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Theophylline

    DEA Class; Rx

    Common Brand Names; Theo 24, Theochron, Elixophyllin, aminophylline, Uniphyl

    • Xanthine Derivatives; 
    • Phosphodiesterase Enzyme Inhibitors, Nonselective

    Oral and intravenous methylxanthine
    Used primarily for maintenance treatment of COPD or asthma but is not a preferred agent in either disease; also used in apnea of prematurity not responding to other therapies
    Aminophylline is converted to theophylline systemically; 1 mg aminophylline = 0.8 mg theophylline

    Indicated for the treatment of asthma exacerbation or for asthma maintenance treatment; or for maintenance treatment or exacerbations due to chronic obstructive pulmonary disease (COPD) (e.g., emphysema or chronic bronchitis).

    For the treatment of acute exacerbations† of reversible airways obstruction (including status asthmaticus) in patients who are not responding to first-line therapies.
    For the treatment of neonatal apnea of prematurity when non-pharmacologic therapies are ineffective.
    For the treatment of sleep apnea in patients with chronic heart failure-induced systolic dysfunction.
    For the treatment of bradycardia due to sinus node dysfunction in post-heart transplant and acute spinal cord injury patients.

    Hypersensitivity

    Peak serum concentration <20 mcg/mL

    • Central nervous system excitement, headache, insomnia, irritability, restlessness, seizure
    • Diarrhea, nausea, vomiting
    • Diuresis (transient)
    • Exfoliative dermatitis
    • Skeletal muscle tremors
    • Tachycardia, flutter
    • Hypercalcemia (with concomitant hyperthyroid disease)
    • Difficulty urinating (elderly males with prostatism)

    Peak serum concentration >30 mcg/mL

    • Acute myocardial infarction
    • Seizures (resistant to anticonvulsants)
    • Urinary retention

    Patients, who develop CNS abnormalities, reported (rarely) to experience nonconvulsive status epilepticus

    Theophylline clearance may decrease in patients with congestive heart failure, acute pulmonary edema, hepatic disease, cor pulmonale, acute hepatitis, hypothyroidism, cirrhosis, fever, or sepsis with multiorgan failure and shock; severe and potentially fatal toxicity may occur if reduced theophylling clearance occurs

    Avoid extravasation; vesicant; ensure proper placement of catherer prior to and during infusion

    Use with caution in patients with hyperthyroidism, seizure disorder, peptic ulcer, or cardiovascular disease

    Some dosage forms may contain propylene glycol; use caution; seizures, hyperosmolality, lactic acidosis, and respiratory depression reported associated with use of large amounts of propylene glycol

    Measure serum levels and withhold subsequent doses if patient develops signs and symptoms of theophylline toxicity

    Use caution in patients with cardiac arrhythmia, excluding bradyarrhythmia; use may exacerbate arrhythmia

    Use with caution in patients with cystic fibrosis; increased theophylline clearance may occur

    Use with caution in patients with seizure disorders; use may exacerbate seizure disorder

    Do not increase dose in response to acute exacerbation of symptoms unless steady state serum theophylline concentration of <10 mcg//mL

    Pregnancy category: C

    Lactation: Theophylline is excreted into breast milk and may cause irritability or other signs of mild toxicity in nursing human infants; serious adverse effects in infant are unlikely unless mother has toxic serum theophylline concentration

    Theophylline has a narrow therapeutic index. The maximum dosage is individualized based on therapeutic drug concentration monitoring and assessment of efficacy and safety parameters. The following are some general guidelines in chronic use (dosage expressed as theophylline):

    Adults

    18 to 60 years: Adults requiring more than 600 mg/day total of theophylline require close monitoring to individualize dosage. It is recommended not to exceed 400 mg/day PO in patients with risk factors for decreased clearance or in whom recommended serum concentration monitoring is not possible.
    60 years and older: Do not exceed 400 mg/day PO, as reduced clearance of theophylline is expected.

    Geriatric

    400 mg/day PO.

    Adolescents

    16 to 17 years: Individualize dosage; 400 mg/day PO, if risk factors for decreased clearance are present or recommended serum concentration monitoring is not possible.
    13 to 15 years: Individualize dosage; 16 mg/kg/day up to 400 mg/day PO, if risk factors for decreased clearance are present or recommended serum concentration monitoring is not possible.

    Children

    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.

    Infants

    Individualize dosage; infant dosing is based on age/weight.

    Neonates

    Individualize dosage; loading doses of 8 mg/kg IV or PO have been used.

    Theophylline anhydrous

    capsule, extended-release (24 hours)

    • 100mg
    • 200mg
    • 300mg
    • 400mg

    tablet, extended release (12 hours)

    • 100mg
    • 200mg
    • 300mg
    • 450mg

    tablet, extended-release (24 hours)

    • 400mg
    • 600mg

    oral elixir

    • 80mg/15mL

    intravenous solution

    • 400mg/250mL D5W
    • 400mg/500mL D5W
    • 800mg/500mL D5W