Intravenous aminophylline dosage. Use of serum theophylline measurement for guidance

Abstract

A practical method for monitoring serum theophylline concentrations has been used to investigate intravenous aminophylline dosage requirements. Initial serum theophylline concentrations were found to vary widely and correlate poorly with drug history. Aminophylline loading doses determined from these values more frequently resulted in drug concentrations in the therapeutic range (10 mug to 20 mug/ml) than when therapy was given without knowledge of serum theophylline concentrations. Continuous intravenous aminophylline therapy administered in a standardized dosage (0.9 mg/kg/hr in adults and 1.0 mg/kg/hr in children) produced variable and often excessive serum concentrations. This resulted from variable drug clearance rates, which in adults averaged 0.64 +/- 0.38 ml/kg/min (mean +/- SD), only half that previously reported. These observations suggest that it is not possible to achieve optimal therapeutic aminophylline dosage without monitoring serum theophylline concentrations.

Serum level monitoring of a new slow release theophylline formulation in patients with chronic lung disease.

“…The profiles of the patients in the clinical monitoring survey indicate numerous factors which might interact to influence theophylline clearance. Hepatic disease, left and right heart failure and severe airways obstruction all reduce theophylline clearance (Zwillich, Sutton, Neff, Cohen, Matthay&Weinberger, 1975;Weinberger, Matthay, Ginchansky, Chidsey & Petty, 1976;Jenne, Chick, Miller & Strickland, 1977;Jusko, Koup, Vance, Schentag & Kuritzky, 1977;Piafsky, Sitar, Rangno & Ogilvie, 1977a & Mangione, Imhoff, Lee, Shum & Jusko, 1978;Powell, Vozeh, Hopewell, Costello, Sheiner & Riegelman, 1978;Vicuna, McNay, Ludden & Schwertner, 1979). The patients were receiving numerous drugs and various quantities of alcohol which might interfere with hepatic enzyme activity and theophylline clearance.…”

Avoidance of Adverse Effects during Chronic Therapy with Theophylline

“…15 " 18 Deaths resulting from theophylline toxicity have been most frequently reported among small children receiving multiple, adult-size doses that had been commonly administered as erratically-absorbed suppositories. 19 However, a recent report from a large university hospital described theophylline-induced seizures in eight adult patients during a 10-month period ( Figure 3). Four of the eight died without regaining consciousness following the seizure.…”

Contemporary Aminophylline Use for Status Asthmaticus in Pediatric ICUs

“…Six of these respondents (43%) identifi ed a therapeutic serum level of 10 to 20 m g/mL for aminophylline, the generally accepted therapeutic range. 4 There was variation in the reporting of both the minimal effective serum level (mean, 10 m g/mL; range, 5-15 m g/mL) and the toxic serum level (mean, 17.9 m g/mL; range, 10-25 m g/mL ).…”