Several factors influence drug concentrations and a single sample will only reflect the concentration at the sampling time. Similar to other theophyllines, aminophylline is indicated for the treatment of lung diseases such as asthma, chronic bronchitis, and copd. If these drugs are used together, therapeutic drug monitoring should be considered. Talk to your doctor about the possible risks of using this drug for your babys condition. Theophylline therapeutic drug monitoring in the case of a new. Therapeutic drug monitoring is a relatively new service in the clinical. Suggestions for therapeutic drug monitoring in adults in primary care. Steinijans vw1, trautmann h, sauter r, staudinger h. Background adequate asthma treatment of childhood exacerbations with iv aminophylline depends on appropriate dosage. Nor have i come across routine monitoring unless pts exhibit signs of toxicity or noncompliance or if starting oral theophylline for the first time.
Therapeutic drug monitoring theophylline evidence search. The most commonly used therapeutic range for aminophylline is 1020 mgl. Therapeutic drug monitoring theophylline evidence search nice. The use of theophylline has declined with the advent of potent steroid inhalants. Evaluation of theophylline therapeutic drug monitoring service article pdf available in international journal of clinical pharmacy 843. Nov 19, 2019 aminophylline injection, usp is a sterile, nonpyrogenic solution of aminophylline in water for injection.
Computerized clinical decision support systems for. Recommendations to aim for a target therapeutic range may be inappropriate as serum concentrations correlate poorly with clinical improvement. Theophylline is prescribed for bronchial asthma, for chronic obstructive pulmonary disease, and for newborn apnea. Sjc, chief of the regional cardiology program, who determined the clinical. Take levels 4 6 hours after starting infusion then daily thereafter. Similar to other theophyllines, aminophylline is indicated for the treatment of lung diseases such. Theophylline therapeutic drug monitoring in the case of a new sustainedrelease pellet formulation for oncedaily evening administration. Updated with approvals from wirral drug and therapeutics committee.
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. Frequently reported side effects of this drug diarrhea anxiety headache. May increase the serum concentration of theophylline derivatives. Aminophylline has a narrow therapeutic index and serum levels should be monitored regularly, particularly during initiation of therapy. 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. Aminophylline hydrate 25mgml solution for injection. Therapeutic drug monitoring an overview sciencedirect topics. Of four rcts of theophylline or aminophylline dosing 8, 12, 17, 31. Nonsteadystate concentrations may be indicated in selected situations. Aminophylline is less potent and shorteracting than theophylline. Computerized clinical decision support systems for therapeutic drug monitoring and dosing.
The rights of drug administration must be followed. Careful attention to dose reduction and frequent monitoring of serum theophylline concentrations are required. Pharma guidelines novel medical drug research pharmaceutical. Tdm of theophylline and digoxin as an indicator of the quality of. Identify these contraindicated and dangerous aminophylline iv drug combinations to avoid with the rxlist drug interaction checker tool. Theophylline acts by either inhibiting phosphodiesterase or blocking adenosine receptors in the bronchi, thereby relaxing smooth muscle. Clinical challenges in therapeutic drug monitoring, 2016. When drug monitoring is performed, the therapeutic range that has been established should be used only as a guide. Learn how to pronounce the drug s name, its indications, dosage, how to take, when.
Aminophylline may diminish the therapeutic effect of thiopental. We evaluated therapeutic drug monitoring service for theophylline in. Pdf evaluation of theophylline therapeutic drug monitoring service. Therapeutic drug monitoring allows clinicians to more accurately titrate drug dosages, thus enhancing individualization of therapy.
Serum drug concentrations are measured following administration for therapeutic drug monitoring tdm purposes. Theophylline plasma concentrations were maintained within the therapeutic range. Computerized clinical decision support systems for therapeutic drug. Aminophylline medical countermeasures database chemm. Bayesian calculations currently represent the gold standard tdm approach but require computation assistance. After 24 h of therapy, the clinical state, the po2 and the pco2 values were markedly improved. 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. If the patient has taken a theophylline product within the previous 24 hours, obtain a level before administering any iv theophylline. Aminophylline is 80% theophylline 100 mg aminophylline 80 mg theophylline. 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. Intravenous iv aminophylline can be used in severe acute asthma or acute exacerbation of chronic obstructive pulmonary disease. Therapeutic drug monitoring tdm is the clinical practice of. It is used as a bronchodilator and also as an antidote to dipyridamole toxicity.
The drug is extensively metabolized 1 with peak serum levels reached four hours after oral dose. 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. 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. Dosage individualization to maintain concentrations within a target range requires pharmacokinetic. Vancomycin for full information on treatment side effects, cautions and contraindications.
Precautions and contraindications theophylline has few contraindications for use other than a history of hypersensitivity to theophylline or any inactive ingredient in the drug. Therapeutic drug monitoring tdm of both ami noglycoside antibiotics. Nms labs does not assume responsibility for billing errors due to reliance on the cpt codes listed in this document. Therapeutic drug monitoring medicines formulary, version 7 principal author. Once in the body, theophylline is released and acts as a phosphodiesterase inhibitor, adenosine receptor blocker, and histone deacetylase activator. Aminophylline dihydrate is approximately 79% of anhydrous theophylline by weight. Survey of therapeutic drug monitoring practices in pediatric. Note assessment of tear concentrations on therapeutic drug monitoring. Therapeutic drug monitoring tdm is the use of drug concentration measurements in body. Find patient medical information for aminophylline rectal on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. 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. Critical care intravenous drug administration guide.
Aminophylline dosage in asthma exacerbations in children. Agents with seizure threshold lowering potential may enhance the neuroexcitatory andor. Therapeutic drug monitoring aims to individualise drug therapy and avoid both sub therapeutic and toxic plasma drug concentrations. 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. Results for therapeutic drug monitoring theophylline 1. The initiation of a tdm program at two pediatric hospitals led to a significant. Evidencebased information on therapeutic drug monitoring theophylline from hundreds of trustworthy sources for health and social care. However, theophylline has a narrow therapeutic index. It is a respiratory smooth muscle relaxant that results in bronchodilation. 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 process of calculating an optimal dosage regimen is simplified with one custom and 15 preconfigured pharmacokinetic parameters. Therapeutic drug monitoring tdm aims to optimize treatments by individualizing dosage regimens based on the measurement of blood concentrations. 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. A slight but noticeable increase of drug serum levels.
Using pharmacokinetic modelling to improve prescribing. Preparing for the new vancomycin guidelines doseme. Some drugs have a narrow therapeutic range and require monitoring and dose adjustments to optimize their efficacy and safety. Drug also stimulates the respiratory center in the medulla and prevents diaphragmatic fatigue. Launching a tdm program for a given drug firstly requires developing and. Find patient medical information for aminophylline oral on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. Nov 20 page 1 of 10 medicines formulary therapeutic drug monitoring contents. Aminophylline is a compound of the bronchodilator theophylline with ethylenediamine in 2. Nov 30, 2012 therapeutic drug monitoring tdm aims to optimize treatments by individualizing dosage regimens based on the measurement of blood concentrations.
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. Computerized clinical decision support systems ccdsss may improve the net benefit of these drugs. This ensures patients are kept within therapeutic drug concentrations, thus maximising the benefit of the drug. 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.
May increase the serum concentration of aminophylline. Monitoring should be done on trough specimens after steadystate has been reached. Therapeutic drug monitoring tdm is the clinical practice of measuring drug concentrations in the blood to optimize drug dosage regimens. Aminophylline definition of aminophylline by medical. Aminophylline theophylline ethylenediamine is 79% theophylline. Uniphyllin phyllocontin nuelin sa slophyllin decision to commence documented by senior fy and above or nmp respiratory specialist nurse. Summary guideline for therapeutic drug monitoring tdm in adults. Treatment with aminophylline, according to the nomogram published by jusko and coworkers, was monitored in patients suffering from acute exacerbations of copd.
Aminophylline is a drug combination that contains theophylline and ethylenediamine in a 2. 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. Moderate ritonavir decreased theophylline auc and cmax by 43% and 52%, respectively, when the two drugs were coadministered. Aminophylline is sometimes used to treat breathing problems in premature infants. Common examples include ciprofloxacin, cimetidine and erythromycin. 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. Aminophylline definition of aminophylline by medical dictionary. Aminophylline is a salt of theophylline with effects similar to those of other xanthines e. Evaluation of theophylline therapeutic drug monitoring service. Development of a novel and simple method for clinical. 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.
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. Aminophylline injection aminophylline dihydrate dose. Refer to theophylline monograph for additional information. Before taking aminophylline, tell your doctor and pharmacist if you are allergic to aminophylline or any other drugs. Using an enzymemultiplied immunoassay emitr system for theophylline analysis, pharmacokinetic estimations were excellent for css r 0. Upcoming 2019 therapeutic drug monitoring recommendations. Troleandomycin and erythromycin may slow theophylline elimination. Indications, dose, contraindications, sideeffects, interactions, cautions, warnings and other safety information for aminophylline. 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. Here now we are providing our readers a comprehensive list of narrow therapeutic range drugs for reference. Oct 15, 2019 aminophylline is a complex of theophylline and ethylenediamine. A novel disposable screenprinted electrode spe modified with mwntssio 2 au composites for the determination of aminophylline concentration in blood samples was developed.
Aminophylline injection norphyl, phyllocontin, truphylline is a bronchodilator injection drug used for the management of acute worsening of asthma or copd. Therapeutic drug monitoring tdm is an essential part of personalized medicine and its role in the management of ibd patients is rapidly expanding. 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. The ethylenediamine improves solubility, and the aminophylline is usually found as a dihydrate. Dosage individualization to maintain concentrations within a target range requires pharmacokinetic and clinical capabilities. When a new drug is introduced, steady state will not be approached until four. 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. Heart failure, liver disease, prolonged fever, certain infections. Adult intravenous aminophylline protocol for use by nursing. Aminophylline injection is administered by slow intravenous injection or diluted and administered by intravenous infusion. Monitoring aminophylline therapy using juskos dosage. Loading dose should be decreased or eliminated if theophylline preparation has been used in pre ceding 24 hr. Aminophylline drug information indications, dosage, side. The monitoring parameters cited are derived from a range of guideline sources, other.
Information on therapeutic drug monitoring for the following drugs. Assessment of tear concentrations on therapeutic drug. May increase the metabolism of theophylline derivatives. Parenteral medication prescriptions and the drug are to be checked with a second registered or endorsed enrolled nurse prior to administration. How clinicians use therapeutic drug monitoring oxford academic. Dose should be determined by theophylline serum level monitoring. Suggestions for drug monitoring in adults in primary care. The theophylline halflife in premature infants has been quoted as 14.
Precisepk is a software application for therapeutic drug monitoring and the ultimate pharmacokinetic tool for both practicing medical professionals and researchers. Summary guideline for therapeutic drug monitoring tdm in. The results of therapeutic drug monitoring tdm factored into aminophylline dosage calculations in the majority of studies. Administration may be oral, intramuscular, intravenous, or rectal. Its most common use is in the treatment of airway obstruction from asthma or copd. 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. Aminophylline similarly has no place in the routine management of copd exacerbations 100,101. For success of therapeutic drug monitoring program, good communication among. The electrochemical performance of aminophylline at the mwntssio 2 au spe was explored by cyclic voltammetry cv and square wave.
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