Paediatric Prescribing Guideline
Severe Acute Asthma: IV Aminophylline
Author: D Annandale / C Chadwick / A Kapur / M Lazner
Approved: November 2020
Version: 1
Publication date: August 2020
Review date: August 2022
Introduction and indication for use
Intravenous (IV) aminophylline provides relief from severe bronchospasm associated with asthma
and forms part of the treatment of severe acute asthma.
IV Aminophylline should only be prescribed in:
Severe acute asthma, which is unresponsive to nebulized bronchodilators
Life threatening asthma
See the RACH Wheeze/asthma treatment pathway for further information.
IV Aminophylline must be prescribed and monitored carefully as a continuous infusion, which may or
may not require a loading dose (see below).
IV Aminophylline may only be administered in CED Resus (at initiation) or HDU
Cautions
Dosing considerations:
Obtain accurate weight for dosing. If an estimated weight is used, an accurate weight
MUST be obtained at the earliest opportunity to avoid toxicity
For obese children calculate the dose using TBW (total body weight) for loading dose and
IBW (ideal body weight) for maintenance
Children <1 year – metabolic pathway is immature, monitor these patients closely for signs
of toxicity
Many drugs interact with Aminophylline and can effect plasma concentrations. These
include some antibiotics and anti-epileptics. Check for drug interactions with a Pharmacist
or in the BNFc
Caution in:
History of seizure activity – risk of seizures even if levels within therapeutic range.
Consider alternative treatment. Monitor for signs of central stimulation if used.
Active influenza
Acute febrile illness
Plasma concentration may be increased in heart failure, hepatic impairment or chronic alcohol use
and renal impairment
Plasma concentration may be decreased in smokers (including cannabis)
Conditions that may be exacerbated by Aminophylline:
Peptic Ulcer Diabetes mellitus Compromised
Hyperthyroidism Severe hypoxaemia cardiac or circulatory
Glaucoma Hypertension function
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Paediatric Prescribing Guideline
Dose and Administration
Loading Dose: 5mg/kg (max 500mg) over 20 minutes. DO NOT GIVE loading dose if the patient
takes oral theophylline or aminophylline
Maintenance Infusion:
1 month – 11 years: 1mg/kg/hour
12 – 17 years: 0.5mg/kg/hour
Round calculated dose to the nearest whole number
Obese Dosing:
Calculate the dose using
TBW for loading dose
IBW for maintenance
(For further information See SPS article “How should medicines be dosed in children who are obese?” reference 11)
Example of prescribing for 18 kg five year old
Loading Dose:
Aminophylline 90mg IV 14:10 A. Doctor 8669
14/02/20
Maintenance Infusion:
Aminophylline A. Doctor
14/02/2020 14:30 Sodium chloride 0.9%w/v 500mL 500mg 18 mL/hr
8669
Administration (using aminophylline 25 mg/ml):
See Medusa IV Monograph for full administration information
Remove 20 mL from a 500 ml bag of 0.9% sodium chloride
Add 500mg Aminophylline to 480 mL Sodium Chloride 0.9% to get an aminophylline
concentration of 1 mg/ml
Prime the IV line with the prepared aminophylline infusion to avoid any delay in the child
receiving the medication
Administer via an infusion pump
If giving a loading dose, administer using the prepared infusion over 20 minutes
For the maintenance infusion, a concentration of 1mg/mL means the mg/kg/hour =
mL/kg/hour (e.g. 20mg/kg/hour dose = 20mL/kg/hour rate)
Always set the volume to be infused on the pump to prevent overdose
DO NOT administer aminophylline using the same IV access as Salbutamol infusion
(incompatible)
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Paediatric Prescribing Guideline
Monitoring
Monitor for clinical effect
Continuous cardiac monitoring (ECG & heart rate)
Observations (Respiratory Rate, Blood Pressure & Oxygen Saturation):
o Every 5 minutes for the first 10 minutes, then
o Every 15 minutes until patient stable and at least 1 hour since starting
o Hourly thereafter
U&Es every 12 hours (minimum) to monitor effect on potassium level
PLASMA LEVELS
Check the Plasma theophylline level every 6 hours until the level is stable, then every 24 hours
(aminophylline is converted to theophylline in vivo)
The therapeutic range is 10-20mg/L
A lower concentration (5 - 15 mg/L) may be effective in some individuals. Adverse effects can occur
within the 10 - 20 mg/L range, increasing in frequency and severity above 20 mg/L
Dose adjustment advice:
<5mg/L: Increase dose by 50% and re-check in 6 hours
5-15mg/L: Continue and re-check in 24 hours
15-20mg/L: Reduce dose by 50% and re-check in 24 hours
>20mg/L: STOP infusion and re-check in 6 hours
Round re-calculated doses to the nearest whole number
Side effects & signs of toxicity
Muscle tremors (especially in hands)
Tachycardia
Nausea & vomiting
Headaches
Agitation & hyperactivity
Palpitations
Feelings of warmth
Discontinuing IV Aminophylline infusion
Criteria to step-down from IV bronchodilator therapy:
Normal respiratory effort
Normal ability to speak
Reduction on oxygen requirement
Reduce the dose of IV aminophylline by 50% every 6 hours. Following cessation of the
infusion, aminophylline will be cleared within 72 hours (elimination half-life 3-5 hours)
Patients should remain on regular inhaled or nebulised bronchodilators whilst weaning off IV
therapy. Rebound bronchospasm can occur 24-48 hours after stopping IV aminophylline –
the patient will need to remain in hospital for observation during this period.
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Paediatric Prescribing Guideline
References
1. Aminophylline hydrate Solution for Intravenous Infusion – Mercury Pharma. Summary of Product Characteristics [on
Electronic Medicines Compendium: (accessed on Aug 2020 www.medicines.org.uk/)
2. BNF for children, August 2020
3. British Thoracic Society, Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma.
Available from url: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/asthma/
4. Singhi S, Grover S, Bansal A, Chopra K. Randomised comparison of intravenous magnesium sulphate, terbutaline
and aminophylline for children with acute severe asthma. Acta Paediatrica 2014; 103(12); 1301-1306.
5. Yung M and South M Randomised control trial of aminophylline for acute severe asthma. Arch Dis Child
1998;79:405-410
6. NHS Injectable Medicines Guide (Medusa). Aminophylline: Intravenous – PAEDIATRIC. Last updated 27/08/2019.
Accessed online via https://medusa.wales.nhs.uk/IVGuideDisplay.asp
7. Norfolk and Norwich University Hospitals NHS Foundation Trust. Intravenous Aminophylline in Acute Severe Asthma
in Children Clinical Guideline. Version 1.1 (04 May 2020)
8. NHS North West & North Wales Paediatric transport Service. Management of acute severe asthma in >1 year.
05/09/2018
9. The Leeds Teaching Hospitals NHS Trust. LTHT Paediatric ICU Administration Guide: Intravenous Aminophylline.
July 2019.
10. Brighton and Sussex Pathology. Biochemistry Tests: Theophylline. 03/12/2018.
11. SPS article “How should medicines be dosed in children who are obese?”Published 18th October 2018, updated 10th
January 2020 https://www.sps.nhs.uk/articles/how-should-medicines-be-dosed-in-children-who-are-obese/
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