Adult Dosing . When a loading dose becomes necessary in the patient who has already received theophylline, estimation of the serum concentration based upon the history is unreliable, and an immediate serum level determination is indicated. Monitor closely for adverse effects (e.g., cardiac effects) with concomitant use of these agents.Pentoxifylline: May increase the serum concentration of Theophylline Derivatives.Phenytoin: May decrease the serum concentration of Theophylline Derivatives. Thyroid Products: May increase the metabolism of Theophylline Derivatives.Tobacco (Smoked): May decrease the serum concentration of Theophylline Derivatives.Verapamil: May increase the serum concentration of Theophylline Derivatives.Zafirlukast: Theophylline Derivatives may decrease the serum concentration of Zafirlukast. Recheck serum concentrations.>30 mcg/mL: Stop dosing and treat overdose; if resumed, decrease subsequent doses by at least 50%. If used together, monitor for decreased concentrations/effects of phenytoin or theophylline if the other agent is initiated/dose increased, or increased concentrations/effects if the other is discontinued/dose decreased.Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics.
Store at controlled room temperature 15° to 30°C (59° to 86°F). Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Aminophylline Injection is administered by slow intravenous injection or diluted and administered by intravenous infusion. If symptoms are not controlled and dosage is tolerated, consider adding additional medications to treatment regimen.15 to 19.9 mcg/mL: Consider 10% dose reduction in infusion rate to improve safety margin even if dose is tolerated.20 to 24.9 mcg/mL: Decrease infusion rate by 25% even if no adverse effects present.25 to 30 mcg/mL: Stop infusion for 24 hours and decrease subsequent infusion rate at least 25%. In these situations, a patient will need to be switched between brands.When switching between brands of theophylline, the total daily dose is kept the same, but the patient will need monitoring to check that levels are stable on the new formulation as they are not necessarily bioequivalent. multiply the hourly dose by 24. Zafirlukast may increase the serum concentration of Theophylline Derivatives. Management: Monitor for reduced theophylline efficacy during concomitant use with any beta-blocker. The brand allowing the most appropriate dose for the patient should be chosen.It may not always be possible to switch a patient to a theophylline dose that is the exact equivalent of their previous aminophylline dose, so the new theophylline dose will have to be either higher or lower. In nonelective procedures, consider use of prophylactic anticonvulsants.Iopamidol: Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iopamidol. Specifically, the risk for seizures may be increased. More frequent measurements should be made during the initiation of therapy and in the presence of any condition that may significantly alter theophylline clearance.Note: In addition to the factors listed above, theophylline clearance is increased and half-life decreased by low carbohydrate/high protein diets, parenteral nutrition, and daily consumption of charcoal-broiled beef. Therefore, in a patient who has received no theophylline in the previous 24 hours, a loading dose of intravenous theophylline of 4.6 mg/kg (5.7 mg/kg as aminophylline), calculated on the basis of ideal body weight and administered over 30 minutes, on average, will produce a maximum post-distribution serum concentration of 10 mcg/mL with a range of 6-16 mcg/mL.
In contrast, if the second sample demonstrates a higher level, accumulation of the drug can be assumed, and the infusion rate should be decreased before the concentration exceeds 20 mcg/mL. Therefore, in a patient who has received no theophylline in the previous 24 hours, a loading dose of intravenous theophylline of 4.6 mg/kg (5.7 mg/kg as aminophylline), calculated on the basis of ideal body weight and administered over 30 minutes, on average, will produce a maximum post-distribution serum concentration of 10 mcg/mL with a range of 6-16 mcg/mL. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use.CYP1A2 Inducers (Moderate): May decrease the serum concentration of Theophylline Derivatives.CYP1A2 Inhibitors (Moderate): May increase the serum concentration of Theophylline Derivatives. Therefore, a second serum concentration should be obtained one expected half-life after starting the constant infusion (e.g., approximately 4 hours for children age 1 to 9 and 8 hours for nonsmoking adults; See Table I for the expected half-life in additional patient populations) to determine if the concentration is accumulating or declining from the post loading dose level. The formation of CYP450 enzymes may be suppressed by increased concentrations of cytokines (e.g., TNF-alpha) during chronic inflammation. Guanethidine may enhance the hypertensive effect of Sympathomimetics.Indacaterol: Theophylline Derivatives may enhance the adverse/toxic effect of Indacaterol. because the patient has been on the medication, it does indeed mean that they have reached Css. (4) For patients who can take either formulation, the main issue is therefore dose.

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