Guideline for Intravenous Aminophylline in adults
Indication
Intravenous (IV) aminophylline can be used in severe acute asthma or acute exacerbation of chronic
obstructive pulmonary disease.
Dosing considerations
Allergy or hypersensitivity to aminophylline or theophylline, caffeine or theobromine.
Contraindicated in acute porphyria.
For obese patients (BMI>30) dose must be calculated using ideal body weight (IBW) to avoid
excessive dosing
How to work out IBW:
Males: IBW (kg) = 50 kg + 2.3 kg for each inch over 5 feet.
Females: IBW (kg) = 45.5 kg + 2.3 kg for each inch over 5 feet
Monitoring
ECG – Cardiac side effects include: Arrhythmias, Hypotension, Tachycardia
Neurology – if convulsions are seen call a ‘MET call’
U+E’s – Hypokalaemia
Loading Dose (See appendix 1 for worked example)
If a patient is admitted on oral aminophylline or theophylline take a level 6 hours after it was
last taken and omit the loading dose
5mg per kg
Maximum loading dose is 500mg
Administration of loading dose
Add the required dose to 100ml compatible fluid (sodium chloride 0.9% or glucose 5%) and
administer over 30 minutes.
Maximum infusion rate of 25ml/minute
Maintenance dose (See appendix 1 for worked example)
500-700 microgram/kg/hour
Elderly or heart failure: 300microgram/kg/hour
Non-smoking adult: 500 micrograms/kg/hour
Smoking Adult: 700 micrograms/kg/hour
Administration of maintenance dose
Add 500mg aminophylline to 500ml of Sodium chloride 0.9% or glucose 5% to administer a
1mg/1ml solution
Maximum administration rate: 25mg/minute
Available as: 250mg/10ml ampoules
Therapeutic Drug monitoring
Take levels 4- 6 hours after starting infusion then daily thereafter
Therapeutic range 10 - 20mg/L
Interactions (See BNF for full list of interactions)
Increased aminophylline concentration Decreased aminophylline concentration
Antibiotics e.g. clarithromycin, erythromycin, Antiepileptic medication e.g. phenytoin &
ciprofloxacin carbamazepine
Antifungals e.g. Fluconazole, ketoconazole Alcohol
Antivirals e.g. Aciclovir Smoking
Diltiazem, verapamil & other calcium channel blockers
Ulcer healing drugs e.g. cimetidine
Elderly
Liver Failure
Heart Failure
Protocol written by: Monograph checked by: Code:
(Name/Job Title/ Date) (Name/Job Title/ Date)
Lucy Lelliott, Rotational Specialist Ana Armstong, Lead Medicine Pharmacist Review Date:
Pharmacist, August 2016 August 2016, Approved by D+T August 2016 August 2018
Appendix1: Worked examples
Ideal body weight worked example
Patient RW male, weighs 105kg, height 178cm (5ft 10) Males: IBW (kg) = 50 kg + 2.3 kg for each inch over 5 feet.
IBW = 50kg + (2.3kg x 10inches) = 73kg
Loading dose worked example:
Dose is 5mg/kg. Based on patient RW with an ideal body weight of 73kg:
5mg x 73kg = 365mg
Name: RW Hospital Number: 1234567 *CHECK ALLERGIES* MONTH:_________ YEAR:_______
DRUGS TO BE ADMINISTERED BY INFUSION
Date Time Infusion Solution Drugs & Dose to be Total Route Rate of Signature Batch Date Start Given by Pharm
added Volume Infusion Registration No (of time /checked by
No./Bleep admin.)
23/10/15 9:00 Sodium Aminophylline 100ml IV 30 Dr X
Chloride 0.9% 365mg minutes 987654
Maintenance dose worked example:
Dose is 500microgram/kg/hr. Based on patient RW with an ideal body weight of 73kg:
500micrograms x 73kg = 36.5mg/hr
Make up 500mg aminophylline in 500millitres of sodium chloride 0.9% (1mg/ml solution) – infuse at 36.5ml/hour (36.5mg/hour)
Name: RW Hospital Number: 1234567 *CHECK ALLERGIES* MONTH:_________ YEAR:_______
DRUGS TO BE ADMINISTERED BY INFUSION
Date Time Infusion Solution Drugs & Dose to Total Route Rate of Signature Batch Date Start Given by Pharm
be added Volume Infusion Registration No (of time /checked by
No./Bleep admin.)
23/10/15 9:00 Sodium Chloride Aminophylline 500ml IV 36.5 Dr x
0.9% 500mg ml/hour 987654
References:
1. SIGN/ BTS Asthma Guidelines 2012. accessed October 2015 via https://www.brit-thoracic.org.uk/document-library/clinical-information/asthma/btssign-guideline-on-the-management-of-asthma/
2. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press <http://www.medicinescomplete.com> [Accessed on [October 2015]]
3. UpToDate Ideal Body Weight Calculator (online) http://www.uptodate.com [Accessed August 2016]
4. Summary Product Characteristics (online) http://www.medicines.org.uk [Accessed August 2016}
Protocol written by: Monograph checked by: Code:
(Name/Job Title/ Date) (Name/Job Title/ Date)
Lucy Lelliott, Rotational Specialist Ana Armstong, Lead Medicine Pharmacist Review Date:
Pharmacist, August 2016 August 2016, Approved by D+T August 2016 August 2018
