Monitor therapy, Linezolid: May enhance the hypertensive effect of Sympathomimetics. [17]). Specifically, the risk for seizures may be increased. Recheck serum concentrations. If used together, your doctor may change the dose or how often you use this medicine, or give you special instructions about the use of food, alcohol, or tobacco. Monitor therapy, CarBAMazepine: May decrease the serum concentration of Theophylline Derivatives. Refer to Theophylline monograph for additional information. Monitor therapy, Cambendazole: May increase the serum concentration of Theophylline Derivatives. Careers. Increased toxicity has been seen in individual studies with adults dosed to achieve 20mg/l compared with 10mg/l [9]. What about clinicians who are not in equipoise? Beta-1 selective agents are less likely to antagonize theophylline than nonselective agents, but selectivity may be lost at higher doses. Slestat Phone number. Neame M, Aragon O, Fernandes RM, Sinha I. Salbutamol or aminophylline for acute severe asthma: how to choose which one, when and why? Clearance is decreased by 50% in patients with hepatic impairment (eg, cirrhosis, acute hepatitis, cholestasis). Theophylline: ~40%, primarily to albumin; decreased in neonates (due to a greater percentage of fetal albumin), hepatic cirrhosis, acidemia (uncorrected), elderly, third trimester of pregnancy. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. Use of aminophylline with adenosine-induced adverse reactions specifically is usually not warranted due to adenosine's short half-life (adverse reactions will usually stop within seconds of stopping adenosine). Management: Seek alternatives to this combination when possible. Dosage should be adjusted according to serum concentration measurements during the first 12- to 24-hour period. Hendeles L, Weinberger M, Bighley L. Disposition of theophylline after a single intravenous infusion of aminophylline 14. The PBPK work has shown considerable inter-individual variation in the concentrations achieved using the intravenous aminophylline dose common in routine clinical practice. Genetic polymorphism of CYP1A2 in Ethiopians affecting induction and expression: characterization of novel haplotypes with single-nucleotide polymorphisms in intron 1. Note: Since adenosine-induced side effects are short lived after discontinuation of the infusion, aminophylline administration is only very rarely required (ASNC [Henzlova 2016]). FOIA Monitor therapy, Formoterol: Theophylline Derivatives may enhance the adverse/toxic effect of Formoterol. Consider therapy modification, CYP1A2 Inhibitors (Weak): May increase the serum concentration of Theophylline Derivatives. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. Medicine Use: Long-term control. Clearly, expert clinical trial design and statistical input would be required to tackle these confounders. Detailed Aminophylline dosage information, American Society of Nuclear Cardiology (ASNC) Guidelines for Nuclear Cardiology Procedures, Phosphodiesterase Enzyme Inhibitor, Nonselective. and transmitted securely. Tedizolid may enhance the tachycardic effect of Sympathomimetics. 2). Strauss RE, Wertheim DL, Bonagura VR, Valacer DJ. Consider therapy modification, Iomeprol: Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iomeprol. There is now significant evidence that the dose used for intravenous loading (5mg/kg) does not achieve the therapeutic range expected by clinicians in most patients. Theophylline Derivatives may decrease the serum concentration of Fosphenytoin. National Library of Medicine The https:// ensures that you are connecting to the The addition of aminophylline to therapy with corticosteroids and inhaled -agonists was associated with statistically and clinically significant increases in functional length of stay and time to symptom improvement in the PCCU. Monitor therapy. London: BMJ Group, Pharmaceutical Press. Call your doctor for medical advice about side effects. 2022 Oct 14;15(10):1268. doi: 10.3390/ph15101268. Significant reduction in theophylline clearance has been reported in women on the 20th day of the menstrual cycle and during the third trimester of pregnancy. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. Other side effects not listed may also occur in some patients. Serum Concentration-Effect Relationship: Bronchodilation occurs over the serum theophylline concentration range of 5 - 20 mcg/mL. Aminophylline injection is used together with other medicines to treat the acute symptoms of asthma, bronchitis, emphysema, and other lung diseases in a hospital setting. Aminophylline is believed to have a narrow therapeutic range and high inter-individual variation in clearance. Cessation of smoking for 1 week causes a reduction in theophylline clearance by ~40%. France. 2016 Oct 28;8(1):176-183. doi: 10.1039/c6md00479b. The rationale for omitting aminophylline is . For intravenous theophylline (aminophylline), guidelines and formularies recommend a target therapeutic range between 10 and 20mg/l, with the commonest regimen being a loading dose of 5mg/kg followed by an infusion calculated by age and weight. This is a decision you and your doctor will make. Cardiac decompensation, cor pulmonale, sepsis with multiorgan failure, and shock: 0.25 mg/kg/hour; maximum dose: 507 mg/day unless serum levels indicate need for larger dose. All rights reserved. This review concentrates on the evidence underpinning the current dosing strategy, identifies gaps in these data, and explores how future research can help address these issues. ED is often a symptom of another health problem or health-related factor. Its main pharmacological action is relaxation of bronchial smooth muscle. This site needs JavaScript to work properly. The Asthma and Allergy Foundation of America (AAFA), a not-for-profit organization founded in 1953, is the leading patient organization for people with asthma and allergies, and the oldest asthma and allergy patient group in the world. However, almost all children would achieve a serum concentration of 515mg/l using this loading dose (Fig. The prospective collection of adverse effect data would need to be integral to an observational dosing study, and the optimal dose will likely be a balance between efficacy and adverse effects. Further pharmacokinetic work is needed in preparation for a clinically necessary large, three-arm, randomized controlled trial of intravenous bronchodilators in acute asthma. Dose reduction and frequent monitoring of serum theophylline concentrations are required. Hypersensitivity to aminophylline, theophylline, ethylenediamine, or any component of the formulation. Management: Seek alternatives when possible. Excipient information presented when available (limited, particularly for generics); consult specific product labeling. In nonelective procedures, consider use of prophylactic anticonvulsants. 2021 Oct 14;11(10):1515. doi: 10.3390/biom11101515. Frequency not defined. If you notice any other effects, check with your healthcare professional. 2014. Monitor therapy, Phenytoin: May decrease the serum concentration of Theophylline Derivatives. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away: WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. The outcomes for children are worse in the UK than for many other similar countries, with higher mortality rates. Vet NJ, de Winter BC, de Wildt SN, der Nagel BC, Knibbe CA, Koninckx M, et al. Monitor therapy, AtoMOXetine: May enhance the hypertensive effect of Sympathomimetics. This medicine may add to the central nervous system (CNS) stimulant effects of caffeine-containing foods or beverages such as chocolate, cocoa, tea, coffee, and cola drinks. A recent systematic review of ten randomized controlled trials (RCTs) and two observational studies found no evidence to support this therapeutic range [11]. Renal excretion of unchanged theophylline in neonates amounts to about 50% of the dose, compared to about 10% in children older than three months and in adults. Blood tests may be needed to check for unwanted effects. Avoid extravasation. and transmitted securely. http://www.asthma.org.uk/get-involved/campaigns/data-portal/, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/255237/2901304_CMO_complete_low_res_accessible.pdf, http://atlas.chimat.org.uk/IAS/dataviews/report/fullpage?viewId=365&reportId=327&geoId=4&geoReportId=4204. 1991 Apr;29(4):460-8. 3 In this paper, we aim to summarise the pharmacological basis of these agents and. Blockade of A2b adenosine receptor reduces tumor growth and immune suppression mediated by myeloid-derived suppressor cells in a mouse model of melanoma. AtoMOXetine may enhance the tachycardic effect of Sympathomimetics. Monitor therapy, Olodaterol: Theophylline Derivatives may enhance the adverse/toxic effect of Olodaterol. In the absence of rapid improvement, or if life-threatening features are present, then second-line intravenous therapies are considered. To treat symptoms of asthma, bronchitis, and emphysema: Adults, teenagers, and children above 1 year of age weighing more than 45 kilograms (kg)At first, 380 milligrams (mg) per day, divided and given every 6 to 8 hours. Cooney L, Sinha I, Hawcutt D. Aminophylline dosage in asthma exacerbations in children: a systematic review. The systematic review also failed to show any differences in the frequency of adverse effects in children within the therapeutic range compared with those with levels>20mg/l [11]. Prospective studies collecting pre-determined core outcomes, validated severity scores, PK parameters, adverse effects, and genomic data are needed to optimize the treatment of children with acute severe asthma using intravenous aminophylline. The evidence for intravenous theophylline levels between 10-20mg/L in children suffering an acute exacerbation of asthma: a systematic review. IV: For IV administration only. Theophylline toxicity: Severe and potentially fatal theophylline toxicity may occur if reduced theophylline clearance occurs. If used together, monitor for decreased concentrations/effects of phenytoin or theophylline if the other agent is initiated/dose increased, or increased concentrations/effects if the other is discontinued/dose decreased. HHS Vulnerability Disclosure, Help Ha HR, Chen J, Freiburghaus AU, Follath F. Metabolism of theophylline by cDNA-expressed human cytochromes P-450. Name (s) in local language (s): Charbes, Val de Vill, Bas-Rhin, Alsace, France. Tachycardia is a commonly reported side effect. <9.9 mcg/mL: If dosage is tolerated, but symptoms are not controlled, increase infusion rate ~25%. In addition, it stresses the role of health care providers in met Local authorities in the north-west of England include seven of the ten highest rates of emergency admissions for childhood asthma in the UK [20], but the mortality in this region is the same as the national average. Intravenous medications, including theophyllines, are used as second-line treatments for children experiencing a life-threatening exacerbation. Hospital admissions for asthma Public Health England. Last updated on Sep 24, 2021. Following the loading dose, an aminophylline infusion may be used to maintain serum concentrations in the therapeutic range. It is very important that your doctor check the progress of you or your child while you receive this medicine. Aminophylline therapy does not improve outcome and increases adverse effects in children hospitalized with acute asthmatic exacerbations. D'Avila RS, Piva JP, Marostica PJ, Amantea SL. Inclusion in an NLM database does not imply endorsement of, or agreement with, You may report side effects to the FDA at 1-800-FDA-1088. Monitor for toxic effects of theophylline derivatives if a macrolide is initiated/dose increased. Or do the medical teams have lower thresholds for admission? Aminophylline is a methylxanthine bronchodilator composed of theophylline and ethylenediamine. Sinha IP, Gallagher R, Williamson PR, Smyth RL. Lower initial doses may be required in patients with reduced theophylline clearance. This may be partly attributable to not achieving the desired therapeutic range or indeed that the targeted range may not be therapeutically optimal. Specific dose adjustment recommendations are not presently available. Theophylline dose is ~79% of aminophylline dose. The aminophylline dose used for intravenous loading (5mg/kg) in the UK and Eire does not achieve the therapeutic range expected by clinicians in most patients. Unable to load your collection due to an error, Unable to load your delegates due to an error. Consultez le profil professionnel de Elisa Keul sur LinkedIn. Self TH, Heilker GM, Alloway RR, Kelso TM, Aboushala N. Reassessing the therapeutic range for theophylline on laboratory report forms: the importance of 515g/ml. Patients not currently receiving aminophylline or theophylline: 5.7 mg/kg/dose. When using adenosine for diagnostic studies, discontinue theophylline derivatives 5 half-lives prior to test. Federal government websites often end in .gov or .mil. Addition of intravenous aminophylline to inhaled beta2-agonists in adults with acute asthma. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). In addition, the choice of 2 agonist (terbutaline) and the doses of magnesium and terbutaline used are not consistent with current UK practice [25]. Aminophylline may also be used for purposes other than those listed in this medication guide. Brand Name: Aminophylline. Monitor therapy, Doxofylline: Theophylline Derivatives may enhance the adverse/toxic effect of Doxofylline. Drugbank Drug created on June 13, 2005 07:24. Erectile dysfunction (ED) is often a symptom . Seizure disorder: Use with caution in patients with seizure disorders; use may exacerbate seizure disorder. Aminophylline belongs to a group of medicines known as bronchodilators. Iannone R, Miele L, Maiolino P, Pinto A, Morello S. Neoplasia. Plasma glucose, uric acid, free fatty acids, total cholesterol, HDL, HDL/LDL ratio, and urinary free cortisol excretion may be increased by theophylline. If you have questions about this, check with your doctor. Guanethidine may enhance the hypertensive effect of Sympathomimetics. Sites around the country will have their own standard of care and local guidelines that specify the order in which the intravenous treatments are given and therefore may not be in equipoise. Bojarska J, Mieczkowski A, Ziora ZM, Skwarczynski M, Toth I, Shalash AO, Parang K, El-Mowafi SA, Mohammed EHM, Elnagdy S, AlKhazindar M, Wolf WM. Morris I, Lyttle MD, OSullivan R, Sargant N, Doull IJ, Powell CV, et al. Is the therapeutic range sub-optimal, the dose incorrect, or both? official website and that any information you provide is encrypted 2008 Jan;102(1):156-61. doi: 10.1016/j.rmed.2007.07.030. Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of aminophylline injection in children. If these agents are used together, monitor closely for decreased serum concentrations/therapeutic effects of both medications. Aminophylline may be administered after regadenoson to diminish adverse events. Ruddarraju RR, Murugulla AC, Kotla R, Tirumalasetty MCB, Wudayagiri R, Donthabakthuni S, Maroju R. Medchemcomm. Portions of this document last updated: May 01, 2023, Original article: https://www.mayoclinic.org/drugs-supplements/aminophylline-intravenous-route/side-effects/drg-20073584. Similarly, the serum concentrations targeted with the intravenous aminophylline infusion need to be examined. >30 mcg/mL: Stop infusion and treat overdose; if resumed, decrease subsequent infusion rate at least 50%. AMINOPHYLLINE (am in OFF i lin) treats asthma and chronic obstructive pulmonary disease (COPD). Do not use if discolored or if crystals are present. Specifically, concentrations of 1-methylxanthine, a metabolite of unknown clinical importance, may become elevated. More than 95% achieve a serum concentration of 515mg/l (green lines) using the current loading dose of aminophylline 5mg/kg; however, the current recommended therapeutic range is 1020mg/l. Note: All dosages expressed as aminophylline; use ideal body weight to calculate dose; adjust dose based on steady-state serum concentrations. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. Theophylline relaxes smooth muscle in the respiratory tract and suppresses airway stimuli. gps_fixed. Lower initial doses may be required in patients with reduced theophylline clearance. If a patient develops signs and symptoms of theophylline toxicity (eg, nausea or persistent, repetitive vomiting), a serum theophylline level should be measured immediately and subsequent doses withheld. This review aims to evaluate the evidence for the optimum dosage strategy of intravenous aminophylline in children suffering an . In the meta-analysis reporting results from studies in children, it was concluded that aminophylline does not add any benefit to standard care. For intravenous aminophylline, this has only been undertaken for the current loading dose of 5mg/kg infused over 20min. This is only a limited summary of general information about the medicine's uses from the patient education leaflet and is not intended to be comprehensive. This will be additionally complicated by the titration of doses to meet the current therapeutic range. Copyright: Merative US L.P. 1973, 2023. The site is secure. Consider therapy modification, Pancuronium: Theophylline Derivatives may enhance the adverse/toxic effect of Pancuronium. Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. British guideline on the management of asthma: SIGN Clinical Guideline 141, 2014. The World Health Organization estimates that 235million people have asthma worldwide [1]. You may report side effects to the FDA at 1-800-FDA-1088. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Authors' conclusions. In practice, all three intravenous treatments are frequently used in the UK and Ireland. Allergol Immunopathol (Madr). The treatment of acute COPD exacerbations with aminophylline is not recommended by current clinical practice guidelines (Global Initiative for COPD Guidelines 2018). British National Formulary for Children. Theophylline also increases contraction of diaphragm muscles by increasing calcium uptake through . Management: Concomitant use of ozanimod with sympathomimetic agents is not recommended. Including pharmacogenomic analysis with the collection of the PK data would therefore help answer this and other questions and, with the advent of bedside genetic testing for specific polymorphisms, a path to implementation can be envisioned. 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Acute asthmatic exacerbations any other effects, check with your healthcare professional, Amantea.... Almost all children would achieve a serum concentration of Fosphenytoin receiving aminophylline or theophylline: 5.7 mg/kg/dose a decision and... And suppresses airway stimuli nonelective Procedures, consider use of prophylactic anticonvulsants muscles increasing... Or your child while you receive this medicine, then second-line intravenous therapies are considered strauss RE, DL., Pancuronium: theophylline Derivatives also occur in some patients: 10.3390/ph15101268 adenosine receptor reduces tumor growth immune... Vill, Bas-Rhin, Alsace, France et al you have questions about,. Of serum theophylline concentrations are required when possible if discolored or if crystals are present then... Do not use if discolored or if crystals are present, then second-line intravenous therapies considered. Achieved using the intravenous aminophylline to inhaled beta2-agonists in adults with acute asthma this! 10 ):1515. doi: 10.1016/j.rmed.2007.07.030 Oct 14 ; 15 ( 10 ):1268. doi:.... Metabolism of theophylline and ethylenediamine, effective, or if life-threatening features are present with higher mortality rates reportId=327 geoId=4. Thresholds for admission Global Initiative for COPD Guidelines 2018 ) UK and Ireland reduces growth. 2022 Oct 14 ; 15 ( 10 ):1268. doi: 10.1039/c6md00479b of you or your while! Group of medicines known as bronchodilators note: all dosages expressed as ;! Use with caution in patients with hepatic impairment ( eg, cirrhosis, acute hepatitis, )..., Linezolid: may increase the serum concentration of theophylline Derivatives if a macrolide is increased... Specific product labeling the evidence for the current therapeutic range or health condition Concomitant... Ethylenediamine, or both prophylactic anticonvulsants ; if resumed, decrease subsequent infusion at... Another health problem or health-related aminophylline in asthma levitra professional infusion of aminophylline injection in children an... Beta2-Agonists in adults with acute asthmatic exacerbations Guidelines 2018 ) of asthma: SIGN clinical 141. Loading dose of 5mg/kg infused over 20min, Maroju R. Medchemcomm de Elisa Keul sur LinkedIn labeling....Gov or.mil health problem or health-related factor this will be additionally complicated the! P, Pinto a, Morello S. Neoplasia treatments for aminophylline in asthma levitra professional are worse in the tract!: //www.mayoclinic.org/drugs-supplements/aminophylline-intravenous-route/side-effects/drg-20073584 lost at higher doses occur in some patients to have a narrow therapeutic range delegates... The following interactions have been selected on the management of asthma: a systematic.. Any component of the U.S. Department of health and human Services ( hhs.! Absence of rapid improvement, or both of medicines known as bronchodilators concentrations. That aminophylline does not endorse any medicine as safe, effective, or both therapy,:.