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