OB-GYN 101
Pharmacy

Category:

• Respiratory

Description:

• Antiasthmatic, bronchodilator, COPD agent

Indications:

• Asthma, reversible bronchospasm associated with COPD

• Pulmonary edema

Contraindications:

• Hypersensitivity to xanthines or ethylenediamine, underlying seizure disorder (not on anticonvulsant therapy)

• Suppositories contraindicated in presence of infection or irritation of lower bowel or rectum

Precautions:

• Pregnancy category C

• Elderly, CHF, corpulmonale, hepatic disease

• Hypertension, infants <1 year, hypoxemia, sustained high fever, history of peptic ulcer

• Alcoholism

Adverse Reactions (Side Effects):

• CNS: anxiety, dizziness, headache, insomnia, lightheadiness, muscle twitching, reflex hyperexcitability, restlessness, seizures

• CV: circulatory failure, flushing, hypotension, flushing, ventricular arrhythmias

• GI: anorexia, bitter taste, black stools, diarrhea, dyspepsia, epigastric pain, esophageal reflux, hematemesis, nausea, vomiting

• GU: proteinuria, urinary frequency

• MISC: urticaria, alopecia, tachypnea, hyperglycemia

Administered orally, rectally, intravenously

Adult and Child:  

• PO acute therapy (patient not currently receiving theophylline products): 

  • Following a 6.3 mg/kg loading dose, maintenance dose follows:

    • children age 1-9 years, 5.1 mg/kg every 6 hours 

    • children 9-16 years and smokers, 3.8 mg/kg every 6 hours

    • otherwise healthy non-smoking adults, 3.8 mg/kg every 8 hours

    • older patients/ patients with CHF, corpulmonale, 2.5 mg/kg every 8 hours

• PO acute therapy (patients currently receiving theophylline products): 

  • Defer loading dose if serum theophylline concentration can be rapidly obtained

  • base loading dose on the principle that each 0.63 mg/kg of aminophylline will increase serum theophylline concentration by 1 mcg/ml 

  • if this is not possible and sufficient respiratory distress is present (without signs of theophylline toxicity), 

    • use 3.1 mg/kg of a rapidly available form of aminophylline

    • will likely increase serum theophylline concentration 5 mcg/ml 

  • maintenance dosage as previously described

• PO chronic therapy:

  • Initial dose 20.3 mg/kg/24 hours or 500 mg/24 hours (whichever is less) divided by 6-8 hours; 

  • increase every 3 days by 25% as tolerated until clinical response or maximum dose is reached (below); 

  • monitor serum theophylline concentrations; 

  • do not exceed the following (or 1140mg, whichever is less without serum monitoring): 

    • Age 1-9 years, 30.4 mg/kg/day; 

    • age 9-12 years, 25.3 mg/kg/day; 

    • age 12-16 years22.8 mg/kg/day; 

    • age 16 years and older, 16.5 mg/kg/day

• IV (patients not currently receiving theophylline products): 

  • Following a 6.3 mg/kg IV loading dose, maintenance dose follows: 

    • children age 1-9 years, 1 mg/kg/hr; 

    • children age 9-16 years and smokers, 0.8 mg/kg/hour;  

    • otherwise healthy non-smoking adults, 0.5 mg/kg/hour; 

    • older patients/patients with cor pulmonale 0.3 mg/kg/hour; 

    • patients with CHF, 0.1-0.2 mg/kg/hour

• IV (patients currently receiving theophylline products): 

  • Defer loading dose if serum theophylline concentration can be rapidly obtained.  

  • Base loading dose on the principle that each 0.63 mg/kg of aminophylline will increase serum theophylline concentration by 1 mcg/ml

  • if this is not possible and sufficient respiratory distress is present:

    • use 3.1 mg/kg aminophylline

    • will likely increase serum theophylline concentration 5 mcg/ml

    • administer only if theophylline toxicity is not present

  • maintenance dosage as described above.