BNF for Children 2011-2012

BNFC 2011–2012 3.1.3 Theophylline 143Indication and doseChronic asthmaSee under preparations below and Management ofChronic Asthma table p. 135Note Plasma-theophylline concentration for optimumresponse 10–20 mg/litre (55–110 micromol/litre); narrowmargin between therapeutic and toxic dose, see alsonotes aboveChild 12–18 years 200 mg every 12 hours, increasedaccording to response to 400 mg every 12 hoursNote May be appropriate to give larger evening ormorning dose to achieve optimum therapeutic effectwhen symptoms most severe; in children whose night ordaytime symptoms persist despite other therapy, who arenot currently receiving theophylline, total daily requirementmay be added as a single evening or morning doseModified releaseNote The rate of absorption from modified-release preparationscan vary between different brands. If a prescription for amodified-release oral theophylline preparation does not specifya brand name, the pharmacist should contact the prescriberand agree the brand to be dispensed. Additionally, it is essentialthat a child discharged from hospital should be maintained onthe brand on which that child was stabilised as an in-patient.Nuelin SA c (Meda)SA tablets, m/r, theophylline 175 mg. Net price 60-tab pack = £3.19. Label: 21, 25DoseChronic asthma. By mouthChild 6–12 years 175 mg every 12 hoursChild 12–18 years 175–350 mg every 12 hoursSA 250 tablets, m/r, scored, theophylline 250 mg.Net price 60-tab pack = £4.46. Label: 21, 25DoseChronic asthma. By mouthChild 6–12 years 125–250 mg every 12 hoursChild 12–18 years 250–500 mg every 12 hoursSlo-Phyllin c (Merck Serono)Capsules, m/r, theophylline 60 mg (white/clear,enclosing white pellets), net price 56-cap pack =£2.76; 125 mg (brown/clear, enclosing white pellets),56-cap pack = £3.48; 250 mg (blue/clear, enclosingwhite pellets), 56-cap pack = £4.34. Label: 25, orcounselling, see belowDoseChronic asthma. By mouthChild 6 months–2 years (body-weight under 10 kg)12 mg/kg every 12 hoursChild 2–6 years (body-weight over 10 kg) 60–120 mgevery 12 hoursChild 6–12 years 125–250 mg every 12 hoursChild 12–18 years 250–500 mg every 12 hoursAdministration Contents of the capsule (enteric-coatedgranules) may be sprinkled on to a spoonful of soft food(e.g. yoghurt) and swallowed without chewingUniphyllin Continus c (Napp)Tablets, m/r, theophylline 200 mg, net price 56-tabpack = £2.94; 300 mg, 56-tab pack = £4.77; 400 mg,56-tab pack = £5.32. Label: 25DoseChronic asthma. By mouthChild 2–12 years 9 mg/kg (up to 200 mg) every 12hours; some children with chronic asthma may require10–16 mg/kg (max. 400 mg) every 12 hoursAMINOPHYLLINENote Aminophylline is a stable mixture or combination oftheophylline and ethylenediamine; the ethylenediamine confersgreater solubility in waterCautions see under Theophylline; also rapid intravenousinjection can cause arrhythmiasHepatic impairment see under TheophyllinePregnancy see under TheophyllineBreast-feeding see under TheophyllineSide-effects see under Theophylline; also allergy toethylenediamine can cause urticaria, erythema, andexfoliative dermatitis; hypotension, arrhythmias, andconvulsions, especially if given rapidly by intravenousinjectionLicensed use Aminophylline injection not licensedfor use in children under 6 monthsIndication and doseTo avoid excessive dosage in obese children, doseshould be calculated on the basis of ideal weight forheightChronic asthma (see also Management of ChronicAsthma, p. 135). By mouthSee under preparations belowSevere acute asthma not previously treatedwith theophylline (with close monitoring; see alsoManagement of Acute Asthma, section 3.1). By intravenous injection over at least 20 minutesChild 1 month–18 years 5 mg/kg (max. 500 mg)then by intravenous infusionSevere acute asthma (with close monitoring; seealso Management of Acute Asthma, section 3.1). By intravenous infusionChild 1 month–12 years 1 mg/kg/hour adjustedaccording to plasma-theophylline concentrationChild 12–18 years 500–700 micrograms/kg/hour adjusted according to plasma-theophyllineconcentrationNote Plasma-theophylline concentration for optimumresponse in asthma 10–20 mg/litre (55–110 micromol/litre);narrow margin between therapeutic and toxic dose; childrentaking oral theophylline or aminophylline should not normallyreceive a loading dose of intravenous aminophylline; itis recommended that plasma-theophylline concentration ismeasured in all children receiving intravenous aminophylline(see notes above)3 Respiratory system