Aminophylline Drip Preparation and Dosing in Pediatric Patients
For pediatric patients requiring aminophylline (theophylline) administration, prepare the drip by adding the calculated dose to D5W at a concentration not exceeding 2 mg/mL, and administer according to age-specific dosing guidelines. 1
Preparation of Aminophylline Drip
- Aminophylline should be diluted in D5W (5% dextrose in water) to a concentration not exceeding 2 mg/mL 1
- The solution must be prepared under sterile conditions and should be used with an infusion pump for accurate delivery 2
- Avoid mixing aminophylline with other medications in the same infusion line to prevent precipitation and compatibility issues 1
Loading Dose Considerations
- For children who have not received theophylline in the past 24 hours: 6 mg/kg IV administered over 20-30 minutes 3
- For children who have received theophylline within the past 24 hours: 3 mg/kg IV (half loading dose) to avoid toxicity 4
- If a patient has taken sustained-release theophylline preparation within 24 hours, check serum levels before administering loading dose 4
Maintenance Infusion Dosing by Age Group
- Neonates (premature): 4-6 mg/kg/day divided as continuous infusion (approximately 0.17-0.25 mg/kg/hour) 3
- Infants 1-6 months: 0.5 mg/kg/hour (12 mg/kg/day) 5
- Children 6 months to 1 year: 0.6-0.7 mg/kg/hour (14-17 mg/kg/day) 5
- Children 1-9 years: 0.8-1.0 mg/kg/hour (19-24 mg/kg/day) 5
- Children 9-16 years: 0.7-0.8 mg/kg/hour (17-19 mg/kg/day) 5
Monitoring and Dose Adjustments
- Target therapeutic serum theophylline concentration: 10-15 μg/mL 6
- Monitor serum theophylline levels 30 minutes after loading dose and then every 24 hours during continuous infusion 6
- Reduce dose by approximately 40% in patients with concurrent upper respiratory tract infections as theophylline clearance is reduced 6
- Adjust dosing based on serum levels, clinical response, and presence of side effects 1
Special Considerations
- Children clear theophylline more rapidly than adults, requiring higher mg/kg dosing 5
- Younger children (1-9 years) eliminate theophylline more rapidly than older children and may need higher doses 5
- Patients with fever, liver dysfunction, or heart failure may require dose adjustments due to altered metabolism 6
- Continuous cardiac monitoring is recommended during initiation of therapy 1
Potential Side Effects and Precautions
- Common side effects include tachycardia, nausea, vomiting, and irritability 1
- Serious toxicity can occur with serum levels >20 μg/mL, including seizures and cardiac arrhythmias 1
- Use with caution in patients with cardiac disease, seizure disorders, or hepatic impairment 1
- Avoid rapid infusion as it may cause hypotension and cardiac arrhythmias 1
Weaning Protocol
- When transitioning to oral therapy, reduce IV dose by 50% when first oral dose is given 5
- Consider switching to oral therapy once the patient can tolerate oral medications and clinical status has improved 5
Remember that aminophylline contains approximately 80% theophylline by weight, so dosing calculations must account for this when converting between the two medications 1.