Adult Dosing
Asthma/COPD maintenance
- LD: 380 mg/day IV div q6-8 hrs x 3 days
- After 3 days: 507 mg/day IV div q6-8 hrs x 3 days
- After 3 more days: 760 mg/day IV div q6-8 hrs ; if tolerated
- Max: 1015 mg/day; 507 mg/day IV for patients with risk factors for impaired clearance/ > 60 yrs
Acute bronchospasm
- Nonsmoker
- 0.5 mg/kg/hr; Loading dose: 6 mg/kg IV (over 20-30 mins) x1 if no theophylline within 24 hrs; then give 0.7 mg/kg/hr IV x12 hrs
- Smoker
- 0.8 mg/kg/hr; Loading dose: 6 mg/kg IV (over 20-30 mins) x1 if no theophylline within 24 hrs; then give 1 mg/kg/hr IV x12 hrs
- Elderly
- 0.3 mg/kg/hr; Loading dose: 6 mg/kg IV (over 20-30 mins) x1 if no theophylline within 24 hrs; then give 0.6 mg/kg/hr IV x12 hrs
- With reduced clearance:
- 0.25 mg/kg/hr; Loading dose: 6 mg/kg IV (over 20-30 mins) x1 if no theophylline within 24 hrs; then give 0.5 mg/kg/hr IV x12 hrs
Acute Asthma [Non-FDA Approved]
- Loading dose: 6 mg/kg IV (over 20-30 mins) x 1 if not receiving theophylline
- Maintenance dose: 0.5-0.7 mg/kg/hr (mix 1 g in 250 mL D5W), at rate of 11 mL/hr; Alt: 0.25 mg/kg/hr in patients with cor pulmonale, heart failure and liver failure
Pediatric Dosing
Asthma/COPD maintenance
>1 yrs
- <45 kgs
- LD: 15.2-17.7 mg/kg/day to Max 380 mg IV div q4-6 hrs x 3 days
- After 3 days: 20.3 mg/kg/day to Max 507 mg IV div q4-6 hrs x 3 days
- After 3 more days: 25.3 mg/kg/day to Max 760 mg IV div q4-6 hrs; if tolerated
- Max: 1015 mg/day; 507 mg/day IV for patients with risk factors for impaired clearance
- >45 kgs: Follow the adult dosage
Acute Bronchospasm
- <6 wks
- Loading dose: 6 mg/kg IV (over 20-30 mins) x 1 if no theophylline within 24 hrs; then give 0.25 mg/kg/hr IV
- 6wks- 6 months
- Loading dose: 6 mg/kg IV (over 20-30 mins) x 1 if no theophylline within 24 hrs; then give 0.6 mg/kg/hr IV
- 6 month-1 yr
- Loading dose: 6 mg/kg IV (over 20-30 mins) x 1 if no theophylline within 24 hrs; then give 0.75-8 mg/kg/hr IV
- 1-9 yrs
- Loading dose: 6 mg/kg IV (over 20-30 mins) x 1 if no theophylline within 24 hrs; then give 1-1.2 mg/kg/hr IV
- 9-12 yrs
- Loading dose: 6 mg/kg IV (over 20-30 mins) x 1 if no theophylline within 24 hrs; then give 0.9 mg/kg/hr IV
[Outline]
See Supplemental Patient Information
- Appropriately reduce infusion rate in presence of risk factors as severe and potentially fatal toxicity have occurred; intensively monitor serum theophylline concentrations in patients with risk factors; assess potential benefits/risk in such patients
- Stop intravenous infusion and immediately measure serum theophylline concentration on suspicion of theophylline toxicity
- Avoid increase of dosage in response to acute exacerbation of symptoms of chronic lung disease
- Adjust dose prior to initiation of theophylline therapy, prior to increases in theophylline dose, and during follow up while considering concomitant use with interacting drugs and physiologic conditions that alters theophylline clearance
- Monitor serum theophylline concentrations while initiating therapy to guide final dosage adjustment after titration, before increasing a dose, on presence of signs or symptoms of toxicity, occurrence of new illness, worsening of a chronic illness or a change in the patient's therapeutic regimen altering theophylline clearance
- On good control of patient's symptoms, no apparent adverse effects, and no intervening factors altering dosage requirements monitor serum theophylline concentrations at 6 month intervals for rapidly growing children and at yearly intervals for all others
- Monitor serum theophylline concentrations q24 hrs in acutely ill patients
- Increased levels of plasma glucose, uric acids, free fatty acids, total cholesterol, HDL/LDL ratio and urinary free cortisol excretion have occurred
- Transient decrease in serum concentrations of triiodothyronine have occurred
Cautions: Use cautiously in:
- Hepatic impairment
- Renal impairment
- Liver disease
- Liver cirrhosis
- Acute hepatitis
- Reduced renal function in infants <3 months of age
- Active peptic ulcer disease
- Seizure disorder
- Cardiac arrhythmias
- Heart failure
- Acute pulmonary edema
- Congestive heart failure
- Cor-pulmonale
- Fever; 102° for 24 hours or more; or lesser temperature elevations for longer periods
- Hypothyroidism
- Sepsis with multi-organ failure
- Shock
- Change in smoking habits
- Neonates (term and premature)
- Children <1 year
- Geriatric population (>60 years)
Supplemental Patient Information
- Instruct patients to discontinue dosage that causes adverse effects and to withhold subsequent doses until the symptoms are resolved, at which time the clinician may instruct the patient to resume the drug at a lower dosage
- Instruct patients to seek medical advice on occurrence of nausea, vomiting, persistent headache, insomnia or rapid heart beat during treatment with theophylline, or even on suspicion of another cause
- Advise patients to contact their physician on developing a new illness accompanied by a persistent fever, worsening of a chronic illness, change in smoking habits or marijuana, another physician prescribes a new medication or discontinues a previously prescribed medication
- Advise patients to inform clinicians that they are on theophylline therapy especially when a medication is being added or deleted from their treatment
- Instruct patients to not alter the dose, timing of the dose, or frequency of administration without first consulting their clinician
- On missing a dose the patient should be instructed to take the next dose at the usually scheduled time and to not attempt to make up for the missed dose
Pregnancy Category:C
Breastfeeding: Probably Safe; stimulation, irritability and fretful sleep may occur in infants due to maternal aminophylline. Slow elimination and low serum protein binding of theophylline affects newborn and preterm infants. No need to avoid aminophylline products; use lower doses and monitor the infant for signs of theophylline side effects. Avoiding breastfeeding for 2 hours after IV use or 4 hours after an immediate-release oral aminophylline product may decrease the dose received by the breastfed infant. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT). This drug is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 last accessed 7 December 2010). Causes irritability or other signs of mild toxicity in nursing human infants. An infant ingesting a liter of breast milk containing 10-20 mcg/mL of theophylline is likely to receive 10-20 mg/day of theophylline. Serious adverse reactions in the infant are unlikely unless the mother has toxic serum theophylline concentrations
