient received any theophylline in the previous 24 hours.
• For acute bronchodilation, a therapeutic serum concentration is best achieved with an intravenous loading dose.

Use(s): As an adjunct to inhaled beta-2 selective agonists and systemic corticosteroids for treatment of acute exacerbations of the symptoms and reversible airflow obstruction associated with asthma and other chronic lung diseases such as emphysema and chronic bronchitis

Usual Geriatric Dose for Asthma - Acute

THESE RECOMMENDATIONS SHOULD SERVE AS THE UPPER LIMIT FOR DOSE ADJUSTMENTS
ADJUST DOSE BASED ON SERUM THEOPHYLLINE CONCENTRATIONS

Loading dose (to achieve a target serum concentration of 10 mcg/mL theophylline):
For patients with NO theophylline use in the previous 24 hours:

• 5.7 mg aminophylline/kg (ideal body weight) intravenously over 30 minutes

For patient who HAVE had theophylline in the past 24 hours, based on theophylline serum concentration measurements in mcg/mL:

• Loading dose = (Desired concentration - measured concentration) (volume of distribution)
• Mean volume of distribution can be assumed to be 0.5 L/kg (actual range 0.3 to 0.7).
• Desired serum concentration should be conservative (e.g. 10 mcg/mL) to allow for variability of volume of distribution.

Once a serum concentration of 10 to 15 mcg/mL theophylline is achieved by loading dose:
1 mg aminophylline/kg ideal body weight/hour as a constant infusion

• Obtain a second serum theophylline concentration about one half-life after starting the infusion; the manufacturer product information should be consulted.

Comments:

• Careful attention to dose reduction and frequent monitoring of serum theophylline concentrations are required.
• Steady state serum theophylline concentrations are a function of the infusion rate and rate of theophylline clearance in the individual patient.
• The dose required to achieve a serum theophylline concentration in the 10 to 20 mcg/mL range varies fourfold because of different rates of theophylline clearance.
• There is no single dose that is safe and effective for all patients.
• Administering the median dose may result in subtherapeutic or toxic blood levels.
• The dose must be individualized based on serum theophylline concentrations to achieve maximum benefit with minimal risk.
• Do not give a loading dose until a serum theophylline concentration has been obtained if the patient received any theophylline in the previous 24 hours.
• For acute bronchodilation, a therapeutic serum concentration is best achieved with an intravenous loading dose.

Use(s): As an adjunct to inhaled beta-2 selective agonists and systemic corticosteroids for treatment of acute exacerbations of the symptoms and reversible airflow obstruction associated with asthma and other chronic lung diseases such as emphysema and chronic bronchitis

Usual Pediatric Dose for Asthma - Acute

THESE RECOMMENDATIONS SHOULD SERVE AS THE UPPER LIMIT FOR DOSE ADJUSTMENTS
ADJUST DOSE BASED ON SERUM THEOPHYLLINE CONCENTRATIONS

Loading dose (to achieve a target serum concentration of 10 mcg/mL theophylline):
For patients with NO theophylline use in the previous 24 hours:

• 5.7 mg aminophylline/kg (ideal body weight) intravenously over 30 minutes

For patient who HAVE had theophylline in the past 24 hours, based on theophylline serum concentration measurements in mcg/mL:

• Loading dose = (Desired concentration - measured concentration) (volume of distribution)
• Mean volume of distribution can be assumed to be 0.5 L/kg (actual range 0.3 to 0.7).
• Desired serum concentration should be conservative (e.g. 10 mcg/mL) to allow for variability of volume of distribution.

Once a serum concentration of 10 to 15 mcg/mL theophylline is achieved by loading dose:
1 mg aminophylline/kg ideal body weight/hour as a constant infusion

• Obtain a second serum theophylline concentration about one half-life after starting the infusion; the manufacturer product information should be consulted.

Comments:

• Select the infusion rate with caution, as theophylline clearance is highly variable across the age range of neonates to adolescents.
• Patients under 1 year old have immature theophylline metabolic pathways; particular attention to dosage and frequent monitoring of serum theophylline concentrations are required.
• Steady state serum theophylline concentrations are a function of the infusion rate and rate of theophylline clearance in the individual patient.
• The dose required to achieve a serum theophylline concentration in the 10 to 20 mcg/mL range varies fourfold because of different rates of theophylline clearance.
• There is no single dose that is safe and effective for all patients.
• Administering the median dose may result in subtherapeutic or toxic blood levels.
• The dose must be individualized based on serum theophylline concentrations to achieve maximum benefit with minimal risk.
• Do not give a loading dose until a serum theophylline concentration has been obtained if the patient received any theophylline in the previous 24 hours.
• For acute bronchodilation, a therapeutic serum concentration is best achieved with an intravenous loading dose.

Use(s): As an adjunct to inhaled beta-2 selective agonists and systemic corticosteroids for treatment of acute exacerbations of the symptoms and reversible airflow obstruction associated with asthma and other chronic lung diseases such as emphysema and chronic bronchitis

Renal Dose Adjustments

No adjustment recommended in adults and children over 3 months with renal insufficiency

• Careful attention to dose reduction and frequent monitoring of serum theophylline concentrations is required in neonates, as a large fraction dose is excreted unchanged in the urine in neonates.

Liver Dose Adjustments

Dose adjustment(s) may be required; however, no specific guidelines have been suggested. Caution is recommended.

• Theophylline clearance is decreased by 50% in hepatic insufficiency.
• Frequent monitoring of serum theophylline concentrations is required.

Precautions

CONTRAINDICATIONS:

• Hypersensitivity to any of the ingredients, theophylline, or ethylenediamine

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Storage requirements:

• Store at controlled room temperature
• Protect from light; store in original carton until time of use

IV compatibility:

• Do not mix in the same syringe as other medications
• Add separately to the intravenous solution.

Monitoring:

• If patients develop nausea or vomiting, particularly repetitive vomiting, or other symptoms consistent with theophylline toxicity, stop the infusion and measure serum theophylline immediately, even if another cause of toxicity is suspected.
• Since theophylline clearance may be dose dependent, dose increases because of subtherapeutic serum concentrations should be conservative; limiting increases to about 25% of the previous infusion rate reduces the risk of excessive serum theophylline concentrations.
• Carefully consider interacting drugs and physiologic conditions that may affect theophylline clearance prior to initiating therapy and prior to dose increases.
• Serum theophylline concentration measurements are readily available and should be used to determine whether the dosage is appropriate.
• Measure serum theophylline before dose increases, for signs and symptoms of theophylline toxicity, for new illness or worsening of existing illness, or changes in the treatment regimen that may alter theophylline clearance.
• The manufacturer product information should be consulted for specific monitoring guidelines.