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Aminophylline

Clinical data
AHFS/Drugs.com	Professional Drug Facts
MedlinePlus	a601015
Pregnancy category	AU: A
Routes of administration	By mouth, intravenous therapy (IV)
ATC code	R03DA05 (WHO)
Legal status
Legal status	AU: S3 (Pharmacist only) UK: P (Pharmacy medicines) US: ℞-only In general: ℞ (Prescription only)
Pharmacokinetic data
Protein binding	60%
Elimination half-life	7–9 hours
Identifiers
IUPAC name 1,3-Dimethyl-7H-purine-2,6-dione; ethane-1,2-diamine
CAS Number	317-34-0
PubChem CID	9433
DrugBank	DB01223
ChemSpider	9062
UNII	27Y3KJK423
KEGG	D00227
ChEBI	CHEBI:2659
ChEMBL	ChEMBL1210
CompTox Dashboard (EPA)	DTXSID40883359
ECHA InfoCard	100.005.696
Chemical and physical data
Formula	C16H24N10O4
Molar mass	420.434 g·mol
3D model (JSmol)	Interactive image
SMILES Cn2c(=O)c1ncc1n(C)c2=O.Cn2c(=O)c1ncc1n(C)c2=O.NCCN
InChI InChI=1S/2C7H8N4O2.C2H8N2/c2*1-10-5-4(8-3-9-5)6(12)11(2)7(10)13;3-1-2-4/h2*3H,1-2H3,(H,8,9);1-4H2 Key:FQPFAHBPWDRTLU-UHFFFAOYSA-N
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Aminophylline is a compound of the bronchodilator theophylline with ethylenediamine in 2:1 ratio. The ethylenediamine improves solubility, and the aminophylline is usually found as a dihydrate.

Aminophylline is less potent and shorter-acting than theophylline. Its most common use is in the treatment of airway obstruction from asthma or COPD. Aminophylline is a nonselective adenosine receptor antagonist and phosphodiesterase inhibitor.

Medical uses

Intravenous aminophylline can be used for acute exacerbation of symptoms and reversible airway obstruction in asthma and other chronic lung disease such as COPD, emphysema and chronic bronchitis. It is used as an adjunct to inhaled beta-2 selective agonists and systemically administered corticosteroids.

Aminophylline is used to reverse regadenoson, dipyridamole or adenosine based infusions during nuclear cardiology stress testing. Aminophylline has also been reported to be effective in preventing slow heart rates during complex cardiovascular interventions (atherectomy of the right coronary artery). It is also used in the treatment of heart block due to acute inferior myocardial infarction. It can also cause cardiac arrest.

Aminophylline has shown some promise as a bodyfat reducer when used as a topical cream. Aminophylline is also a treatment option for anaphylactic shock.

While it has been suggested for use in cardiac arrest evidence does not support a benefit.

Side effects

Aminophylline can lead to theophylline toxicity. Aminophylline has been found to decrease the sedative effects of propofol and decrease topiramate antiseizure action.

Properties

It is more soluble in water than theophylline. White or slightly yellowish granules or powder, having a slight ammoniacal odor and a bitter taste. Upon exposure to air, it gradually loses ethylenediamine and absorbs carbon dioxide with the liberation of free theophylline. Its solutions are alkaline. 1 g dissolves in 25 mL of water to give a clear solution; 1 g dissolved in 5 mL of water crystallizes upon standing, but redissolves when a small amount of ethylenediamine is added. Insoluble in alcohol and in ether.

Pharmacology

Like other methylated xanthine derivatives, aminophylline is both a

1. competitive nonselective phosphodiesterase inhibitor which raises intracellular cAMP, activates PKA, inhibits TNF-alpha and leukotriene synthesis, and reduces inflammation and innate immunity and
2. nonselective adenosine receptor antagonist.

Aminophylline causes bronchodilation, diuresis, central nervous system and cardiac stimulation, and gastric acid secretion by blocking phosphodiesterase which increases tissue concentrations of cyclic adenosine monophosphate (cAMP) which in turn promotes catecholamine stimulation of lipolysis, glycogenolysis, and gluconeogenesis, and induces release of epinephrine from adrenal medulla cells.
Diuresis is caused by an increase in cAMP which acts in the CNS to inhibit the release of antidiuretic hormone (arginine-vasopressin).

Adenosine is an endogenous extracellular messenger that can regulate myocardial oxygen needs. It acts through cellular surface receptors which effect intracellular signalling pathways to increase coronary artery blood flow, slow heart rate, block atrioventricular node conduction, suppress cardiac automaticity, and decrease β-adrenergic effects on contractility. Adenosine also antagonizes chronotropic and ionotropic effects of circulating catecholamines. Overall, adenosine decreases the heart’s rate and force of contraction, which increases blood supply to the cardiac muscle. Given specific circumstances this mechanism (which is intended to protect the heart) may cause atropine-resistant refractory bradyasystole. Adenosine's effects are concentration-dependent. Adenosine’s receptors are competitively antagonized by methylxanthines such as aminophylline. Aminophylline competitively antagonizes the cardiac actions of adenosine at the cell surface receptors. Thus, it increases heart rate and contractility.

References

1. "FDA-Approved Drugs Abbreviated New Drug Application (ANDA): 087242". fda.gov. October 26, 1983. Retrieved December 2, 2023.
2. "Aminophylline Professional Monograph". Drugs.com.
3. ^ Mader TJ, Smithline HA, Durkin L, Scriver G (March 2003). "A randomized controlled trial of intravenous aminophylline for atropine-resistant out-of-hospital asystolic cardiac arrest". Academic Emergency Medicine. 10 (3): 192–197. doi:10.1197/aemj.10.3.192. PMID 12615581.
4. "Aminophylline Injection". Drugs.com. Retrieved 6 January 2018.
5. "Aminophylline for Preventing Bradyarrhythmias During Orbital or Rotational Atherectomy of the Right Coronary Artery". invasivecardiology.com. Archived from the original on 2020-08-03. Retrieved 2018-06-15.
6. Caruso MK, Pekarovic S, Raum WJ, Greenway F (May 2007). "Topical fat reduction from the waist". Diabetes, Obesity & Metabolism. 9 (3): 300–303. doi:10.1111/j.1463-1326.2006.00600.x. PMID 17391155. S2CID 988473.
7. Blackbourne LH. Surgical Recall. Lippincott Williams and Wilkins, 2009. pp169
8. Hayward E, Showler L, Soar J (August 2007). "Aminophylline in bradyasystolic cardiac arrest". Emergency Medicine Journal. 24 (8): 582–583. doi:10.1136/emj.2007.051342. PMC 2660094. PMID 17652689.
9. Hurley KF, Magee K, Green R (November 2015). "Aminophylline for bradyasystolic cardiac arrest in adults". The Cochrane Database of Systematic Reviews. 2015 (11): CD006781. doi:10.1002/14651858.CD006781.pub3. PMC 8454042. PMID 26593309.
10. Turan A, Kasuya Y, Govinda R, Obal D, Rauch S, Dalton JE, et al. (February 2010). "The effect of aminophylline on loss of consciousness, bispectral index, propofol requirement, and minimum alveolar concentration of desflurane in volunteers". Anesthesia and Analgesia. 110 (2): 449–454. doi:10.1213/ane.0b013e3181c6be7e. PMID 19955506. S2CID 29111498.
11. Luszczki JJ, Jankiewicz K, Jankiewicz M, Czuczwar SJ (May 2007). "Pharmacokinetic and pharmacodynamic interactions of aminophylline and topiramate in the mouse maximal electroshock-induced seizure model". European Journal of Pharmacology. 562 (1–2): 53–59. doi:10.1016/j.ejphar.2007.01.038. PMID 17320861.
12. Essayan DM (November 2001). "Cyclic nucleotide phosphodiesterases". The Journal of Allergy and Clinical Immunology. 108 (5): 671–680. doi:10.1067/mai.2001.119555. PMID 11692087.
13. Deree J, Martins JO, Melbostad H, Loomis WH, Coimbra R (June 2008). "Insights into the regulation of TNF-alpha production in human mononuclear cells: the effects of non-specific phosphodiesterase inhibition". Clinics. 63 (3): 321–328. doi:10.1590/S1807-59322008000300006. PMC 2664230. PMID 18568240.
14. Marques LJ, Zheng L, Poulakis N, Guzman J, Costabel U (February 1999). "Pentoxifylline inhibits TNF-alpha production from human alveolar macrophages". American Journal of Respiratory and Critical Care Medicine. 159 (2): 508–511. doi:10.1164/ajrccm.159.2.9804085. PMID 9927365.
15. ^ Peters-Golden M, Canetti C, Mancuso P, Coffey MJ (January 2005). "Leukotrienes: underappreciated mediators of innate immune responses". Journal of Immunology. 174 (2): 589–594. doi:10.4049/jimmunol.174.2.589. PMID 15634873.
16. Daly JW, Jacobson KA, Ukena D (1987). "Adenosine receptors: development of selective agonists and antagonists". Progress in Clinical and Biological Research. 230 (1): 41–63. PMID 3588607.
17. ^ Mader TJ, Gibson P (August 1997). "Adenosine receptor antagonism in refractory asystolic cardiac arrest: results of a human pilot study". Resuscitation. 35 (1): 3–7. doi:10.1016/s0300-9572(97)01097-6. PMID 9259053.
18. ^ Perouansky M, Shamir M, Hershkowitz E, Donchin Y (July 1998). "Successful resuscitation using aminophylline in refractory cardiac arrest with asystole". Resuscitation. 38 (1): 39–41. doi:10.1016/s0300-9572(98)00079-3. PMID 9783508.

External links

• "Aminophylline". Drug Information Portal. U.S. National Library of Medicine.

• Medicine

• Adenosine receptor antagonists
• Bronchodilators
• Phosphodiesterase inhibitors
• Xanthines