Aminophylline

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Aminophylline
Aminophylline Formula V.1.svg
Systematic (IUPAC) name
1,3-dimethyl-7H-purine-2,6-dione; ethane-1,2-diamine
Clinical data
AHFS/Drugs.comConsumer Drug Information
MedlinePlusa601015
Pregnancy cat.A (AU) C (US)
Legal statusPharmacist Only (S3) (AU) P (UK)
Routesoral, i.v.
Pharmacokinetic data
Protein binding60%
Half-life7-9 hours
Identifiers
CAS number317-34-0 YesY
ATC codeR03DA05
PubChemCID 9433
DrugBankDB01223
ChemSpider9062 YesY
UNII27Y3KJK423 YesY
KEGGD00227 YesY
ChEMBLCHEMBL1210 N
Chemical data
FormulaC16H24N10O4 
Mol. mass420.427 g/mol
 N (what is this?)  (verify)
 
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Aminophylline
Aminophylline Formula V.1.svg
Systematic (IUPAC) name
1,3-dimethyl-7H-purine-2,6-dione; ethane-1,2-diamine
Clinical data
AHFS/Drugs.comConsumer Drug Information
MedlinePlusa601015
Pregnancy cat.A (AU) C (US)
Legal statusPharmacist Only (S3) (AU) P (UK)
Routesoral, i.v.
Pharmacokinetic data
Protein binding60%
Half-life7-9 hours
Identifiers
CAS number317-34-0 YesY
ATC codeR03DA05
PubChemCID 9433
DrugBankDB01223
ChemSpider9062 YesY
UNII27Y3KJK423 YesY
KEGGD00227 YesY
ChEMBLCHEMBL1210 N
Chemical data
FormulaC16H24N10O4 
Mol. mass420.427 g/mol
 N (what is this?)  (verify)

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.[1]

Aminophylline is less potent and shorter-acting than theophylline. Its most common use is in the treatment of airway obstruction from asthma or COPD. It is used off-label as a reversal agent during nuclear stress testing. Aminophylline is a nonselective adenosine receptor antagonist and phosphodiesterase inhibitor.[2]

Properties[edit]

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. One 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.

Mechanism of action[edit]

Like other methylated xanthine derivatives, aminophylline is both a

  1. competitive nonselective phosphodiesterase inhibitor[3] which raises intracellular cAMP, activates PKA, inhibits TNF-alpha[4][5] and leukotriene[6] synthesis, and reduces inflammation and innate immunity[6] and
  2. nonselective adenosine receptor antagonist.[7]

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

Adenosine is an endogenous extracellular messenger that can regulate myocardial oxygen needs.[2][8] 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.[2][8] Adenosine also antagonizes chronotropic and ionotropic effects of circulating catecholamines.[9] 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.[2] Adenosine’s effects are concentration-dependent. Adenosine’s receptors are competitively antagonized by methylxanthines such as aminophylline.[2][8][9] Aminophylline competitively antagonizes the cardiac actions of adenosine at the cell surface receptors.[8] Thus, it increases heart rate and contractility.

Precautions, contraindications and interactions[edit]

Aminophylline can lead to theophylline toxicity. Aminophylline has been found to decrease the sedative effects of propofol[10] and decrease topiramate antiseizure action.[11]

Other uses[edit]

Aminophylline is used to reverse regadenoson, dipyridamole or adenosine based infusions during nuclear cardiology stress testing.

Some suggest aminophylline may be administered in resuscitation efforts to re-establish cardiac rhythm.[8] However, a 2007 metanalysis concluded aminophylline offers no benefit in this scenario.[12]

Aminophylline has shown some promise as a bodyfat reducer when used as a topical cream (sometimes referred to as "cutting gel").[13] Aminophylline is also a treatment option for anaphylactic shock.[14]

Brand names[edit]

References[edit]

  1. ^ "Aminophylline Professional Monograph". 
  2. ^ a b c d e Mader, TJ; Smithline HA; Durkin L; Scriver G (March 2003). "A randomized control 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. Retrieved Feb 10, 2012. 
  3. ^ Essayan DM. (2001). "Cyclic nucleotide phosphodiesterases.". J Allergy Clin Immunol. 108 (5): 671–80. doi:10.1067/mai.2001.119555. PMID 11692087. 
  4. ^ Deree J, Martins JO, Melbostad H, Loomis WH, Coimbra R. (2008). "Insights into the Regulation of TNF-α Production in Human Mononuclear Cells: The Effects of Non-Specific Phosphodiesterase Inhibition". Clinics (Sao Paulo). 63 (3): 321–8. doi:10.1590/S1807-59322008000300006. PMC 2664230. PMID 18568240. 
  5. ^ Marques LJ, Zheng L, Poulakis N, Guzman J, Costabel U (February 1999). "Pentoxifylline inhibits TNF-alpha production from human alveolar macrophages". Am. J. Respir. Crit. Care Med. 159 (2): 508–11. doi:10.1164/ajrccm.159.2.9804085. PMID 9927365. 
  6. ^ a b Peters-Golden M, Canetti C, Mancuso P, Coffey MJ. (2005). "Leukotrienes: underappreciated mediators of innate immune responses". J Immunol. 174 (2): 589–94. doi:10.4049/jimmunol.174.2.589. PMID 15634873. 
  7. ^ Daly JW, Jacobson KA, Ukena D. (1987). "Adenosine receptors: development of selective agonists and antagonists". Prog Clin Biol Res. 230 (1): 41–632. PMID 3588607. 
  8. ^ a b c d e Mader, TJ; Gibson, P (7 January 1997). cws_home/505959/description#description "Adenosine receptor antagonism in refractory asystolic cardiac arrest: results of a human pilot study". Elsevier Resuscitation 35: 3–7. doi:10.1016/s0300-9572(97)01097-6. Retrieved Feb 10, 2012. 
  9. ^ a b Perouansky, M; Shamir M; Hershkowitz E; Donchin Y (12 June 1998). portal.info.subzero.lib.uoguelph.ca/tmp/5676621964383762041.pdf "Successful resuscitation using aminophylline in refrectory cardiac arrest with asystole". Elsevier Resuscitation 38: 39–41. doi:10.1016/s0300-9572(98)00079-3. Retrieved Feb 16, 2012. 
  10. ^ Turan, A; Kasuya Y; Govinda R; Obal D; Rauch S; Dalton J; et al (February 2010). content/110/2/449 "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. Retrieved Feb 17, 2012. 
  11. ^ Luszczki, JJ; Jankiewicz K; Jankiewicz M; Czuczwar SJ (May 2007). portal.info.sub zero.lib.uoguelph.ca/detailssfx.xqy?uri=/0014299 9/v562i12/53_papio atmmesm.xml "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. Retrieved Feb 17, 2012. 
  12. ^ "Aminophylline in bradyasystolic cardiac arrest", Emerg Med J. 24 (8), 2007: 582–3, doi:10.1136/emj.2007.051342, PMC 2660094, PMID 17652689 
  13. ^ Caruso MK, Pekarovic S, Raum WJ, Greenway F (May 2007). "Topical fat reduction from the waist". Diabetes, obesity & metabolism 9 (3): 300–3. doi:10.1111/j.1463-1326.2006.00600.x. PMID 17391155. 
  14. ^ Blackbourne LH. Surgical Recall. Lippincott Williams and Wilkins, 2009. pp169