Aminophylline dose for copd

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Reading File

Here is a summary of aminophylline dosing in COPD, drawn from authoritative textbooks:

Aminophylline in COPD

Role in COPD

Aminophylline (the ethylenediamine salt of theophylline) is a bronchodilator with additional effects including improved diaphragmatic contractility, increased central respiratory drive, and phosphodiesterase inhibition. However, its role has become increasingly limited — nebulized β₂ agonists are now preferred over IV aminophylline for acute exacerbations of both asthma and COPD.

Current evidence does not support the routine use of methylxanthines in acute COPD exacerbations. — Tintinalli's Emergency Medicine

Dosing

Acute / IV (COPD Exacerbation)

Parameter	Dose
Loading dose	3–5 mg/kg IV over 30 minutes (COPD exacerbation, per Tintinalli's)
Loading dose (general)	6 mg/kg IV over 20–30 min (acute severe asthma, per Goodman & Gilman)
Maintenance	0.5 mg/kg/hour infusion
If already on theophylline	Halve all doses and monitor plasma levels closely

Oral (Chronic Maintenance via Theophylline/Aminophylline SR)

Sustained-release preparations: ~8 mg/kg twice daily
Oral immediate-release formulations are not recommended due to wide plasma level fluctuations

Therapeutic Drug Monitoring

Target plasma level: 5–15 mg/L (older target was up to 20 mg/L, but toxicity risk increases)
Check level 4 hours after last dose (steady-state with slow-release)

Factors Reducing Clearance (→ reduce dose)

Congestive heart failure
Liver disease
Pneumonia / viral infections
Old age
Drugs: cimetidine, erythromycin, ciprofloxacin, allopurinol, fluoxetine, zileuton

Factors Increasing Clearance (→ may need higher dose)

Smoking (tobacco/marijuana) — CYP1A2 induction
Rifampicin, barbiturates, ethanol
Childhood

Key Clinical Points

Not a first-line agent for COPD — reserve for patients who fail or cannot tolerate β₂ agonists
Narrow therapeutic index — individualize dosing and monitor levels
The ethylenediamine component of aminophylline (vs. theophylline) has been implicated in allergic reactions

Sources: Goodman & Gilman's Pharmacological Basis of Therapeutics, Tintinalli's Emergency Medicine, Fishman's Pulmonary Diseases and Disorders, Textbook of Family Medicine 9e

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