page202
mouth and at least 5 days after starting oral treatment;
measure plasma-theophylline concentration 4–6 hours after
the start of intravenous infusion;
narrow margin between
therapeutic and toxic dose, see also notes above
To avoid excessive dosage in obese patients,
dose
should be calculated on the basis of
ideal
weight for
height
Aminophylline
(Non-proprietary) A
Injection
,
aminophylline 25 mg/mL, net price 10-mL
amp = 84p
Dose
severe acute asthma or acute exacerbation of chronic
obstructive pulmonary disease in patients not previously treated
with theophylline,
by slow intravenous injection over at least 20
minutes (with close monitoring), 250–500 mg (5 mg/kg), then see
below;
CHILD under 12 years 5 mg/kg, then see below
Severe acute asthma or acute exacerbation of chronic obstructive
pulmonary disease by intravenous infusion (with close monitor-
ing),
500–700 micrograms/kg/hour,
adjusted according to
plasma-theophylline concentration;
ELDERLY 300 micrograms/
kg/hour;
CHILD under 12 years 1 mg/kg/hour, adjusted according
to plasma-theophylline concentration
Note
Patients taking oral
theophylline or aminophylline should not
normally receive a loading dose of intravenous aminophylline;
plasma-theophylline concentration should be measured in all
patients receiving intravenous aminophylline (see note above)
Modified release
Note
Advice about modified-release theophylline preparations
(see p.
181) also applies to modified-release aminophylline
preparations
Phyllocontin Continus
c
(Napp)
Tablets
,
m/r,
yellow,
f/c,
aminophylline hydrate
225 mg,
net price 56-tab pack = £2.39.
Label:
25
Dose
ADULT and CHILD body-weight over 40 kg initially 1 tablet
twice daily,
increased after 1 week to 2 tablets twice daily
according to plasma-theophylline concentration
Forte tablets
, m/r, yellow, f/c, aminophylline hydrate
350 mg,
net price 56-tab pack = £4.22.
Label:
25
Dose
initially 1 tablet twice daily,
increased after 1 week to 2
tablets twice daily if necessary
Note
Phyllocontin Continus
c
Forte
tablets are for smokers and
other patients with shorter theophylline half-life (see notes above)
3.1.4
Compound bronchodilator
preparations
In general,
patients are best treated with single-ingre-
dient
preparations,
such as a selective beta
2
agonist
(section
3.1.1.1)
or
ipratropium bromide
(section
3.1.2),
so that the dose of
each drug can be adjusted.
This flexibility is lost
with compound bronchodilator
preparations.
However,
a combination product may be
appropriate for patients stabilised on individual compo-
nents in the same proportion.
For prescribing information, see under individual drugs.
Ipratropium bromide with salbutamol
(Non-proprie-
tary) A U
Nebuliser solution
,
ipratropium bromide 500 micr-
ograms, salbutamol (as sulphate) 2.5 mg/2.5-mL vial,
net price 60 unit-dose vials = £23.75
Brands include
Salipraneb, Ipramol
Dose
bronchospasm in chronic obstructive pulmonary disease,
by inhalation of nebulised solution,
ADULT and CHILD over 12
years,
1 vial (2.5 mL) 3–4 times daily
Glaucoma
In addition to other potential side-effects acute angle-
closure glaucoma has been reported with nebulised ipratropium—
for details, see p.
180
Combivent
c
(Boehringer Ingelheim) A U
Nebuliser solution
,
isotonic,
ipratropium bromide
500 micrograms, salbutamol (as sulphate) 2.5 mg/2.5-
mL vial,
net price 60 unit-dose vials = £24.10
Dose
bronchospasm in chronic obstructive pulmonary disease,
by inhalation of nebulised solution,
ADULT and CHILD over 12
years,
1 vial (2.5 mL) 3–4 times daily
Glaucoma
In addition to other potential side-effects acute angle-
closure glaucoma has been reported with nebulised ipratropium—
for details, see p.
180
Duovent
c
(Boehringer Ingelheim) A U
Nebuliser solution
, isotonic, fenoterol hydrobromide
1.25 mg,
ipratropium bromide 500 micrograms/4-mL
vial,
net price 20 unit-dose vials = £8.00
Dose
acute severe asthma or acute exacerbation of chronic
asthma,
by inhalation of nebulised solution,
ADULT and CHILD
over 14 years, 1 vial (4 mL); may be repeated up to max. 4 vials in
24 hours
Glaucoma
In addition to other potential side-effects acute angle-
closure glaucoma has been reported with nebulised ipratropium—
for details, see p.
180
3.1.5
Peak flow meters, inhaler
devices and nebulisers
Peak flow meters
Measurement
of
peak flow is particularly helpful
for
patients who are ‘poor perceivers’
and hence slow to
detect deterioration in their asthma,
and for those with
moderate or severe asthma.
Standard-range peak flow meters are suitable for both
adults and children;
low-range peak flow meters are
appropriate for severely restricted airflow in adults and
children.
Patients must be given clear guidelines as to
the action they should take if their peak flow falls below
a certain level.
Patients can be encouraged to adjust
some of
their own treatment
(within specified limits)
according to changes in peak flow rate.
Standard Range Peak Flow Meter
Conforms to standard EN ISO 23747:2007
AirZone
c
, range 60–720 litres/minute, net price = £4.50,
replacement mouthpiece = 38p (Clement Clarke)
Medi
c
,
range 60–800 litres/minute, net price = £4.50
(Medicare)
MicroPeak
c
, range 60–800 litres/minute, net price = £6.50,
replacement mouthpiece = 38p (Micro Medical)
Mini-Wright
c
, range 60–800 litres/minute, net price = £6.86,
replacement mouthpiece = 38p (Clement Clarke)
Personal Best
c
,
range 60–800 litres/minute,
net price =
£6.86, replacement mouthpiece = 25p (Respironics)
Piko-1
c
, range 15–999 litres/minute, net price = £9.50,
replacement mouthpiece = 38p (nSPIRE Health)
Pinnacle
c
,
range 60–900 litres/minute,
net price = £6.50
(Fyne Dynamics)
Pocketpeak
c
, range 60–800 litres/minute, net price = £6.53,
replacement mouthpiece = 38p (nSPIRE Health)
Vitalograph
c
, range 50–800 litres/minute, net price = £4.75
(children’s coloured version also available), replacement
mouthpiece = 40p (Vitalograph)
Note
Readings from new peak flow meters are often lower than
those obtained from old Wright-scale peak flow meters and the
correct recording chart should be used
Low Range Peak Flow Meter
Compliant to standard EN 23747:2007 except for scale
range
Medi
c
,
range 40–420 litres/minute, net price = £6.50
(Medicare)
182
3.1.4 Compound bronchodilator preparations
BNF 61
3
Respiratory system