Maintenance dosage guidelines for theophylline in children older than six months and adults who have no risk factors for decreased theophylline clearance*

Variable	Weight-adjusted and maximal dose	Comments	Adjustment to dose
Initial dose	~10 mg/kg of body weight/day; maximum, 300 mg/day	If initial dose is tolerated, increase the dose no sooner than 3 days later to the first dose increase.
First dose increase	~13 mg/kg/day; maximum 450 mg/day	If the first dose increase is tolerated, increase the dose no sooner than 3 days later to the second dose increase.
Second dose increase	~16 mg/kg/day; maximum 600 mg/day	Measure the peak serum concentration after at least 3 days at the highest tolerated dose^¶.
Serum theophylline concentration (µg/mL)
<10			Increase approximately 25 percent.
10 to 15			Maintain dose if tolerated.
15.1 to 19.9			Consider a reduction of approximately 10 percent.
20 to 25			Withhold next dose, then resume treatment with next lower dose level.
>25			Withhold next 2 doses, then resume treatment with initial dose or lower dose.

* For infants 6 weeks to 6 months of age, the initial daily dose is calculated according to the following regression equation: dose (in milligrams per kilogram per day) = (0.2) (age in weeks) + 5.0. Subsequent increases in the dose in this age group should be based on peak serum concentrations measured no sooner than three days after the start of therapy.
¶ The length of time to the peak serum concentration depends on the rate of absorption, the rate of elimination, and the dosing interval.
Δ This decreases the likelihood of side effects due to fluctuations in the absorption or elimination rate that may result in serum concentrations above 20 µg per milliliter and is especially important for patients who require doses higher than those used in the second dose increase.

Adapted from Weinberger, M, Hendeles, L, N Engl J Med 1996; 334:1380.

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Maintenance dosage guidelines for theophylline in children older than six months and adults who have no risk factors for decreased theophylline clearance*