Adult Dosing
Acute bronchospasm; adjunctive therapy
Healthy nonsmokers
- LD: 4.6 mg/kg IV (over 30 mins) x 1 (if no theophylline within 24 hrs); then give 0.4 mg/kg/hr IV. Max: 900 mg/day, unless serum levels indicate need for a larger dose
Smokers
- LD: 4.6 mg/kg IV (over 30 mins) x 1 (if no theophylline within 24 hrs); then give 0.7 mg/kg/hr IV
Elderly > 60 yrs
- LD: 4.6 mg/kg IV (over 30 mins) x 1 (if no theophylline within 24 hrs); then give 0.3 mg/kg/hr IV. Max: 400 mg/day, unless serum levels indicate need for a larger dose
Patients with reduced clearance
- LD: 4.6 mg/kg IV (over 30 mins) x 1 (if no theophylline within 24 hrs); then give 0.2 mg/kg/hr IV. Max: 400 mg/day, unless serum levels indicate need for a larger dose
Note: Adjust dose based on serum theophylline levels
Pediatric Dosing
Acute bronchospasm; adjunctive therapy
Neonates
- LD: 4.6 mg/kg IV (over 30 mins) x 1 (if no theophylline within 24 hrs); then give 1-1.5 mg/kg q12 hrs, target concentration 7.5 mcg/mL for neonatal apnea
Infants (6-52 weeks)
- LD: 4.6 mg/kg IV (over 30 mins) x 1 (if no theophylline within 24 hrs); then calculate mg/kg/hr = (0.008) x (age in weeks) + 0.21
Young pediatrics (1-9 yrs)
- LD: 4.6 mg/kg IV (over 30 mins) x 1 (if no theophylline within 24 hrs); then give 0.8 mg/kg/hr
Old pediatrics (9-12 yrs)
- LD: 4.6 mg/kg IV (over 30 mins) x 1 (if no theophylline within 24 hrs); then give 0.7 mg/kg/hr
Older pediatrics (12-16 yrs)
- LD: 4.6 mg/kg IV (over 30 mins) x 1 (if no theophylline within 24 hrs); then give 0.5 mg/kg/hr
- Discontinue the intravenous infusion if the patient develops any sign and symptoms of theophylline toxicity (nausea or vomiting, particularly repetitive vomiting) and immediately measure serum theophylline concentration
- No additives should be made to theophylline in 5% Dextrose Injection as it may cause fluid overloading resulting in dilution of serum electrolyte concentrations, overhydration, congested states or pulmonary edema
- Should not increase the dose of intravenous theophylline in response to an acute exacerbation of symptoms unless the steady-state serum theophylline concentration is <10 mcg/mL
- Before starting theophylline therapy or before increasing theophylline dose careful consideration of the various interacting drugs and physiologic conditions that can alter theophylline clearance and require dosage adjustment, should be made
- Monitor serum theophylline concentration before making a dose increase, if signs and symptoms of toxicity occurs and when there is new illness or worsening of current illness
Cautions: Use cautiously in
- Active peptic ulcer disease
- Seizure disorder
- Cardiac arrhythmias
- Neonates/infants
- Elderly (>60 years)
- CHF
- Acute pulmonary edema
- Cor-pulmonale
- Sepsis with multi-organ failure
- Shock
- Fever
102o for 24 hrs or more - Liver disease; cirrhosis, acute hepatitis
- Reduced renal functioning in infants <3 mo of age
- Hypothyroidism
- Change in smoking habit
Pregnancy Category:C
Breastfeeding: Theophylline is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublicatio ns.org/cgi/content/full/pediatrics;108/3/776). Theophylline is excreted in breast milk and may occasionally cause irritability or other signs of mild toxicity in nursing human infants. Avoiding breastfeeding for 2 hours after an IV dose may decrease infant exposure. This information is based upon based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 23 Nov 2010)
