Formulary
Theophylline: Indications, Dosing, Side Effects and Interactions
Theophylline clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 5 min read
Theophylline: Indications, Dosing, Side Effects and Interactions
Theophylline clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Chronic asthma**
- **Child** (By Mouth Using Modified-Release Medicines): 12-17 years 200 mg every 12 hours, adjusted according to response to 400 mg every 12 hours, may be appropriate to give larger evening or morning dose to achieve optimum therapeutic effect when symptoms most severe; in patients whose night or daytime symptoms persist despite other therapy, who are not currently receiving theophylline, total daily requirement may be added as single evening or morning dose.
**Reversible airways obstruction,Severe acute asthma,Chronic asthma**
- **Adult** (By Mouth Using Modified-Release Medicines): 200 mg every 12 hours, adjusted according to response to 400 mg every 12 hours, may be appropriate to give larger evening or morning dose to achieve optimum therapeutic effect when symptoms most severe; in patients whose night or daytime symptoms persist despite other therapy, who are not currently receiving theophylline, total daily requirement may be added as single evening or morning dose.
**Chronic asthma for Uniphyllin Continus**
- **Child 2-11 years** (By mouth using modified-release medicines): 9 mg/kg every 12 hours (max. per dose 200 mg), dose may be increased in some children with chronic asthma; increased to 10-16 mg/kg every 12 hours (max. per dose 400 mg), may be appropriate to give larger evening or morning dose to achieve optimum therapeutic effect when symptoms most severe; in patients whose night or daytime symptoms persist despite other therapy, who are not currently receiving theophylline, total daily requirement may be added as single evening or morning dose.
- **Child 12-17 years** (By mouth using modified-release medicines): 200 mg every 12 hours, adjusted according to response to 400 mg every 12 hours, may be appropriate to give larger evening or morning dose to achieve optimum therapeutic effect when symptoms most severe; in patients whose night or daytime symptoms persist despite other therapy, who are not currently receiving theophylline, total daily requirement may be added as single evening or morning dose.
Cautions
Cardiac arrhythmias or other cardiac disease; elderly (increased plasma-theophylline concentration) (in adults); epilepsy; fever; hypertension; peptic ulcer; risk of hypokalaemia; thyroid disorder Cautions, further information Elderly In adults: Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information): potentially inappropriate as monotherapy for COPD (safer and more effective alternatives available; risk of adverse effects due to narrow therapeutic index).
Side effects
Frequency not known Anxiety; arrhythmias; diarrhoea; dizziness; gastrointestinal discomfort; gastrooesophageal reflux disease; headache; hyperuricaemia; nausea; palpitations; seizure; skin reactions; sleep disorders; tremor; urinary disorders; vomiting Side-effects, further information Potentially serious hypokalaemia may result from beta 2 -agonist therapy. Particular caution is required in severe asthma, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics, and by hypoxia. Plasma-potassium concentration should therefore be monitored in severe asthma. Overdose Theophylline in overdose can cause vomiting (which may be severe and intractable), agitation, restlessness, dilated pupils, sinus tachycardia, and hyperglycaemia. More serious effects are haematemesis, convulsions, and supraventricular and ventricular arrhythmias. Severe hypokalaemia may develop rapidly. For details on the management of poisoning, see Theophylline, under Emergency treatment of poisoning .
Interactions
**Severe interactions:**
- Also the effects of anti-inflammatory drugs, NSAIDs, theophylline, immunosuppressive and cytostatic drugs on the acute cellular effects of IMMUKIN and its therapeutic effects in CGD or severe,...
- Actually, neither pharmacodynamic nor significant pharmacokinetic interaction was reported in drug-drug interactions studies performed, notably with pseudoephedrine or theophylline (400 mg/day).
- Possible toxicity with phenytoin on stopping primidone); stiripentol, tiagabine, valproic acid, zonisamide.
- On the basis of the above metabolic considerations no significant interaction may be expected with ethambutol, theophylline, sulfonamides, pyrazinamide and zalcitabine (DDC).
- Theophylline, carbamazepine Results of clinical studies indicate that there was a modest but statistically significant (p 0.05) increase of circulating theophylline or carbamazepine levels when...
- This warning is not only restricted to medicinal products but also to a considerable number of foods (for example: cola, chocolate, coffee, tea, and energy drinks) and nutritional products aimed at...
**Other interactions (110):**
- Drug induced changes in thyroid status may affect the dosage requirements for theophylline and digitalis.
- The doses of digitalis and theophylline may need to be reduced as thyroid function returns to normal.
- When starting or stopping therapy with tocilizumab, patients taking medicinal products which are individually adjusted and are metabolised via CYP450 3A4, 1A2 or 2C9 (e.g.
- There are no data on the interaction of sildenafil and non-specific phosphodiesterase inhibitors such as theophylline or dipyridamole.
- Xanthines (Theophylline): Use of fluconazole 200mg for 14 days showed an 18% decrease in the mean plasma clearance of theophylline.
- Patients who require high doses of theophylline or who may be at increased risk of theophylline toxicity should be monitored for signs of theophylline toxicity when fluconazole is co- administered.
Pregnancy
Neonatal irritability and apnoea have been reported. Theophylline can be taken as normal during pregnancy as it is particularly important that asthma should be well controlled during pregnancy.
Breast feeding
Present in milk-irritability in infant reported; modified-release preparations preferable. Theophylline can be taken as normal during breast-feeding.
Hepatic impairment
Manufacturer advises caution (risk of increased exposure). Dose adjustments Manufacturer advises consider dose reduction.
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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