Quinine: (Major) The coadministration of theophylline, aminophylline with quinine may increase the Cmax and AUC of quinine and decrease the AUC of theophylline, aminophylline. Fluticasone; Salmeterol: (Moderate) Beta-agonists are commonly used in conjunction with aminophylline or theophylline therapy. Fosphenytoin: (Moderate) Theophylline is primarily metabolized in the liver by the CYP1A2 isoenzyme, and also by the CYP3A4 isoenzyme. It is a bronchodilator. Explore lung, breathing and allergy disorders, treatments, tests and prevention services provided by the Cleveland Clinic Respiratory Institute. More serious effects are rare, but may result in additive cardiovascular effects such as increased blood pressure and heart rate. (Moderate) Concurrent administration of theophylline or aminophylline with sympathomimetics can produce excessive stimulation manifested by skeletal muscle activity, agitation, and hyperactivity. Theophylline is a CYP1A2 substrate and viloxazine is a strong CYP1A2 inhibitor. Further dose adjustments may be needed due to concomitant drug therapy; review drug interactions. (Minor) Monitor theophylline levels and watch for an increase in theophylline-related adverse reactions if coadministration with rucaparib is necessary; a theophylline dose reduction may be necessary. Golimumab: (Moderate) If golimumab is initiated or discontinued in a patient taking aminophylline, monitor the theophylline concentration; aminophylline dose adjustment may be needed. Clinically relevant drug interactions may occur with CYP450 substrates that have a narrow therapeutic index such as theophylline. Extreme caution is recommended during concurrent use of other drugs that may lower the seizure threshold such as aminophylline. It does not work right away and should not be used to relieve sudden breathing problems. The effects of adenosine are antagonized by methylxanthines. Dosage adjustments may be necessary, particularly during initiation of theophylline therapy or following changes in theophylline dosage. Fosaprepitant 150 mg IV as a single dose increased the AUC of midazolam (given on days 1 and 4) by approximately 1.8-fold on day 1; there was no effect on day 4. They provide immediate relief for acute (sudden) breathing problems. Cobicistat: (Moderate) Caution is warranted when cobicistat is administered with theophylline; aminophylline as there is a potential for elevated theophylline concentrations. Lumacaftor; Ivacaftor: (Major) Concomitant use of theophylline and lumacaftor; ivacaftor is not recommended. Riociguat: (Contraindicated) Coadministration of riociguat and phosphodiesterase inhibitors, including nonspecific phosphodiesterase inhibitors (e.g., theophylline, aminophylline) is contraindicated due to the risk of hypotension. Acetaminophen; Dextromethorphan; Guaifenesin; Pseudoephedrine: (Moderate) Concurrent administration of theophylline or aminophylline with some sympathomimetics can produce excessive stimulation and effects such as nervousness, irritability, or insomnia. Other types of bronchodilators may be short-acting. (Minor) Theophylline is primarily metabolized in the liver by the CYP1A2 isoenzyme. Consider smaller, more frequent doses in patients with rapid metabolism, identified by higher than average dose requirements. The labeling for aminophylline products states that aminophylline clearance may be decreased by up to 35% when clarithromycin is prescribed concurrently; these interactions can be clinically important. He armed himself with a balaclava, latex gloves, condoms . Adjust dose to maintain therapeutic range; doses of 400 to 1,600 mg/day PO may be needed. Monitor theophylline concentrations. Seizures or cardiac arrhythmias are also possible. In studies, increases in theophylline levels of 25% up to 100% have occurred. Barbiturates: (Moderate) The metabolism of aminophylline can be increased by concurrent use with barbiturates. Its use in cats and dogs to treat cough and bronchoconstriction is 'off label' or 'extra label. Theophylline is partially metabolized by CYP3A3. Loratadine; Pseudoephedrine: (Moderate) Concurrent administration of theophylline or aminophylline with some sympathomimetics can produce excessive stimulation and effects such as nervousness, irritability, or insomnia. It provides relief over six to 24 hours. This medication belongs to a class of drugs known as xanthines. These changes were not considered statistically significant. Sodium Phenylbutyrate; Taurursodiol: (Moderate) Monitor theophylline concentrations and watch for decreased efficacy of theophylline if coadministration with taurursodiol is necessary; a theophylline dose increase may be necessary. Ethotoin: (Moderate) Theophylline is primarily metabolized in the liver by the CYP1A2 isoenzyme, and also by the CYP3A4 isoenzyme. However, children younger than 1 year of age are more likely to have serious side effects, which may require caution and an adjustment in the dose for patients receiving theophylline. (Moderate) The metabolism of theophylline can be increased by concurrent use with barbiturates. Regular (i.e., nonsustained-release) tablets produce peak serum concentrations within 60 minutes after administration. Intravenous loading dose bolus:If the patient has received any theophylline within 24 hours, obtain serum theophylline concentration prior to administration of a theophylline loading dose.Manufacturers recommend administering the bolus dose over 30 minutes.Monitor patient clinically as appropriate during infusion.Obtain theophylline serum concentration 30 minutes after administration of intravenous loading dose to assess the need for and size of subsequent loading doses, if clinically indicated, and for guidance of continuing therapy. Consider increased monitoring and dose reductions in neonates with renal impairment. Adjust subsequent dosage based on serum theophylline concentrations. In patients who have received theophylline within the previous 24 hours, a theophylline serum concentration must be drawn and loading dose, if needed, calculated accordingly. Patients should be monitored for loss of therapeutic effect if a barbiturate is added is added to aminophylline therapy. Initially, 12 to 14 mg/kg/day (Max: 300 mg/day) PO every 24 hours; evening dosing is not recommended. Phenobarbital; Hyoscyamine; Atropine; Scopolamine: (Moderate) The metabolism of aminophylline can be increased by concurrent use with barbiturates. Budesonide; Glycopyrrolate; Formoterol: (Moderate) Beta-agonists are commonly used in conjunction with aminophylline or theophylline therapy. If use is necessary, consider decreasing the theophylline dose. Pets with liver disease or heart failure should receive lower doses of the medication. In general, famotidine does not interact with aminophylline and does not affect theophylline levels in most patients. Concurrent use of theophylline with caffeine in neonates is not recommended due to the potential for additive toxicity. Colesevelam: (Moderate) Colesevelam may decrease the absorption of oral aminophylline. Discontinuation of St. John's Wort in a patient on theophylline may result in theophylline toxicity. Dosages of theophylline may need to be adjusted while the patient is receiving rifampin. Calculate initial dosage using the following equation: (0.008 x age in weeks) + 0.21 = theophylline dosage in mg/kg/hour IV; reduced doses may be needed in patients with risk factors for reduced theophylline clearance (e.g., cardiac or liver dysfunction, renal dysfunction in infants younger than 3 months). Protein binding is approximately 40% for healthy adults and is lower in neonates and patients with hepatic impairment. Concomitant use can cause additive CNS stimulation; some patients may experience tremor or nervousness with combined use. Get useful, helpful and relevant health + wellness information. Sucralfate should be given 2 hours before or after the oral administration of theophylline. Patients with uncorrected acidemia can have an increase in the volume of distribution of theophylline due to a decrease in plasma protein binding. The following are some general guidelines in chronic use (dosage expressed as theophylline): 18 to 60 years: Adults requiring more than 600 mg/day total of theophylline require close monitoring to individualize dosage. If theophylline is being initiated in a patient who is already taking a drug that inhibits its clearance, the dose of theophylline required to achieve a therapeutic theophylline concentration will be smaller. Further dose adjustments may be needed due to concomitant drug therapy; review drug interactions. Continue taking theophylline as long as your healthcare provider recommends. Monitor for lack of aminophylline efficacy. What is theophylline? More importantly, serious theophylline toxicity can result if any of these drugs are discontinued and the dose of theophylline is not correspondingly decreased. Epinephrine: (Moderate) Concurrent administration of theophylline or aminophylline with sympathomimetics can produce excessive stimulation manifested by skeletal muscle activity, agitation, and hyperactivity. Butabarbital: (Moderate) The metabolism of aminophylline can be increased by concurrent use with barbiturates. The clinical significance of this interaction is not certain. Extended-release products should NOT be used to treat acute symptoms. Remimazolam: (Minor) Aminophylline or Theophylline have been reported to counteract the pharmacodynamic effects of diazepam and possibly other benzodiazepines. Generic Viagra (sildenafil) is available as a 20-, 25-, 50-, and 100-milligram (mg) pill and in liquid form. Dupilumab: (Moderate) Coadministration of dupilumab may result in altered exposure to theophylline. Adenosine antagonism has been considered as an explanation for theophylline's bronchodilating effects. Decreased elimination of both caffeine and theophylline may explain some of these reactions; decreased elimination has been demonstrated in healthy men on theophylline consuming dietary caffeine. Theophylline and aminophylline are CYP3A4 substrates. The clinical significance of this interaction is not certain. Acetaminophen; Pseudoephedrine: (Moderate) Concurrent administration of theophylline or aminophylline with some sympathomimetics can produce excessive stimulation and effects such as nervousness, irritability, or insomnia. Patients should avoid medications containing caffeine when possible. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. Duloxetine: (Moderate) Close monitoring of theophylline levels is advisable during concurrent use of duloxetine and theophylline. To minimize potential for interactions, consider administering oral aminophylline at least 1 hour before or at least 4 hours after colesevelam. Patients may also need to limit their intake of caffeine-containing beverages or foods (e.g., coffee, green tea, other teas, colas, or chocolate) to avoid caffeine-like side effects. Patients may also need to limit their intake of caffeine-containing beverages or foods (e.g., coffee, green tea, other teas, colas, or chocolate) to avoid caffeine-like side effects. Theophylline may require dosage adjustment when therapy with lansoprazole is initiated or discontinued. Geriatric Echinacea: (Moderate) Aminophylline is metabolized by both CYP1A2 and CYP3A4. Do not exceed 16 mg/kg/day (up to 400 mg/day) in patients with risk factors for decreased theophylline clearance or who cannot receive recommended serum concentration monitoring. Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: (Moderate) Ritonavir decreased theophylline AUC and Cmax by 43% and 52%, respectively, when the two drugs were coadministered. Seizures or cardiac arrhythmias are also possible. The labeling for aminophylline products states that aminophylline clearance may be decreased by up to 35% when clarithromycin is prescribed concurrently; these interactions can be clinically important. (Major) Caffeine is a CNS stimulant. Aminophylline is a derivative of theophylline. These interactions are particularly significant when theophylline serum concentrations are already in the high therapeutic range (i.e., > 15 mcg/ml). However, children younger than 1 year of age are more likely to have serious side effects, which may require caution and an adjustment in the dose for patients receiving theophylline. Cimetidine inhibits the CYP1A2 isoenzyme and not only reduces the hepatic metabolism of aminophylline, but a reduction in the renal clearance of theophylline may occur via competition for renal tubular secretion. Seizures or cardiac arrhythmias are also possible. Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of theophylline in children. Patients may also need to limit their intake of caffeine-containing beverages or foods (e.g., coffee, green tea, other teas, colas, or chocolate) to avoid caffeine-like side effects. (Moderate) Concurrent administration of theophylline or aminophylline with sympathomimetics can produce excessive stimulation manifested by skeletal muscle activity, agitation, and hyperactivity. The concurrent administration of caffeine to patients taking aminophylline may produce excessive caffeine-like side effects, such as nausea, irritability or nervousness. Dosages of aminophylline may need to be adjusted while the patient is receiving rifampin. Seizures or cardiac arrhythmias are also possible. A aminophylline or theophylline dose adjustment may be needed in some patients. Other extrapulmonary effects attributed to theophylline include CNS stimulation, improved diaphragmatic contractility, and prostaglandin inhibition. Extreme caution is recommended during concurrent use of other drugs that may lower the seizure threshold such as theophylline. Extended-release products should NOT be used to treat acute symptoms. Individualize dosage; do not exceed 16 mg/kg/day up to 400 mg/day PO if risk factors for decreased clearance are present or recommended serum theophylline concentration monitoring is not possible. The labeling for aminophylline products states that aminophylline clearance may be decreased by up to 35% when clarithromycin is prescribed concurrently; these interactions can be clinically important. (Major) Caffeine is a CNS stimulant. Be alert for any evidence of interaction, and monitor the patients aminophylline therapy as per standard of care or if side effects are reported. Although the concomitant administration of dronedarone and CYP3A substrates may result in increased exposure of the substrate, data from clinical studies indicate dronedarone does not increase the steady state theophylline exposure. Medications that cause induction of hepatic CYP450 enzymes, such as phenytoin, ethotoin, or fosphenytoin, may increase the hepatic oxidative metabolism of theophylline or aminophylline. Atazanavir; Cobicistat: (Moderate) Caution is warranted when atazanavir is administered with theophylline; aminophylline as there is a potential for elevated theophylline concentrations. Since ketoconazole is well-known to inhibit the hepatic metabolism of many drugs and theophylline concentrations would be expected to increase, it is suspected that ketoconazole may have interfered with oral bioavailability of theophylline. In general, famotidine does not interact with aminophylline and does not affect theophylline levels in most patients. A proposed mechanism is competitive binding of these methylxanthines to adenosine receptors in the brain. Extended-release products should NOT be used to treat acute symptoms. Ibuprofen; Famotidine: (Minor) Aminophylline is a prodrug of theophylline, and is primarily metabolized in the liver by the CYP1A2 isoenzyme. Consider checking potassium levels if clinically indicated. Although data regarding this drug interaction are conflicting, it appears that this can be explained by the duration of isoniazid administration. The resulting increased half-life and decreased clearance may necessitate a decrease in aminophylline dosage. Close monitoring is recommended, particularly in a newborn. Aminophylline is converted to theophylline in the body. No interaction of concern is expected when aminophylline is used concomitantly with the chronic dipyridamole therapy. The trek . Reduce the theophylline dose by approximately 50% and monitor theophylline plasma concentrations when zileuton is prescribed to an existing regimen. Carbamazepine: (Major) Aminophylline is expected to decrease plasma concentrations of carbamazepine via 3A4 induction. Concurrent use of theophylline with caffeine in neonates is not recommended due to the potential for additive toxicity. Clinical monitoring for adverse effects is recommended during coadministration. Reductions in CYP1A2 activity have been noted with various alpha interferons, and likely provide a mechanism for the interaction. Concomitant use may result in a significant increase in theophylline concentrations due to reduced aminophylline clearance. More serious effects are rare, but may result in additive cardiovascular effects such as increased blood pressure and heart rate. When ketamine and theophylline are given concurrently a clinically significant reduction in the seizure threshold is observed. Theophylline in 5% Dextrose Injection Flexible Plastic Container, Phosphodiesterase Enzyme Inhibitors, Nonselective, Surviving Respiratory Syncytial Virus (RSV). Theophylline metabolism by CYP3A4 is minor and independent of theophylline plasma concentration; oritavancin is a weak CYP3A4 inducer. Clarithromycin: (Major) Clarithromycin can inhibit aminophylline clearance by inhibiting the cytochrome P450 CYP3A isoenzymes. These interactions are particularly significant when aminophylline serum concentrations are already in the high therapeutic range (i.e., > 15 mcg/ml). (Moderate) Theophylline may potentiate the hypokalemic effects of epinephrine. (Minor) Isoniazid, INH may reduce aminophylline clearance. (Minor) Correction of hypothyroidism to the euthyroid state may precipitate certain drug interactions. Oritavancin: (Moderate) Avoid oritavancin with drugs that have a narrow therapeutic window, such as aminophylline. Consider smaller, more frequent doses of immediate-release products or use of extended-release products in patients with rapid metabolism, identified by higher than average dose requirements. The formation of CYP450 enzymes may be altered by increased concentrations of cytokines during chronic inflammation. This interaction occurs from the inhibition of methylxanthine oxidation in the liver. You may report side effects to FDA at 1-800-FDA-1088. More serious effects are rare, but may result in additive cardiovascular effects such as increased blood pressure and heart rate. In vitro data suggest that while metabolism is mediated by CYP1A2 at low plasma concentrations, metabolism shifts to CYP2E1 at higher concentrations, and metabolism by CYP3A4 is minor, independent of theophylline plasma concentration. This may occur with mestranol. Inhibition of IL-6 signaling by siltuximab may restore CYP450 activities to higher levels leading to increased metabolism of drugs that are CYP450 substrates compared to metabolism prior to treatment. Carbamazepine can stimulate the hepatic metabolism of theophylline if used concurrently. Other types of bronchodilators may be short-acting. If these drugs are used together, therapeutic drug monitoring should be considered. Monitor the patient clinically for increased cetirizine/levocetirizine-related adverse effects if coadministered with theophylline. (Major) Clarithromycin can inhibit theophylline clearance by inhibiting the cytochrome P450 CYP3A isoenzymes. It should be used with caution in very young or very old pets, as toxic effects are more likely. Patients should avoid any drugs containing theophylline, aminophylline for at least 12 hours before regadenoson administration. Aminophylline dosage adjustments may be needed with thyroid hormone replacement. Of the macrolides, azithromycin may be an alternative since it does not inhibit cytochrome P450 enzymes; no dosage adjustment of theophylline (or aminophylline) is required when azithromycin is coadministered. Adjust subsequent dosage based on serum theophylline concentrations. The mechanism of this interaction is not known. Theophylline is available under the following different brand names: Theo 24, Theochron, Patients not currently taking theophylline: 5-7 mg/kg intravenously/orally; not to exceed 25 mg/min intravenously (IV), Aminophylline: 6-7 mg/kg intravenously/orally; IV infused over 20 minutes, 0.4-0.6 mg/kg/hour intravenously (IV) or 4.8-7.2 mg/kg orally (extended release) every 12 hours to maintain levels 10-15 mg/L, Smokers: 0.79 mg/kg/hour IV for next 12 hours after loading dose, then 0.63 mg/kg/hour or 5 mg/kg orally (extended release) every 8 hours. Elimination is usually a first-order process, but zero-order elimination has been reported in some cases. Monitor the patient clinically for increased cetirizine/levocetirizine-related adverse effects if coadministered with theophylline. Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate: (Moderate) Theophylline or aminophylline concentrations may be increased during administration with ethinyl estradiol. Although data regarding this drug interaction are conflicting, it appears that this can be explained by the duration of isoniazid administration. Seizures or cardiac arrhythmias are also possible. Patients should be monitored for aminophylline toxicity if pentoxifylline is added. If any of these . Adverse effects such as tremors, insomnia, seizures, or cardiac arrhythmias are also possible when excessive dosages of caffeine are taken concurrently with theophylline. More importantly, serious theophylline toxicity can result if carbamazepine is discontinued and the dose of theophylline is not correspondingly decreased. 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