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Dosage schedule for intravenous aminophylline in apnoea of prematurity, based on pharmacokinetic studies
Insights
Theophylline treatment for preterm infant apnea showed inconsistent oral absorption. Intravenous aminophylline dosing was calculated to achieve safe and effective serum levels in preterm infants.
Area of Science:
- Neonatal Medicine
- Pharmacology
- Respiratory Medicine
Background:
- Recurrent apnea is a common concern in preterm infants.
- Theophylline is a potential treatment for apnea of prematurity.
- Previous oral formulations had absorption issues.
Purpose of the Study:
- To evaluate theophylline pharmacokinetics in preterm infants.
- To determine optimal intravenous aminophylline dosing for apnea treatment.
Main Methods:
- 15 preterm infants received theophylline for recurrent apnea.
- Oral choline theophyllinate was administered to 5 infants.
- Intravenous aminophylline was given to 14 infants on 23 occasions.
Main Results:
- Oral choline theophyllinate showed erratic absorption.
- Theophylline volume of distribution was 0.71 L/kg (n=12).
- Plasma clearance rate was 18.6 ml/kg/hr (n=11).
Conclusions:
- Calculated IV aminophylline loading dose: 6.2 mg/kg.
- Calculated IV aminophylline maintenance dose: 4.4 mg/kg/day.
- This regimen is predicted to maintain therapeutic serum levels (6-12 mg/l) without toxicity.
Abstract:
15 preterm infants were treated for recurrent apnoea with theophylline. 5 were given oral choline theophyllinate, but this was erratically absorbed. 14 were given IV aminophylline on 23 occasions. Apparent volume of distribution of theophylline in 12 infants was 0.71 +/- 0.18 1/kg (mean +/- SD). Plasma clearance rate measured in 11 infants at steady state was 18.6 +/- 4.8 ml/kg per hour. Calculations show that a loading dose of 6.2 mg/kg aminophylline intravenously and maintenance of 4.4 mg/kg per day would produce serum levels of between 6 and 12 mg/l in all but one of the infants studied, with no infant having toxic levels.