What is the protocol for aminophylline (a methylxanthine derivative) infusion?

From the Guidelines

Aminophylline infusion should be administered at a dose of 0.5 mg/kg per hour by continuous infusion, with consideration of measuring blood levels of theophylline on a daily basis, as recommended by the British Thoracic Society guidelines for the management of chronic obstructive pulmonary disease 1. The protocol for aminophylline infusion involves careful consideration of the patient's response to other treatments and their overall clinical condition.

• Key points to consider when administering aminophylline infusion include:
  • The patient's response to nebulised bronchodilators and the need for additional treatment
  • The potential for aminophylline to be effective in severe exacerbations or when the response to other treatments is poor
  • The importance of monitoring blood levels of theophylline to avoid toxicity
  • The need for careful dosing and monitoring to maintain efficacy while preventing toxicity Other studies, such as the British Thoracic Society nebulizer project group guidelines 2 and the guidelines on the management of asthma 3, provide additional information on the use of aminophylline and other treatments for respiratory conditions. However, the most relevant and recent guideline for the management of chronic obstructive pulmonary disease is the British Thoracic Society guidelines 1, which provides the recommended dose of 0.5 mg/kg per hour for aminophylline infusion. It is essential to prioritize the patient's morbidity, mortality, and quality of life when making decisions about aminophylline infusion, and to carefully consider the potential benefits and risks of treatment.
• Important considerations for patient care include:
  • Monitoring for side effects, such as tachycardia, nausea, and vomiting
  • Adjusting the dose as needed to maintain therapeutic levels and prevent toxicity
  • Considering alternative treatments or adjustments to the treatment plan if the patient's condition does not improve with aminophylline infusion.

From the Research

Aminophylline Infusion Protocol

• The protocol for aminophylline infusion is not explicitly stated in the provided studies, but the dosage and administration can be inferred from the study results.
• According to the study 4, aminophylline was administered at a dose of 5 mg/kg/dose followed by a continuous infusion at 1 mg/kg/hour for 3 hours.
• The study 5 does not provide specific details on the infusion protocol, but it mentions that patients received intravenous aminophylline in addition to inhaled bronchodilators.
• The study 6 provides practical guidelines on how to achieve optimal serum levels when planning theophylline therapy, including the use of nomograms to decide loading and maintenance doses for nonsmoking adult asthmatic patients and adjustments for asthmatic patients with complications or on other drugs that may alter the kinetic disposition of theophylline.
• The study 7 suggests that theophylline, when given with bronchodilators with or without steroids, is a cost-effective and safe choice for acute asthma exacerbations, but it does not provide specific details on the infusion protocol.

Key Considerations

• The dosage and administration of aminophylline may vary depending on the patient's condition, age, and concomitant medications.
• The study 4 found that magnesium sulfate was more effective and safer than aminophylline as a second-line drug for acute asthma in children.
• The study 5 found that the demographic, clinical, pulmonary function, and outcome data were not significantly different between patients who received aminophylline and those who received a control treatment.
• The study 8 found that available trials do not provide adequate evidence to support or reject the use of aminophylline in the treatment of severe, acute asthma.

Administration and Monitoring

• Aminophylline should be administered with caution and monitoring, as it can cause adverse effects such as tachycardia and premature ventricular contractions 5, 4.
• The study 7 found that theophylline was not significantly different from other drugs in its effects on respiratory rate, forced vital capacity, peak expiratory flow rate, admission rate, use of rescue medication, oxygen saturation, or symptom score.
• The study 6 emphasizes the importance of considering factors that influence the kinetic disposition of theophylline, such as physiopathological conditions and interactions with concomitantly administered drugs, when planning theophylline therapy.