**6.4.6 Aminophylline**

Treatment of neonatal apnea, including post-extubation, post-anesthesia, and prostaglandin E1-inducted. Bronchodilator. May improve respiratory function (Kavakl et al, 1998; Young & Mangum, 2010).

*Dose:* Loading dose: 8 mg/kg IV infusion over 30 minutes, or PO. Maintenance: 1.5 to 3 mg/kg per dose PO, or IV slow push Q8 to 12 hours. In preterms infants, changing from IV aminophylline to PO theophylline requires no dose adjustment (Young & Mangum, 2010).

The dose of 20 mg/kg/day should not be exceeded in rectal application. IM administration of drug is not advised as it causes long-term pains in the injection area (Kavakl et al, 1998). When the drug is administered by IV route it reaches the highest level in blood within 30 minutes; by oral route it reaches within 1-2 hours.

The drug is metabolized in liver and discharged from body via urinary system. It reaches fetus through placenta in pregnancy period and is transmitted to child through natural nutrition in lactation period (Kavakl et al, 1998).

*Side Effects:* An allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives); seizures; increased or irregular heartbeats; or severe nausea or vomiting (Kavakl et al, 1998; Young & Mangum, 2010).

*The things to be considered by nurse applying the drug:* The solution should be given in 20-30 minutes in IV administration. In infants younger than 6 months it should be slowly administered by infusion prepared in 5% dextrose. And it should not be mixed with other drugs.

In oral administration the drug should be administered with water half an hour or one hour before or 2 hours after meals as drug absorption is faster when child is hungry. Child should not break or chew the tablet; but swallow it as a whole. Tablet is not advised for children under the age of 12. Rectal route of administration is used for children who cannot take by oral route. If possible, drug use should be adjusted according to the excretion times of children as drug absorption is faster when rectum is empty. After the administration of drug child should be laid in supine position for 15-20 minutes. As the absorption via rectal route in children is way faster than adults the probability of toxicity is also higher. So nurse should be warned not to exceed recommended dose.

Vital signs and inputs/outputs are observed and recorded at frequent intervals. Instant and clear tachycardia is one of the symptoms of toxicity.

When side effect-related symptoms appear the drug should not be administered and doctor should be notified. In the event that the symptoms are light it can be administered with higher doses.

Such commonly consumed beverages as coffee, tea, coke can increase the reactions. While a diet rich in protein increases the output of drug; a diet rich in carbohydrate decreases the output of it. These conditions result in changes in the drug level in blood. So it may be required to readjust the dose.

The drug should be stored in refrigerator. Suppository forms should be stored either outside or in refrigerator according to the recommendation of the manufacturer (Kavakl et al, 1998).
