There are several factors which may predispose a patient to higher serum concentrations and, thus, toxicity. These factors may include increased age, concomitant drugs which reduce the clearance of theophylline, hypothyroidism, congestive heart failure, liver disease, renal failure, and alterations in smoking habits. One series of patients with theophylline intoxication had recent upper respiratory tract infections. Theophylline is rapidly and completely absorbed after oral administration in solution or immediate-release solid oral dosage form. Theophylline does not undergo any appreciable pre-systemic elimination, distributes freely into fat-free tissues and is extensively metabolized in the liver. spod.info estrace
True RJ, Berman JM, Mahutte CK. Treatment of theophylline toxicity with oral activated charcoal. Still have major difficulty breathing despite using both an inhaled beta2-agonist and an inhaled anticholinergic. Case reports of Theophylline overdose in humans and animal studies suggest that phenytoin is ineffective in terminating Theophylline-induced seizures. The doses of benzodiazepines and phenobarbital required to terminate Theophylline-induced seizures are close to the doses that may cause severe respiratory depression or respiratory arrest; the healthcare professional should therefore be prepared to provide assisted ventilation. Elderly patients and patients with COPD may be more susceptible to the respiratory depressant effects of anticonvulsants. Barbiturate-induced coma or administration of general anesthesia may be required to terminate repetitive seizures or status epilepticus. General anesthesia should be used with caution in patients with Theophylline overdose because fluorinated volatile anesthetics may sensitize the myocardium to endogenous catecholamines released by Theophylline. Enflurane appears less likely to be associated with this effect than halothane and may, therefore, be safer. Neuromuscular blocking agents alone should not be used to terminate seizures since they abolish the musculoskeletal manifestations without terminating seizure activity in the brain.
Lower initial doses may be required in patients with reduced theophylline clearance. Dosage should be adjusted according to serum level measurements. Wort Hypericum perforatum should not be taken at the same time as Theophylline, since it may result in decreased Theophylline levels. Always consult a healthcare professional for medical advice. Decreased and subsequent decreased were noted in rats and dogs treated with doses of enoxacin that produced plasma levels in the animals three times higher than those produced in humans at the recommended therapeutic dosage. The potential for enoxacin to affect spermatogenesis in male patients is unknown.
Whenever signs or symptoms of Theophylline toxicity are present. The dose of theophylline must be individualized on the basis of peak serum theophylline concentration measurements in order to achieve a dose that will provide maximum potential benefit with minimal risk of adverse effects. Metabolism Following oral dosing, theophylline does not undergo any measurable first-pass elimination. In adults and children beyond one year of age, approximately 90% of the dose is metabolized in the liver.
The addition of theophylline to an inhaled corticosteroid can improve function in adults with uncontrolled mild-to-moderate persistent asthma. Keep ZYFLO and all medicines out of the reach of children. Human experience of acute overdose with zileuton is limited. Seizure disorder: Use with caution in patients with seizure disorders; use may exacerbate seizure disorder. Caution is advised when using this drug in the elderly because they may be more sensitive to its effects. Careful monitoring of side effects and drug levels is recommended. To guide a dose increase, the blood sample should be obtained at the time of the expected peak serum theophylline concentration: 1-2 hours after a dose at steady-state. For most patients, steady-state will be reached after 3 days of dosing when no doses have been missed, no extra doses have been added, and none of the doses has been taken at unequal intervals. Smokers: Tobacco and marijuana smoking appears to increase the clearance of Theophylline by induction of metabolic pathways. Theophylline clearance has been shown to increase by approximately 50% in young adult tobacco smokers and by approximately 80% in elderly tobacco smokers compared to non-smoking subjects. Passive smoke exposure has also been shown to increase Theophylline clearance by up to 50%. Abstinence from tobacco smoking for one week causes a reduction of approximately 40% in Theophylline clearance. Careful attention to dose reduction and frequent monitoring of serum Theophylline concentrations are required in patients who stop smoking see . Use of nicotine gum has been shown to have no effect on Theophylline clearance. Erythromycin metabolite decreases Theophylline clearance by inhibiting cytochrome P450 3A3. Enoxacin is a potent inhibitor of the cytochrome P-450 isozymes responsible for the of methylxanthines. In a multiple-dose study, enoxacin caused a dose-related increase in the mean elimination half-life of caffeine, thereby decreasing the clearance of caffeine by up to 80% and leading to a five-fold increase in the AUC and the half-life of caffeine. Trough enoxacin levels were also 20% higher when caffeine and enoxacin were administered concomitantly. Caffeine-related adverse effects have occurred in patients consuming caffeine while on therapy with enoxacin. Dosage reduction may alleviate the caffeine-like adverse effects in these patients, however, persistent adverse effects should result in a reevaluation of the need for continued theophylline therapy and the potential therapeutic benefit of alternative treatment. Table V contains theophylline dosing titration schema recommended for patients in various age groups and clinical circumstances. Table VI contains recommendations for theophylline dosage adjustment based upon serum theophylline concentrations. Application of these general dosing recommendations to individual patients must take into account the unique clinical characteristics of each patient. In general, these recommendations should serve as the upper limit for dosage adjustments in order to decrease the risk of potentially serious adverse events associated with unexpected large increases in serum theophylline concentration. COPD may be more susceptible to the respiratory depressant effects of anticonvulsants. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split the tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing. See Drug Reference for a full list of side effects. Drug Reference is not available in all systems. Taking Theophylline extended-release tablets immediately after a high-fat content meal may result in a somewhat higher C max and delayed T max and somewhat greater extent of absorption. Other medicines may be a better choice than methylxanthines for treating COPD, because the dose needed to improve symptoms is so close to a dose that causes serious side effects.
Milgrom H, Bender B "Current issues in the use of theophylline. Larger diazepam doses may be required to produce desired level of sedation. This medication does not work right away and should not be used for sudden attacks of breathing trouble. United States are appropriate, unless specifically indicated otherwise. Interpretation involves the correlation of the diameter obtained in the disk test with the minimum inhibitory concentration MIC for enoxacin. Theo-24 is available as capsules intended for oral administration, containing 100 mg, 200 mg, 300 mg, or 400 mg of anhydrous theophylline per capsule, in an extended-release formulation which allows a 24-hour dosing interval for appropriate patients. During the initiation of Theophylline therapy, caffeine-like adverse effects may transiently alter patient behavior, especially in school age children, but this response rarely persists. Loading dose: IV: Refer to adult dosing. Serious side effects may be more likely in older adults taking theophylline. Refer to for information regarding table. Experts have not studied guarana extensively. So far, studies have not found that guarana is helpful for improving cognitive ability or mood. Some people use guarana to boost athletic or sexual performance. CYP1A2 Inhibitors Strong: May decrease the metabolism of CYP1A2 Substrates. Ask your doctor if you are a candidate for allergy shots. Sublingual Immunotherapy SLIT is an alternative to allergy shots. The medicine is dissolved under your instead of through a shot. meloxicam
Both the N-demethylation and hydroxylation pathways of theophylline biotransformation are capacity-limited. Gastrointestinal side effects have included anorexia, nausea, vomiting, and abdominal pain. Theophylline may also cause locally-mediated gastrointestinal upset. Benzodiazepines: Theophylline Derivatives may diminish the therapeutic effect of Benzodiazepines. Dosing Guidelines, Table VI. American Academy of Cosmetic Surgery: “Reality Vs Myth. Theophylline is rapidly and completely absorbed after oral administration in solution or immediate-release solid oral dosage form. About FAERS: The FDA Adverse Event Reporting System FAERS is used by FDA for activities such as looking for new safety concerns that might be related to a marketed product, evaluating a manufacturer's compliance to reporting regulations and responding to outside requests for information. Reporting of adverse events is a voluntary process, and not every report is sent to FDA and entered into FAERS. This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. How often did hospital staff describe possible side effects in a way you could understand? Your dose and the number of times you take theophylline daily will depend on the reason you are taking this medication. Gal P, Miller A, McCue JD. Oral activated charcoal to enhance theophylline elimination in an acute overdose. Cyproterone: May decrease the serum concentration of CYP1A2 Substrates. The first-line controller medications for asthma based on the Expert Panel Report EPR-3 asthma guidelines from the National Heart, Blood, and Lung Institute NHLBI are inhaled corticosteroids. These medications are delivered either through inhaler devices or a nebulizer and help to control inflammation in the lungs due to asthma, thus improving symptoms and decreasing the risk of exacerbations. Inhaled corticosteroids by both generic and brand names include fluticasone Flovent and Arnuity Ellipta Pulmicort beclomethasone Asmanex and ciclesonide Alvesco. Do not take theophylline in larger or smaller amounts or for longer than recommended. Theophylline overdose can occur if you accidentally take too much at one time, or if your daily doses are too high. To be sure you are using the correct dose, your blood will need to be tested often. Do not start, stop, or change the dosage of any medicines without your doctor's approval. Theophylline passes freely across the placenta, into breast milk and into the cerebrospinal fluid CSF. Saliva theophylline concentrations approximate unbound serum concentrations, but are not reliable for routine or therapeutic monitoring unless special techniques are used. An increase in the volume of distribution of theophylline, primarily due to reduction in plasma protein binding, occurs in premature neonates, patients with hepatic cirrhosis, uncorrected acidemia, the elderly and in women during the third trimester of pregnancy.
Table IV. Manifestations of Theophylline toxicity. Note: All dosages expressed as aminophylline; use ideal body weight theophylline distributes poorly into body fat to calculate dose; individualize dose based on steady-state serum concentrations. Enoxacin is known to be excreted by the and the risk of adverse reactions may be greater in patients with impaired renal function. The dosage should be reduced in patients with renal impairment. Theophylline clearance is altered by another drug resulting in increased or decreased serum Theophylline concentrations. Theophylline only rarely alters the pharmacokinetics of other drugs. Infants 1 to 3 months: Consider dose reduction and frequent monitoring of serum theophylline concentrations. Drug Interactions Theophylline interacts with a wide variety of drugs. The mechanism of theophylline-induced seizures has not been determined. Seizures are generally focal with secondary generalization. Permanent neurologic deficits have been reported and morbidity may be high, especially in the elderly, patients with severe underlying disease, and patients with prolonged, uncontrolled seizure activity. The onset of seizures is not always preceded by less severe symptoms of aminophylline toxicity. Patients with an abnormal neurologic history, including a history of seizures, cerebral infarct, or head trauma, may be predisposed to seizure activity. If theophylline is used in these types of patients, serum concentrations should be monitored closely and maintained in the low, therapeutic range. Therefore, it is important to consider this in patients who present with subsequent to the administration of antibacterial agents. Theophylline concentration in the pharmacologically active unbound form. AST SGOT elevated ALT SGPT. It is not known whether these abnormalities were caused by the drug or the underlying conditions. Label "shake well". Stable for 90 days at room temperature. Wort may result in Theophylline toxicity. cheap motrin purchase visa
Ask your doctor or pharmacist about using this product safely. If you become pregnant while taking theophylline, call your doctor. The pharmacokinetics of theophylline vary widely among similar patients and cannot be predicted by age, sex, body weight or other demographic characteristics. In addition, certain concurrent illnesses and alterations in normal physiology see Table I and co-administration of other drugs see Table II can significantly alter the pharmacokinetic characteristics of theophylline. Within-subject variability in metabolism has also been reported in some studies, especially in acutely ill patients. RxList is part of the WebMD Health Network. The opinions expressed in the WebMD User Reviews are solely those of the User, who may or may not have medical or scientific training, and do not represent the opinions of WebMD. These member reviews have not been reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other purpose except for compliance with our Terms and Conditions. Store at room temperature away from moisture, heat, and light. Acebrophylline: May enhance the stimulatory effect of Theophylline Derivatives. Gender Gender differences in theophylline clearance are relatively small and unlikely to be of clinical significance. Significant reduction in theophylline clearance, however, has been reported in women on the 20th day of the menstrual cycle and during the third trimester of pregnancy. Theophylline interacts with a wide variety of drugs. Dosing began one-half hour after the evening meal with the test dose occurring one-half hour after breakfast. Cocaine: May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use.
Pharmaceuticals, Northridge, CA 91324. MAY 1998. Side effects may go away after you take the medicine for a while. Iobenguane I 123: Sympathomimetics may diminish the therapeutic effect of Iobenguane I 123. Serum Theophylline Concentration Monitoring. Beta-Blockers Beta1 Selective: May diminish the bronchodilatory effect of Theophylline Derivatives. Management: Monitor for reduced theophylline efficacy during concomitant use with any beta-blocker. Beta-1 selective agents are less likely to antagonize theophylline than nonselective agents, but selectivity may be lost at higher doses. Overdose symptoms may include severe forms of some of the side effects listed in this medication guide. What should I avoid while taking TheoCap theophylline? P-450 1A2 and 3A3 activity. Table III. Drugs that have been documented not to interact with theophylline or drugs that produce no clinically significant interaction with theophylline. endep in usa
Long-term use of caffeine may result in tolerance and psychological dependence. Seizure disorder: Use with caution in patients with a history of seizure disorder; use may exacerbate this condition. Theophylline concentrations should be monitored at 6 month intervals for rapidly growing children and at yearly intervals for all others. Increases theophylline clearance by increasing demethylation and hydroxylation. Decreases renal clearance of theophylline. Do not stop taking any medications without consulting your healthcare provider. Fever: Fever, regardless of its underlying cause, can decrease the clearance of Theophylline. The magnitude and duration of the fever appear to be directly correlated to the degree of decrease of Theophylline clearance. Fluid and electrolyte abnormalities should be promptly corrected. Morning is the best time to do postural drainage, because it helps clear mucus that has built up during the night. Note: Doses should be adjusted to maintain the peak steady state serum concentrations. The time to reach steady state will vary based on age and the presence of risk factors which may affect theophylline clearance.
Monitor the patient and obtain a serum theophylline concentration in 2-4 hours to insure that the concentration is not increasing. Hyperthyroidism: Use with caution in patients with hyperthyroidism; use may exacerbate this condition. The listing of drugs in Table II and III are current as of February 9, 1995. New interactions are continuously being reported for theophylline, especially with new chemical entities. What is theophylline Uniphyl? These reactions may occur following the first dose. If these reactions occur in patients receiving enoxacin, the drug should be discontinued and appropriate measures instituted. If you've been experiencing symptoms like those listed above, make an appointment with your doctor. Overdose symptoms may include severe forms of some of the side effects listed in this medication guide. Teratogenic effects were observed in animal reproduction studies. Theophylline crosses the placenta; adverse effects may be seen in the newborn. unisom
However, the incidence of drug-related adverse reactions was comparable between age groups. Jain R, Tholl DA. Activated charcoal for theophylline toxicity in a premature infant on the second day of life. TiZANidine: CYP1A2 Inhibitors Weak may increase the serum concentration of TiZANidine. Management: Avoid these combinations when possible. If combined use cannot be avoided, initiate tizanidine at an adult dose of 2 mg and increase in 2-4 mg increments based on patient response. Monitor for increased effects of tizanidine, including adverse reactions. Short-acting bronchodilators provide quick relief and can be used in conjunction for -induced symptoms. Albuterol Proventil, Ventolin, ProAir, Maxair, Xopenex is a short-acting bronchodilator. Iomeprol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iomeprol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants. Cardiovascular disease: Use with caution in patients with cardiac arrhythmias excluding bradyarrhythmias; use may exacerbate arrhythmias. The clearance of theophylline is very low in neonates see . Theophylline clearance reaches maximal values by one year of age, remains relatively constant until about 9 years of age and then slowly decreases by approximately 50% to adult values at about age 16. Renal excretion of unchanged theophylline in neonates amounts to about 50% of the dose, compared to about 10% in children older than three months and in adults. Whenever signs or symptoms of theophylline toxicity are present. Barry M, Feely J. Allopurinol influences aminophenazone elimination. Phenytoin increases Theophylline clearance by increasing microsomal enzyme activity. Theophylline decreases phenytoin absorption. AtoMOXetine: May enhance the hypertensive effect of Sympathomimetics. AtoMOXetine may enhance the tachycardic effect of Sympathomimetics. The majority of side effects have been dependent on the serum concentration. Cimetidine: May decrease the metabolism of Theophylline Derivatives. Uniphyl theophylline anhydrous tablet Tablet regimens.
Theophylline Tablets are not to be chewed or crushed because it may lead to a rapid release of Theophylline with the potential for toxicity. The scored tablet may be split. Patients receiving Theophylline tablets may pass an intact matrix tablet in the stool or via colostomy. These matrix tablets usually contain little or no residual Theophylline. Decrease dose by 25%even if no adverse effects are present. However, it can actually make the dimpled fat left behind look worse. DexPak are often used during asthma flares to provide prompt relief for patients. Although very effective, these medications have many side effects and are only used when absolutely necessary. Some patients with severe asthma, however, may require oral steroids frequently or even on a daily basis. Avoid drinks or foods that contain caffeine, such as coffee, tea, cola, and chocolate. Store at room temperature between 59-86 degrees F 15-30 degrees C away from light and moisture. not store in the bathroom. Keep all medicines away from children and pets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split the tablets unless they have a score line and your doctor or tells you to do so. Swallow the whole or split tablet without crushing or chewing. BALF from asthmatic patients. Oriordan JI, Hutchinson J, Fitzgerald MX, Hutchinson M "Amnesic syndrome after theophylline associated seizures: iatrogenic brain injury. Tell your doctor if you have any major changes in your diet. Your doctor may need to adjust your dose. Administer multiple-dose oral activated charcoal and measures to control emesis. Your doctor will work with you to help find the number and dose of medicines that work best. Some believe that the effects of guarana are less intense and longer-lasting than caffeine. Studies have not established this. How much guarana should you take? In patients with chronic asthma, including patients with severe asthma requiring inhaled corticosteroids or alternate-day oral corticosteroids, many clinical studies have shown that theophylline decreases the frequency and severity of symptoms, including nocturnal exacerbations, and decreases the "as needed" use of inhaled beta 2 agonists. Theophylline has also been shown to reduce the need for short courses of daily oral prednisone to relieve exacerbations of airway obstruction that are unresponsive to bronchodilators in asthmatics. plendil buy pepco
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Indacaterol. Theophylline Derivatives may enhance the hypokalemic effect of Indacaterol. Fever Fever, regardless of its underlying cause, can decrease the clearance of theophylline. The magnitude and duration of the fever appear to be directly correlated to the degree of decrease of theophylline clearance. What happens if I miss a dose Uniphyl? furosemide price at tesco
Following oral dosing, Theophylline does not undergo any measurable first-pass elimination. In adults and children beyond one year of age, approximately 90% of the dose is metabolized in the liver. Moderate. These medicines may cause some risk when taken together. Cannabis: May decrease the serum concentration of CYP1A2 Substrates.
Impairment of Fertility: Long-term studies in animals to determine the potential of enoxacin have not been conducted. What happens if I overdose? Do not consider WebMD User-generated content as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare provider because of something you have read on WebMD. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. WebMD understands that reading individual, real-life experiences can be a helpful resource but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately.
How should I take theophylline? Decreases Theophylline clearance by inhibiting cytochrome P450 1A2. Exceptions: Gemifloxacin; LevoFLOXacin Systemic; Lomefloxacin; Moxifloxacin Systemic; Nalidixic Acid; Sparfloxacin.