Guideline recommendations: Asthma: The 2020 Global Initiative for Asthma Guidelines (GINA) and the 2007 National Heart, Lung and Blood Institute Asthma Guidelines recommend against theophylline for the treatment of asthma exacerbations due to poor efficacy and safety concerns (GINA 2020; NAEPP 2007). However, the total dose is usually not more than 20 mg per kg of body weight per day or 600 mg per day. Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. This is a decision you and your doctor will make. However, elderly patients may be more sensitive to the effects of theophylline than younger adults, and are more likely to have kidney, liver, heart, or lung problems, which may require caution and an adjustment in the dose for patients receiving theophylline. That's why it's important to have blood tests to reduce the risk. These side effects may go away during treatment as your body adjusts to the medicine. Available for Android and iOS devices. In a couple of weeks, rock overlords Queens Of The Stone Age will return with their new album In Times New Roman; we've already posted the singles "Emotion Sickness" and "Carnavoyeur." Oral theophylline has been used as a bronchodilator to treat chronic obstructive pulmonary disease (COPD) for decades, but it has fallen out of favor due to the side effects that come with the . The Romance Retreat will see a group of single parents looking . Show More Uses Cilostazol is used to improve the symptoms of a certain blood flow problem in the legs ( intermittent claudication ). Furukawa CT, Shapiro GG, Bierman CW, Kraemer MJ, Ward DJ, Pierson WE. T eres flojito, verdad? Specifically, the risk for seizures may be increased. Your doctor may adjust your dose as needed. As the rate of theophylline clearance may be dose-dependent, an increase in dose based upon a subtherapeutic serum concentration measurement should be limited to ~25% increase of the previous infusion rate or daily dose. You may report side effects to the FDA at 1-800-FDA-1088. Mayo Clinic does not endorse companies or products. Alzheimers Res Ther. Consider therapy modification, Methotrexate: May increase the serum concentration of Theophylline Derivatives. -A few seizures have been reported in patients with underlying neurological disease or in elderly patients with serum theophylline under 20 mcg/mL. Theophylline clearance may be decreased in patients with acute pulmonary edema, heart failure, cor pulmonale, fever (102F for 24 hours or lesser temperature elevations for longer periods), hepatic disease, acute hepatitis, cirrhosis, hypothyroidism, sepsis with multiorgan failure, shock, neonates (term and premature), infants <3 months of age with decreased renal function, infants <1 year of age, elderly >60 years of age, and patients following cessation of smoking. Cardiovascular: Cardiac flutter, tachycardia, Central nervous system: Headache, hyperactivity (children), insomnia, restlessness, seizure, status epilepticus (nonconvulsive), Endocrine & metabolic: Hypercalcemia (with concomitant hyperthyroid disease), Gastrointestinal: Gastroesophageal reflux (aggravation), gastrointestinal ulcer (aggravation), nausea, vomiting, Genitourinary: Difficulty in micturition (elderly males with prostatism), diuresis (transient). Injection: Treatment of acute exacerbations of the symptoms and reversible airflow obstruction associated with asthma and other chronic lung diseases (eg, chronic bronchitis, emphysema) as an adjunct to inhaled beta-2 selective agonists and systemically administered corticosteroids. 2018 American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) Guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay, Phosphodiesterase Enzyme Inhibitor, Nonselective. Answer: Theophylline is a "methylxanthine." confusion about identity, place, and time, dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position, fast, pounding, or irregular heartbeat or pulse, numbness or tingling in the hands, feet, or lips, pain or discomfort in the arms, jaw, back, or neck, shakiness in the legs, arms, hands, or feet, vomiting of blood or material that looks like coffee grounds. Canadian Asthma Consensus Report, 1999. PDEs come in several different types in humans, with numbers assigned to each type to tell them apart. Management: Concomitant use of ozanimod with sympathomimetic agents is not recommended. Consider therapy modification, Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Side effects Interactions Dosage What is theophylline? Theophylline may favorably impact functional impairment in COPD patients, but exact effects are unclear. Due to pregnancy-induced physiologic changes, some pharmacokinetic properties of theophylline are altered. Many people experience side effects for the first few days of taking theophylline, and then the side effects decrease or disappear. Would you like email updates of new search results? Theophylline may decrease adenosine efficacy and higher adenosine doses may be required. Cystic fibrosis: Use with caution in patients with cystic fibrosis; increased theophylline clearance may occur. "Vitamn C njdete v ovoc, ako s pomarane a jahody, a vitamn E v . Heart rate, CNS effects (insomnia, irritability); respiratory rate (COPD patients often have resting controlled respiratory rates in low 20s); arterial or capillary blood gases (if applicable); fluid balance, electrolyte concentrations, and acid-base balance during prolonged IV therapy. Theophylline systemic 200 mg (WARRICK 1660). There are safer and more effective medicines available, such as inhaled steroids and leukotriene modifiers. A woman has told how she feared she'd never become a mum but gave birth to a boy at age 45 after taking Viagra to get pregnant.. Carin Rockind, 48, welcomed a "miracle" baby after trying to have a . These results support the findings of the previous pilot study but, in addition, raise concern about depression and anxiety as possible long-term side effects of long-term theophylline therapy. Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat. >30 mcg/mL: Stop dosing and treat overdose; if resumed, decrease subsequent doses by at least 50%. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: Other side effects not listed may also occur in some patients. Rappaport L, Coffman H, Guare R, Fenton T, DeGraw C, Twarog F. Am J Dis Child. If trouble breathing increases or side effects appear, then a level should be checked. COPD treatment: The treatment of acute COPD with theophylline IV is not supported or recommended by current clinical practice guidelines due to significant side effects (GOLD 2019). Answer: The starting dose is determined by your age and body weight. There are safer and more effective medicines available, such as inhaled steroids and leukotriene modifiers. Consult drug interactions database for more information. Infants 6 to 52 weeks: Dose (mg/kg/hour) = (0.008 x age in weeks) + 0.21. They provide immediate relief for acute (sudden) breathing problems. -Consider the possibility of non-convulsive status epilepticus in patients with abnormal central nervous system function and theophylline use. If used together, monitor for decreased concentrations/effects of phenytoin or theophylline if the other agent is initiated/dose increased, or increased concentrations/effects if the other is discontinued/dose decreased. This means it is used daily to maintain control of your lung disease. Common side effects may include difficulty sleeping, stomach upset, headache and increased irritability. Loading dose: Note: Doses presented intended to achieve a serum level of approximately 10 mcg/mL; loading doses should be given intravenously (preferred) or with a rapidly absorbed oral product (not an extended release product). Patients currently receiving methylxanthines: A loading dose is not recommended without first obtaining a serum theophylline concentration in patients who have received aminophylline or theophylline within the past 24 hours. Have started or stopped smoking tobacco or marijuana in the last few weeks. Question: How long after my theophylline dose should my blood be drawn? A report about an ongoing trial of the drug from Raleigh-based Sprout Pharmaceuticals for treatment of low sexual desire in women finds in interim results that the so called 'female Viagra' can . Theophylline is not recommended for routine use as a long-term control medication in asthma due to weak efficacy. 8600 Rockville Pike Bronchodilation is mediated by inhibition of two isoenzymes, phosphodiesterase (PDE III and, to a lesser extent, PDE IV) while non-bronchodilation effects are mediated through other molecular mechanisms. However, the total dose is usually not more than 600 mg per day. There were also significant correlations between length of time theophylline was taken and scores on the depression (p less than 0.03) and the obsessive-compulsive (p less than 0.04) subscales of the Child Behavior Checklist. Bradycardia, heart transplantation (off-label use): Based on limited data and clinical experience: Oral: Initial: 150 mg twice daily; titrate as needed based on heart rate response and tolerability; daily doses of up to 900 mg/day have been reported (ACC/AHA/HRS [Kusumoto 2018]; Bertolet 1996; Redmond 1993). Management: Seek alternatives to this combination when possible. The results of some tests may be affected by this medicine. For people with chronic lung disease theophylline may be added to other medicines to improve symptoms and lung function. Management: Seek alternatives when possible. Monitor therapy, Verapamil: May increase the serum concentration of Theophylline Derivatives. Recheck serum concentrations. Highly variable and dependent upon age, hepatic function, cardiac function, lung disease, and smoking history (Hendeles 1995): Premature infants, postnatal age 3 to 15 days: 30 hours (range: 17 to 43 hours), Premature infants, postnatal age 25 to 57 days: 20 hours (range: 9.4 to 30.6 hours), Term infants, postnatal age 1 to 2 days: 25.7 hours (range: 25 to 26.5 hours), Term infants, postnatal age 3 to 30 weeks: 11 hours (range: 6 to 29 hours), Children 1 to 4 years: 3.4 hours (range: 1.2 to 5.6 hours), Children and Adolescents 6 to 17 years: 3.7 hours (range: 1.5 to 5.9 hours), Adults 18 years to 60 years (nonsmoking, asthmatic, otherwise healthy): 8.7 hours (range: 6.1 to 12.8 hours), Elderly >60 years (nonsmoking, healthy): 9.8 hours (range: 1.6 to 18 hours), ~40%, primarily to albumin; decreased in neonates (due to a greater percentage of fetal albumin), hepatic cirrhosis, acidemia (uncorrected), third trimester of pregnancy, and elderly. Talk with the doctor. Avoid combination, Febuxostat: May increase serum concentrations of the active metabolite(s) of Theophylline Derivatives. Avoid combination, Acebrophylline: May enhance the stimulatory effect of Theophylline Derivatives. Other macrolides appear to have little to no effect. Children 6 years and Adolescents <16 years, weighing 45 kg: Days 1 to 3: 12 to 14 mg/kg/day; maximum daily dose: 300 mg/day. Monitor therapy, Formoterol: Theophylline Derivatives may enhance the adverse/toxic effect of Formoterol. Monitor therapy, Adenosine: Theophylline Derivatives may diminish the therapeutic effect of Adenosine. Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. Management: Hold theophylline for 12 to 48 hours before methacholine use. They are found in coffee, tea, and chocolate/cocoa, but they are not as strong as theophylline. >30 mcg/mL: Discontinue infusion and treat overdose as indicated; if theophylline is resumed, decrease dose or infusion rate by at least 50% and recheck serum concentrations after 24 hours (IV) or 3 days (oral) to guide further dosage adjustment. The following information includes only the average doses of this medicine. Theophylline may also help the improve contraction of the diaphragm, which may help a persons breathing. Avoid excessive heat. Check with your doctor immediately if any of the following side effects occur: Get emergency help immediately if any of the following symptoms of overdose occur: Some side effects may occur that usually do not need medical attention. Theophylline is a medication used to treat asthma and chronic obstructive pulmonary disease as a second-line drug. Szefler SJ, Bender BG, Jusko WJ, Lanier BQ, Lemanske RF Jr, Skoner DP, Stempel DA. It is best to take the extended-release capsule one hour before a high-fat meal or without food. Infants exposed to theophylline during the third trimester should be monitored for adverse events (irritability, tachycardia, vomiting) (ERS/TSANZ [Middleton 2020]). Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Data at hand show limited to moderate bronchodilatator effect of theophylline, which is comparable to beta 2-adrenergic drugs only in some studies using high dose regimen with theophylline levels of about 20 mg/l, i.e. Reversible airflow obstruction, chronic conditions: Oral: Starting doses in older adults should be reduced by 25% compared to younger adult populations (Brodeur 2015). In conclusion, theophylline seems to act via several mechanisms: bronchodilation, protection against various stimuli, increase of ventilation and muscular contractility, which might explain its clinical benefit, although less potent than other drugs as a bronchodilatator of prophylactic agent. An official website of the United States government. Patients should consistently take theophylline with food or in fasting state. In a prior pilot study involving six children, we noted improved memory and concentration and improved behavior when these children were switched from theophylline to cromolyn sodium therapy. Advertising revenue supports our not-for-profit mission. If your dose is different, do not change it unless your doctor tells you to do so. The site is secure. Theophylline relaxes the smooth muscles around the airways. Monitor therapy, Cannabis: May decrease the serum concentration of CYP1A2 Substrates (High risk with Inducers). The effects may be increased because of slower removal of the medicine from the body. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. Obtain theophylline serum concentration 30 minutes (IV) or 24 hours (oral) after loading dose (when distribution is complete) to assess the need for and size of subsequent loading doses (and for guidance of continuing therapy). The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. Ask your healthcare professional how you should dispose of any medicine you do not use. Question: Are some theophylline preparations better than others? He armed himself with a balaclava, latex gloves, condoms and Viagra pills and posed as a cab driver in a Mercedes to roam the streets of Brighton, East Sussex. If at risk for impaired theophylline clearance or not feasible to monitor serum theophylline concentrations, do not exceed maximum dose of 400 mg/day. COPD: Based on the Global Initiative for Chronic Obstructive Lung Disease Guidelines (2019), use of theophylline in patients with COPD is controversial and lacks data. Do not take other medicines unless they have been discussed with your doctor. and transmitted securely. Theophylline dose reductions will likely be required. Have started or stopped taking another medicine in the last few weeks. Do not double doses. -Seizures in elderly patients with serum theophylline under 20 mcg/mL may be due to decreased protein binding causing higher unbound (pharmacologically active) theophylline levels. 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