Aminophylline dihydrate is approximately 79% of anhydrous theophylline by weight. Copd or respiratory tract infections interact with both theophylline and aminophylline leading to increased plasma concentrations of both and thus an increased risk of toxicity in the absence or presence of therapeutic drug concentration monitoring facilities. Aminophylline theophylline ethylenediamine is 79% theophylline. Once in the body, theophylline is released and acts as a phosphodiesterase inhibitor, adenosine receptor blocker, and histone deacetylase activator.
Indications, dose, contraindications, sideeffects, interactions, cautions, warnings and other safety information for aminophylline. Summary guideline for therapeutic drug monitoring tdm in adults. A novel disposable screenprinted electrode spe modified with mwntssio 2 au composites for the determination of aminophylline concentration in blood samples was developed. Vancomycin for full information on treatment side effects, cautions and contraindications. Aminophylline is a drug combination that contains theophylline and ethylenediamine in a 2. Theophylline acts by either inhibiting phosphodiesterase or blocking adenosine receptors in the bronchi, thereby relaxing smooth muscle. Uniphyllin phyllocontin nuelin sa slophyllin decision to commence documented by senior fy and above or nmp respiratory specialist nurse. Evaluation of theophylline therapeutic drug monitoring service. Adult intravenous aminophylline protocol for use by nursing. Note assessment of tear concentrations on therapeutic drug monitoring. Suggestions for therapeutic drug monitoring in adults in primary care.
Troleandomycin and erythromycin may slow theophylline elimination. Therapeutic drug monitoring tdm is the use of drug concentration measurements in body. Using an enzymemultiplied immunoassay emitr system for theophylline analysis, pharmacokinetic estimations were excellent for css r 0. When intravenous aminophylline is used, it should be given as a slow intravenous infusion with careful monitoring of vital signs, and plasma theophylline concentrations should be measured prior to and after infusion. Parenteral medication prescriptions and the drug are to be checked with a second registered or endorsed enrolled nurse prior to administration. Theophylline plasma concentrations were maintained within the therapeutic range. Aminophylline is a drug that needs therapeutic drug monitoring in clinical treatment. Key learning topics the concept of therapeutic drug monitoring pharmacological action and clinical use of lithum, digoxin and theophylline adverse toxic effects of lithium, digoxin and theophylline how blood values are used to optimise lithium, digoxin and theophylline dose this chapter is concerned with how laboratory measurement of drug concentration in blood helps in determining. Because of the many factors which can affect theophylline metabolism including a number of potential drug interactions, therapeutic drug monitoring is recommended to avoid serious or even fatal toxicity. Treatment with aminophylline, according to the nomogram published by jusko and coworkers, was monitored in patients suffering from acute exacerbations of copd. When drug monitoring is performed, the therapeutic range that has been established should be used only as a guide.
Therapeutic drug monitoring allows clinicians to more accurately titrate drug dosages, thus enhancing individualization of therapy. Similar to other theophyllines, aminophylline is indicated for the treatment of lung diseases such as asthma, chronic bronchitis, and copd. Dosage individualization to maintain concentrations within a target range requires pharmacokinetic and clinical capabilities. Therapeutic drug monitoring tdm aims to optimize treatments by individualizing dosage regimens based on the measurement of blood concentrations. Dose should be determined by theophylline serum level monitoring. Talk to your doctor about the possible risks of using this drug for your babys condition. Drug also stimulates the respiratory center in the medulla and prevents diaphragmatic fatigue. Computerized clinical decision support systems for therapeutic drug monitoring and dosing. When a new drug is introduced, steady state will not be approached until four. Survey of therapeutic drug monitoring practices in pediatric. Updated with approvals from wirral drug and therapeutics committee. Information on therapeutic drug monitoring for the following drugs. Aminophylline similarly has no place in the routine management of copd exacerbations 100,101. Adult intravenous aminophylline protocol for use by.
Agents with seizure threshold lowering potential may enhance the neuroexcitatory andor. Therapeutic drug monitoring is a relatively new service in the clinical. Loading dose should be decreased or eliminated if theophylline preparation has been used in pre ceding 24 hr. Identify these contraindicated and dangerous aminophylline iv drug combinations to avoid with the rxlist drug interaction checker tool. Feb 26, 2019 1 mg aminophylline kg ideal body weighthour as a constant infusionobtain a second serum theophylline concentration about one halflife after starting the infusion. After 24 h of therapy, the clinical state, the po2 and the pco2 values were markedly improved.
The initiation of a tdm program at two pediatric hospitals led to a significant. Similar to other theophyllines, aminophylline is indicated for the treatment of lung diseases such. How clinicians use therapeutic drug monitoring oxford academic. Results for therapeutic drug monitoring theophylline 1. May increase the serum concentration of aminophylline. The use of theophylline has declined with the advent of potent steroid inhalants.
Nov 30, 2012 therapeutic drug monitoring tdm aims to optimize treatments by individualizing dosage regimens based on the measurement of blood concentrations. Evidencebased information on therapeutic drug monitoring theophylline from hundreds of trustworthy sources for health and social care. Its most common use is in the treatment of airway obstruction from asthma or copd. Launching a tdm program for a given drug firstly requires developing and.
Dosage individualization to maintain concentrations within a target range requires pharmacokinetic. Nov 19, 2019 aminophylline injection, usp is a sterile, nonpyrogenic solution of aminophylline in water for injection. The cpt codes provided in this document are based on ama guidelines and are for informational purposes only. In general, maintaining the average serum theophylline concentration between 10 and 15 mcgml will achieve most of the drug s potential therapeutic benefit while minimizing the risk of serious adverse events. Summary guideline for therapeutic drug monitoring tdm in. It is a respiratory smooth muscle relaxant that results in bronchodilation. With the development of improved analytical techniques, the clinician is able to predict the therapeutic or toxic effects by monitoring the relationship between serum concentrations and response of the patient. Some drugs have a narrow therapeutic range and require monitoring and dose adjustments to optimize their efficacy and safety. Before taking aminophylline, tell your doctor and pharmacist if you are allergic to aminophylline or any other drugs. Clinical challenges in therapeutic drug monitoring, 2016. Steinijans vw1, trautmann h, sauter r, staudinger h.
Therapeutic drug monitoring medicines formulary, version 7 principal author. The most commonly used therapeutic range for aminophylline is 1020 mgl. Because of the therapeutic index of this drug, monitoring of theophylline concentrations in plasma is essential. Aminophylline is sometimes used to treat breathing problems in premature infants. Therapeutic drug monitoring or tdm is the clinical pharmacology of measuring specific drugs at designated intervals to uphold a constant level of drug in a patients blood circulation, thereby. Sjc, chief of the regional cardiology program, who determined the clinical. Aminophylline injection aminophylline dihydrate dose. Aminophylline definition of aminophylline by medical dictionary. Serum drug concentrations are measured following administration for therapeutic drug monitoring tdm purposes. Therapeutic drug monitoring an overview sciencedirect topics. Nor have i come across routine monitoring unless pts exhibit signs of toxicity or noncompliance or if starting oral theophylline for the first time.
Heart failure, liver disease, prolonged fever, certain infections. Recommendations to aim for a target therapeutic range may be inappropriate as serum concentrations correlate poorly with clinical improvement. Monitoring aminophylline therapy using juskos dosage. Take levels 4 6 hours after starting infusion then daily thereafter. Aminophylline injection norphyl, phyllocontin, truphylline is a bronchodilator injection drug used for the management of acute worsening of asthma or copd. Determination of theophylline in tears by gas chromatographymass spectrometry with electron ionization mode masaharu nakajima, 1 shinji sato, 2 susumu yamato, 1 kenji shimada, 1 shuji kitagawa, 2 akira honda, 3 jiro miyamoto, 3 harunobu hirano, 4 mitsuyuki suzuki, 4 hiroshi miyazaki, 5 1 department of. Moderate ritonavir decreased theophylline auc and cmax by 43% and 52%, respectively, when the two drugs were coadministered. Therapeutic drug monitoring aims to individualise drug therapy and avoid both sub therapeutic and toxic plasma drug concentrations. Therapeutic drug monitoring tdm is an essential part of personalized medicine and its role in the management of ibd patients is rapidly expanding.
Find patient medical information for aminophylline oral on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Aminophylline is 80% theophylline 100 mg aminophylline 80 mg theophylline. Oct 15, 2019 aminophylline is a complex of theophylline and ethylenediamine. A slight but noticeable increase of drug serum levels. Administration may be oral, intramuscular, intravenous, or rectal. We evaluated therapeutic drug monitoring service for theophylline in. Aminophylline definition of aminophylline by medical. Nms labs does not assume responsibility for billing errors due to reliance on the cpt codes listed in this document. Aminophylline drug information indications, dosage, side. Theophylline therapeutic drug monitoring in the case of a new sustainedrelease pellet formulation for oncedaily evening administration. If these drugs are used together, therapeutic drug monitoring should be considered. Precisepk is a software application for therapeutic drug monitoring and the ultimate pharmacokinetic tool for both practicing medical professionals and researchers. Refer to theophylline monograph for additional information. Aminophylline injection is administered by slow intravenous injection or diluted and administered by intravenous infusion.
Preparing for the new vancomycin guidelines doseme. Aminophylline hydrate 25mgml solution for injection. Development of a novel and simple method for clinical. Evaluation of theophylline therapeutic drug monitoring service article pdf available in international journal of clinical pharmacy 843. Mechanism of action this drug acts by relaxing bronchial smooth muscle, causing bronchodilation and increasing vital capacity, which has been impaired by bronchospasm and air trapping. Therapeutic drug monitoring tdm of both ami noglycoside antibiotics. Several factors influence drug concentrations and a single sample will only reflect the concentration at the sampling time. Therapeutic drug monitoring therapeutic range 10 to 20 mgl in patients receiving oral theophyllines prior to admission to hospital, plasma levels should be done before the aminophylline infusion is started. The drug is extensively metabolized 1 with peak serum levels reached four hours after oral dose. Background adequate asthma treatment of childhood exacerbations with iv aminophylline depends on appropriate dosage.
Monitoring should be done on trough specimens after steadystate has been reached. Learn how to pronounce the drug s name, its indications, dosage, how to take, when. The results of therapeutic drug monitoring tdm factored into aminophylline dosage calculations in the majority of studies. Theophylline therapeutic drug monitoring in the case of a new. The electrochemical performance of aminophylline at the mwntssio 2 au spe was explored by cyclic voltammetry cv and square wave. Aminophylline has a narrow therapeutic index and serum levels should be monitored regularly, particularly during initiation of therapy. Upcoming 2019 therapeutic drug monitoring recommendations.
It is helpful in situations where a drug has a narrow therapeutic index, a drug dosage does not reliably predict serum concentration, or a serum drug concentration has surrogate value. Nonsteadystate concentrations may be indicated in selected situations. The process of calculating an optimal dosage regimen is simplified with one custom and 15 preconfigured pharmacokinetic parameters. The monitoring parameters cited are derived from a range of guideline sources, other.
Computerized clinical decision support systems ccdsss may improve the net benefit of these drugs. Frequently reported side effects of this drug diarrhea anxiety headache. Intravenous iv aminophylline can be used in severe acute asthma or acute exacerbation of chronic obstructive pulmonary disease. Bayesian calculations currently represent the gold standard tdm approach but require computation assistance. Assessment of tear concentrations on therapeutic drug. To reduce the undesirable stimulating effects of aminophylline on the central nervous and cardiovascular systems, intravenous administration of the drug should be slow and should not exceed a rate of 25 mgmin.
Common examples include ciprofloxacin, cimetidine and erythromycin. However, theophylline has a narrow therapeutic index. Under normal circumstances, this can only be done empirically by monitoring serum theophylline concentration at intervals and adjusting dosage until a steady state is reached with the serum theophylline concentration within the 10 to 20. Dec 12, 2010 in earlier article we have discussed in details about what is therapeutic index and what is meant by narrow therapeutic index drug. Some drugs have a narrow therapeutic range and require monitoring and. Tdm of theophylline and digoxin as an indicator of the quality of. Computerized clinical decision support systems for. Infusion rates were adjusted based to keep serum theophylline levels within a predefined range in nine studies 21, 23 26, 28, 30, 32, 34 in two studies 28, 32 serum theophylline levels were factored into loading dose calculations. The theophylline halflife in premature infants has been quoted as 14. Nhs grampian acute sector summary guideline for therapeutic drug monitoring tdm in adults version 2 antibiotic assays on the microbiology request card for serum levels, please supply details of the antibiotic level required, the time and date of the sample.
Chiou method using serum concentrations obtained 1 and 6 h after the start of a constantrate intravenous aminophylline infusion in 10 male patients averaging 57 years of age. Of four rcts of theophylline or aminophylline dosing 8, 12, 17, 31. Here now we are providing our readers a comprehensive list of narrow therapeutic range drugs for reference. Therapeutic drug monitoring tdm is the clinical practice of measuring drug concentrations in the blood to optimize drug dosage regimens. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Aminophylline medical countermeasures database chemm. The rights of drug administration must be followed. Pharma guidelines novel medical drug research pharmaceutical. The ethylenediamine improves solubility, and the aminophylline is usually found as a dihydrate. Aminophylline is less potent and shorteracting than theophylline. Therapeutic drug monitoring theophylline evidence search nice. Action is dependent on theophylline content approximately 80% and is measured as theophylline in the serum. Computerized clinical decision support systems for therapeutic drug.
Therapeutic drug monitoring tdm is the use of drug concentration measurements in body fluids as an aid to the management of drug therapy for the cure, alleviation or prevention of disease. Aminophylline is a compound of the bronchodilator theophylline with ethylenediamine in 2. Critical care intravenous drug administration guide. This ensures patients are kept within therapeutic drug concentrations, thus maximising the benefit of the drug. Using pharmacokinetic modelling to improve prescribing. Aminophylline is a salt of theophylline with effects similar to those of other xanthines e. Aminophylline may diminish the therapeutic effect of thiopental. Find patient medical information for aminophylline rectal on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Aminophylline dosage in asthma exacerbations in children. If the patient has taken a theophylline product within the previous 24 hours, obtain a level before administering any iv theophylline. Theophylline is prescribed for bronchial asthma, for chronic obstructive pulmonary disease, and for newborn apnea.
Therapeutic drug monitoring theophylline evidence search. Nov 20 page 1 of 10 medicines formulary therapeutic drug monitoring contents. Therapeutic drug monitoring tdm is the clinical practice of. The proposed vancomycin therapeutic guidelines recommend population pharmacokinetic modelling with the use of bayesian software what many are now referring to as the gold standard of clinical decision support for vancomycin dosing and monitoring.
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