SASH Surrey and Sussex Healthcare NHS Trust



Guideline for Intravenous Aminophylline in adultsIndicationIntravenous (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 dosingHow 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 feetMonitoringECG – Cardiac side effects include: Arrhythmias, Hypotension, Tachycardia Neurology – if convulsions are seen call a ‘MET call’U+E’s – HypokalaemiaLoading 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 dose5mg per kg Maximum loading dose is 500mg Administration of loading doseAdd the required dose to 100ml compatible fluid (sodium chloride 0.9% or glucose 5%) and administer over 30 minutes. Maximum infusion rate of 25ml/minuteMaintenance dose (See appendix 1 for worked example)500-700 microgram/kg/hourElderly or heart failure: 300microgram/kg/hourNon-smoking adult: 500 micrograms/kg/hourSmoking Adult: 700 micrograms/kg/hourAdministration of maintenance doseAdd 500mg aminophylline to 500ml of Sodium chloride 0.9% or glucose 5% to administer a 1mg/1ml solutionMaximum administration rate: 25mg/minuteAvailable as: 250mg/10ml ampoulesTherapeutic Drug monitoringTake levels 4- 6 hours after starting infusion then daily thereafterTherapeutic range 10 - 20mg/LInteractions (See BNF for full list of interactions)Increased aminophylline concentrationDecreased aminophylline concentrationAntibiotics e.g. clarithromycin, erythromycin, ciprofloxacin Antiepileptic medication e.g. phenytoin & carbamazepine Antifungals e.g. Fluconazole, ketoconazoleAlcoholAntivirals e.g. AciclovirSmokingDiltiazem, verapamil & other calcium channel blockersUlcer healing drugs e.g. cimetidineElderlyLiver FailureHeart FailureAppendix1: Worked examplesIdeal body weight worked examplePatient 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) = 73kgLoading dose worked example:Dose is 5mg/kg. Based on patient RW with an ideal body weight of 73kg:5mg x 73kg = 365mgName: RW Hospital Number: 1234567 *CHECK ALLERGIES* MONTH:_________ YEAR:_______DRUGS TO BE ADMINISTERED BY INFUSIONDateTimeInfusion SolutionDrugs & Dose to be addedTotalVolumeRouteRate of InfusionSignature Registration No./BleepBatchNoDate(of admin.)Start timeGiven by/checked byPharm23/10/159:00Sodium Chloride 0.9%Aminophylline 365mg100mlIV30 minutesDr X987654Maintenance dose worked example: Dose is 500microgram/kg/hr. Based on patient RW with an ideal body weight of 73kg:500micrograms x 73kg = 36.5mg/hrMake up 500mg aminophylline in 500millitres of sodium chloride 0.9% (1mg/ml solution) – infuse at 36.5ml/hour (36.5mg/hour)Name: RWHospital Number: 1234567 *CHECK ALLERGIES* MONTH:_________ YEAR:_______DRUGS TO BE ADMINISTERED BY INFUSIONDateTimeInfusion SolutionDrugs & Dose to be addedTotalVolumeRouteRate of InfusionSignature Registration No./BleepBatchNoDate(of admin.)Start timeGiven by/checked byPharm23/10/159:00Sodium Chloride 0.9%Aminophylline 500mg500mlIV36.5 ml/hourDr x987654References:SIGN/ BTS Asthma Guidelines 2012. accessed October 2015 via Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press <; [Accessed on [October 2015]]UpToDate Ideal Body Weight Calculator (online) [Accessed August 2016]Summary Product Characteristics (online) [Accessed August 2016} ................
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