* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Preparation : Vials contain 250mg aminophylline in 10mL
Survey
Document related concepts
Discovery and development of proton pump inhibitors wikipedia , lookup
Psychopharmacology wikipedia , lookup
Pharmacognosy wikipedia , lookup
Hormonal contraception wikipedia , lookup
Drug interaction wikipedia , lookup
Ciprofloxacin wikipedia , lookup
Discovery and development of direct thrombin inhibitors wikipedia , lookup
Plateau principle wikipedia , lookup
Intravenous therapy wikipedia , lookup
Oral rehydration therapy wikipedia , lookup
Pharmacokinetics wikipedia , lookup
Dydrogesterone wikipedia , lookup
Transcript
Dosing Information for Intravenous (IV) Aminophylline in Adults Preparation: Vials contain 250mg aminophylline in 10mL **PATIENTS ALREADY TAKING ORAL AMINOPHYLLINE/THEOPHYLLINE SHOULD NOT RECEIVE A LOADING DOSE OF IV AMINOPHYLLINE** Contraindications Hypersensitivity to aminophylline, ethylenediamine or those allergic to theophyllines, caffeine or theobromine. Acute porphyria. Aminophylline should not be administered concomitantly with other aminophylline/theophylline preparations. Loading dose 5mg/kg to a maximum of 500mg based on ideal bodyweight(1,2). Loading dose aminophylline infusion Dilute required dose in 100mL of sodium chloride 0.9% or glucose 5%. Maximum concentration 25mg/mL. Administer by intravenous infusion over 20-30 minutes using an infusion pump. Maximum rate not to exceed 25mg/min. Requires ECG and BP monitoring. Note: Loading dose must be given with a doctor present. How do I administer a loading dose infusion of aminophylline?* *Refer to Trust IV guide for further details Maintenance dose for aminophylline 500 micrograms/kg/hr based on ideal body weight (2) Dose may be lower in patients with heart failure, hepatic disease and in the elderly. Consider: Elderly or cor pulmonale a dose of 300 micrograms/kg/hr. Congestive heart failure or liver impairment a dose of 100-200 micrograms/kg/hr. Dilute 1mg aminophylline in 1mL (i.e. 500mg in 500mL) with sodium chloride How do I administer 0.9% or glucose 5%* and administer by intravenous infusion over 24 hours an intravenous using an infusion pump. Maximum concentration 25mg/mL. Maximum rate maintenance dose should not exceed 25mg/min. of aminophylline? Requires ECG and BP monitoring. * Refer to Trust IV guide for further details Aminophylline Monitoring and Adverse Effects Requires ECG, blood pressure and electrolyte monitoring. Therapeutic drug level monitoring required to prevent toxicity (see below). Rapid administration may cause hypotension, headache, anxiety, arrhythmias, insomnia and convulsions. Other possibly adverse effects – hypersensitivity reactions, rash, erythema, pruritis and tachycardia. Monitor for extravasation – extreme pH (8.6-9). Extravasation very likely to cause tissue damage. Therapeutic Drug Monitoring Refer to Guidelines for the Management of Common Medical Emergencies and the Use of Antimicrobial Drugs, current edition for further details. Target aminophylline level is 10 – 20mg/L Sampling Time Monitor at 4 – 6 hours post loading dose then at 24 hourly intervals during IV infusion or after 5 days following initiation of oral aminophylline/theophylline to prevent toxicity. Time to steady state 2 days (following infusion where loading dose has not been given), 3 days (following oral loading). (1) Trust guidance (2) BNF 62 September 2011 December 2011 Interactions See BNF for full details Aminophylline/ theophylline can interact with many drugs. All concurrent medications should be assessed for potential interactions before aminophylline/theophylline is initiated. Some clinically important interactions include: Drugs/substances that increase Drugs/substances that decrease aminophylline/theophylline concentrations aminophylline/theophylline levels leading to sub leading to toxicity therapeutic levels Antiepileptics e.g. carbamazepine, Antibacterials e.g. azithromycin phenobarbitone Antifungals e.g. fluconazole Smoking Antivirals e.g. aciclovir Calcium-channel blockers e.g. verapamil Oestrogens Interferons Converting IV aminophylline to oral aminophylline 1. Convert the hourly rate to the total amount administered in 24 hours by multiplying the hourly dose by 24. 2. Divide this total amount by the dosing interval for oral administration, e.g. 2 for twice a day. It is assumed that the oral product is completely absorbed, i.e. the bioavailability is 100%. For example: If the IV aminophylline dose is 35mg /hr and the dosing interval for oral aminophylline is every 12 hours, i.e. twice a day, divide the total daily dose 840mg by 2. This gives the equivalent oral dose to be 420mg twice a day. 35mg x 24 = 420mg 2 A suitable aminophylline dosing regimen could be Phyllocontin Continus ® 225mg, 450mg (2x225mg tablets) twice a day. Converting IV aminophylline to oral theophylline Convert the hourly rate to the total amount administered in 24 hours by multiplying the hourly dose by 24. In order to calculate the equivalent theophylline dose, multiply this total aminophylline dose by 0.8, which is the salt correction factor. It is assumed that the oral product is completely absorbed. For example If the IV aminophylline dose is 35mg/hr, then the total daily dose is 840mg. The oral theophylline dose is 840mg x 0.8 = 672mg daily A suitable theophylline dosing regimen could be Uniphyllin Continus®, 300mg in the morning and 400mg in the evening. Oral aminophylline and theophylline modified release preparations available Brand Phyllocontin Continus® Brand Nuelin SA® Slo-Phyllin® Uniphyllin Continus® Aminophylline Available strengths 225mg Theophylline Available strengths 175mg 60mg, 125mg, 250mg 200mg, 300mg, 400mg Dosing frequency Twice daily Dosing frequency Twice daily Twice daily Twice daily December 2011