See for information on appropriate pathogens and patient populations. CarBAMazepine: May decrease the serum concentration of Theophylline Derivatives. Theophylline Derivatives may decrease the serum concentration of CarBAMazepine. Management: Seek alternatives to this combination when possible. Regadenoson: Theophylline may diminish the vasodilatory effect of Regadenoson.
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. In contrast, approximately 50% of the administered Theophylline dose is excreted unchanged in the urine in neonates. Cardiac decompensation, cor pulmonale, sepsis with multiorgan failure, and shock: Refer to adult dosing. Wort, since their Theophylline concentrations may rise when this is done, resulting in toxicity. Patients should be instructed to inform all healthcare professional involved in their care that they are taking Theophylline, especially when a medication is being added or deleted from their treatment. Patients should be instructed to not alter the dose, timing of the dose, or frequency of administration without first consulting their healthcare professional. If a dose is missed, the patient should be instructed to take the next dose at the usually scheduled time and to not attempt to make up for the missed dose.
For a given population there is no single theophylline dose that will provide both safe and effective serum concentrations for all patients. Administration of the median theophylline dose required to achieve a therapeutic serum theophylline concentration in a given population may result in either sub-therapeutic or potentially toxic serum theophylline concentrations in individual patients. Reversible airflow obstruction: Treatment of acute exacerbations of symptoms and reversible airflow obstruction due to asthma or other chronic lung diseases eg, emphysema, chronic bronchitis as an adjunct to inhaled beta-2 selective agonists and systemically administered corticosteroids.
Doses should be individualized based on steady-state serum concentrations and ideal body weight. 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. Sometimes it is not safe to use certain drugs at the same time. Many drugs can interact with theophylline. Tell your doctor about all other medicines you use. Also tell your doctor if you start or stop using any of your other medications. Consider 10% decrease in dose to provide greater margin of safety even if current dosage is tolerated.
Serum Theophylline concentrations may continue to increase after presentation of the patient for medical care as a result of continued absorption of Theophylline from the gastrointestinal tract. Serial monitoring of serum Theophylline serum concentrations should be continued until it is clear that the concentration is no longer rising and has returned to non-toxic levels. At steady state, on a dosage regimen with 6-hour intervals, the expected mean trough concentration is approximately 60% of the mean peak concentration, assuming a mean theophylline half-life of 8 hours. The difference between peak and trough concentrations is larger in patients with more rapid theophylline clearance. In patients with high theophylline clearance and half-lives of about 4-5 hours, such as children age 1 to 9 years, the trough serum theophylline concentration may be only 30% of peak with a 6-hour dosing interval. Theophylline from extended-release dosage forms administered at night. The exact relationship of these and other factors to nighttime serum concentrations and the clinical significance of such findings require additional study. Therefore, it is not recommended that Theophylline extended-release once-daily dosing be administered at night. Schiff GD, Hegde HK, LaCloche L, Hryhorczuk DO "Inpatient theophylline toxicity: preventable factors. Most of the side effects of aminophylline theophylline have been dependent on serum concentrations. Methotrexate: May increase the serum concentration of Theophylline Derivatives. What are the possible side effects of ZYFLO? Smoking: Clearance is increased by smoking ie, marijuana or tobacco by approximately 50% in young adult smokers and 80% in elderly tobacco smokers. Cessation of smoking for 1 week improves theophylline Cl by 40%. 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. 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. Should be taken with water 1 hour before or 2 hours after meals. Premixed injection may contain corn-derived dextrose and its use is contraindicated in patients with allergy to corn-related products. If symptoms are controlled and current dosage is tolerated, maintain dose and recheck serum concentration at 6-12 month intervals.
Bronchitis itself can be caused by a virus or bacteria, which are contagious. However, chronic asthmatic bronchitis typically is not contagious. If symptoms are not controlled and current dosage is tolerated, increase dose about 25%. It can liquefy fat, cut connective tissue to loosen puckering, boost growth and tightening, increase flow, and lessen fluid retention. Expect results to last at least 6 months. Lithium dose required to achieve a therapeutic serum concentration increased an average of 60%. Your pharmacist can provide more information about theophylline. 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.
Theophylline has two distinct actions; smooth muscle relaxation ie, bronchodilation and suppression of the response of the airways to stimuli ie, non-bronchodilator prophylactic effects. 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. Theophylline increases the force of contraction of diaphragmatic muscles through enhancement of calcium uptake through adenosine-mediated channels. There was a minimal, dose-related, statistically significant increase in micronuclei at high doses in mice. The significance of these findings, in the absence of effects in other test systems, is not established. Your dosage needs may change if you are ill, or if your doctor changes your brand, strength, or type of theophylline. You will need regular medical tests to be sure you are using the right dose. Do not change your medication dose or schedule without your doctor's advice. Injectables. Some doctors inject chemicals into the fat layer below the skin to encourage breakdown and make cellulite less noticeable. This procedure is often called mesotherapy. The chemicals used include phosphatidylcholine, aminophylline, hormones, herbal extracts, vitamins, and minerals. Transient caffeine-like adverse effects and excessive serum concentrations in slow metabolizers can be avoided in most patients by starting with a sufficiently low dose and slowly increasing the dose, if judged to be clinically indicated, in small increments See . Dose increases should only be made if the previous dosage is well tolerated and at intervals of no less than 3 days to allow serum theophylline concentrations to reach the new steady state. Clinical Interventions in Aging: “Can cellulite be treated with low-energy extracorporeal shock wave therapy?
Elevated serum CK-MB levels have been associated with theophylline toxicity in the absence of cardiac disease. CK-MB levels have returned to normal following discontinuation of theophylline therapy. Ophthalmologic abnormalities, including cataracts and multiple punctate lenticular opacities, have been noted in patients undergoing treatment with enoxacin, as well as with some other quinolones, but have also been observed in patients receiving in comparative trials. In using multiple-dose therapy, levels of enoxacin and other quinolones were significantly higher than respective concentrations. The causal relationship, if any, of quinolones to lenticular abnormalities has not been established. Get medical help right away if you have any very serious side effects, including: seizures. Theophylline is a methylxanthine. Sustained-release methylxanthine medicines are used to control in the airways in the bronchial tubes. Short-acting methylxanthine medicines are used to control narrowing of the bronchial tubes. This may reduce symptoms. Not reported in a comparable manner. RD, Stevenson HC "Generalized dermatitis to aminophylline. Hemodialysis should be considered as an alternative when charcoal hemoperfusion is not feasible and multiple-dose oral charcoal is ineffective because of intractable emesis. Also called radiofrequency systems, they show promise for cellulite. Barbiturates: May decrease the serum concentration of Theophylline Derivatives. Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take. Most options are based on the idea that massaging the problem area will increase flow and reduce fluid buildup. The result: Better-looking hips and buttocks. Elderly patients are at significantly greater risk of experiencing serious toxicity from theophylline than younger patients due to pharmacokinetic and pharmacodynamic changes associated with aging. Theophylline clearance is reduced in patients greater than 60 years of age, resulting in increased serum theophylline concentrations in response to a given theophylline dose. Protein binding may be decreased in the elderly resulting in a larger proportion of the total serum theophylline concentration in the pharmacologically active unbound form. Elderly patients also appear to be more sensitive to the toxic effects of theophylline after chronic overdosage than younger patients. Anti-IgE can be used in moderate to severe allergic asthma. Omalizumab Xolair is an anti-IgE medication. Hall RC, Beresford TP, Stickney SK, et al "Psychiatric reactions produced by respiratory drugs.
Pediatrics: 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. WebMD User Reviews should not be considered as medical advice and are not a substitute for professional medical advice, diagnosis, or treatment. Never delay or disregard seeking professional medical advice from your physician 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 may be a helpful health information resource but they are never a substitute for professional medical advice from a qualified healthcare provider. MTX, higher dose MTX may have a greater effect. Cellfina was approved in 2015 to make this procedure more precise. It provides vacuum-assisted control of the depth and area treated. About 20 to 30 individual cellulite dimples are treated during an average 1-hour session. Results can last up to 2 years. Stabilized patients, 12 years of age or older, who are taking an immediate-release or controlled-release theophylline product may be transferred to once-daily administration of 400 mg or 600 mg Uniphyl Tablets on a mg-for-mg basis. Distribution Once theophylline enters the systemic circulation, about 40% is bound to plasma protein, primarily albumin. Unbound theophylline distributes throughout body water, but distributes poorly into body fat. Remember that your doctor has prescribed this because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication not have serious side effects. Make sure lab personnel and all your doctors know you use this drug. Is there any way to eliminate the “cottage cheese” on your thighs and rear end? Leukotriene modifiers can also serve as anti-inflammatory agents. These medications include montelukast Singulair zafirlukast Accolate and zileuton Zyflo. 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. 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. Serious side effects may be more likely in older adults taking theophylline.
United States for delivery via a nebulizer. Cromolyn is suggested as an alternative medication to inhaled corticosteroids for asthma control, usually in mild asthma. It is not a commonly used asthma medication. Cardiovascular disease: Use with caution in patients with cardiac arrhythmias excluding bradyarrhythmias; use may exacerbate arrhythmias. Non-steroidal anti-inflammatory agents: Seizures have been reported in patients taking enoxacin concomitantly with the fenbufen. Animal studies also suggest an increased potential for seizures when these two drugs are given concomitantly. Fenbufen is not approved in the United States at this time. What other drugs will affect theophylline? Significant reduction in theophylline clearance has been reported in women on the 20th day of the menstrual cycle and during the third trimester of pregnancy. Postural drainage is getting in positions that make it easier for mucus to drain. Medscape: “Cord-Cutting Technique Smooths Cellulite for 3 Years. The steady-state peak serum Theophylline concentration is a function of the dose, the dosing interval, and the rate of Theophylline absorption and clearance in the individual patient. If the serum sample is drawn more than two hours after the dose, the results must be interpreted with caution since the concentration may not be reflective of the peak concentration. In contrast, when signs or symptoms of theophylline toxicity are present, the serum sample should be obtained as soon as possible, analyzed immediately, and the result reported to the clinician without delay. This is not a complete list of side effects and others may occur. Besides the guarana seed itself, there are no natural food sources of guarana. It has become a common additive to some foods and drinks. Decrease your cellulite using the latest science. 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. CloZAPine: CYP1A2 Inhibitors Weak may increase the serum concentration of CloZAPine. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your or local waste disposal company.
Anticipate Need for Anticonvulsants. What should I discuss with my healthcare provider before taking theophylline Uniphyl? There are several readily identifiable causes of reduced theophylline clearance. This group of medications includes and . These medications may be used alone in milder asthma but are often used along with inhaled corticosteroids in moderate to severe asthma. 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 to adverse effects. There was no significant interaction between ZYFLO and any of these drugs. Therapy with theophyllines should be administered cautiously in patients presenting with one or more of these risk factors, and the dosage should be appropriately reduced to prevent toxicity. More intensive monitoring of serum theophylline concentrations may be required. Theo-24 Extended-release capsules meet Drug Release Test 6 as published in the current USP monograph for Theophylline Extended-release Capsules. Maintain infusion rate if dosage is tolerated and symptoms controlled. Recheck serum concentrations at 24-hour intervals. If symptoms are not controlled and dosage is tolerated, consider adding additional medications to treatment regimen. Fed conditions were the same as those previously cited. Cmax of terfenadine of approximately 35%. Theophylline Oral Solution USP is contraindicated in patients with a history of hypersensitivity to theophylline or other components in the product. Theophylline is excreted into breast milk and may cause irritability or other signs of mild toxicity in nursing human infants. The concentration of theophylline in breast milk is about equivalent to the maternal serum concentration.
Tablets can be taken once a day in the morning or evening. It is recommended that Uniphyl be taken with meals. Patients should be advised that if they choose to take Uniphyl with food it should be taken consistently with food and if they take it in a fasted condition it should routinely be taken fasted. It is important that the product whenever dosed be dosed consistently with or without food. National Institutes of Health 2007. National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma NIH Publication No. 08-5846. Table IV. Manifestations of Theophylline toxicity. Store at room temperature away from moisture, heat, and light. If the serum sample is drawn more or less than twelve 12 hours after the dose, the results must be interpreted with caution since the concentration may not be reflective of the peak concentration. In contrast, when signs or symptoms of theophylline toxicity are present, the serum sample should be obtained as soon as possible, analyzed immediately, and the result reported to the healthcare professional without delay.
Sulfinpyrazone: May decrease the serum concentration of Theophylline Derivatives. AUC achieved at the maximum recommended human daily oral dose. Goldberg MJ, Spector R, Park GD, Johnson GF, Roberts P. The effect of sorbitol and activated charcoal on serum theophylline concentrations after slow-release theophylline. THE SAFETY AND EFFECTIVENESS OF ENOXACIN IN PATIENTS AND ADOLESCENTS UNDER THE AGE OF 18 YEARS WOMEN, AND LACTATING WOMEN HAVE NOT BEEN ESTABLISHED. Vemurafenib: May increase the serum concentration of CYP1A2 Substrates. Management: Consider alternatives to such combinations whenever possible, particularly if the CYP1A2 substrate has a relatively narrow therapeutic index.
In contrast, approximately 50% of the administered theophylline dose is excreted unchanged in the urine in neonates. Uniphyl theophylline anhydrous tablet Tablets whether dosed in the morning or evening. Table IV. Manifestations of theophylline toxicity. Benzodiazepines: Theophylline Derivatives may diminish the therapeutic effect of Benzodiazepines. 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. Metabolic side effects have included hypokalemia, hyperglycemia, respiratory alkalosis, hypophosphatemia, and hypomagnesemia. The magnitude of these abnormalities have been correlated with theophylline concentrations. Saliva concentrations of theophylline cannot be used reliably to adjust dosage without special techniques. What Causes Asthmatic Bronchitis? Asthma: The 2007 National Heart, Lung, and Blood Institute Asthma Guidelines and the 2016 Global Initiative for Asthma Guidelines GINA recommend against aminophylline for the treatment of asthma exacerbations because of poor efficacy and safety concerns GINA 2016; NAEPP 2007. 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 clinician 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. Discuss the risks and benefits with your doctor. Changes in your body during the last may affect the amount of this drug in your blood. Your doctor should carefully monitor the amount of drug in your blood, as well as any side effects, so that your dose may be changed if needed.
What other drugs will affect TheoCap theophylline? Alterman P, Spiegel D, Feldman J, Yaretzky A "Histamine h2-receptor antagonists and chronic theophylline toxicity. Researchers once believed that the active ingredient of guarana was a chemical specific to the plant -- guaranine. Genitourinary side effects have included urinary retention. High levels of theophylline cause increased side effects. When your caregiver claps, you should hear a hollow sound. If you hear a slapping, the hand is not cupped enough. Levels of theophylline in the blood may be decreased, making the theophylline less effective. Skip next dose and decrease subsequent doses at least 25% even if no adverse effects are present. Recheck serum concentration after 3 days to guide further dosage adjustment. If symptomatic, consider whether overdose treatment is indicated see recommendations for chronic overdosage. Interpretation involves the correlation of the diameter obtained in the disk test with the minimum inhibitory concentration MIC for enoxacin. Monitor the patient and obtain a serum theophylline concentration in 2 - 4 hours to insure that the concentration is not increasing. 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. GINA 2015. Both guidelines recommend against theophylline for the treatment of asthma exacerbations due to poor efficacy and safety concerns GINA 2016; NAEPP 2007. Recheck level in 3 days. Clearance represents the volume of blood completely cleared of Theophylline by the liver in one minute. Seizure disorder: Use with caution in patients with a history of seizure disorder; use may exacerbate this condition.
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Serious adverse effects in the infant are unlikely unless the mother has toxic serum theophylline concentrations. Many drugs can interact with theophylline and not all possible interactions are listed in this medication guide. Increases theophylline clearance by increasing demethylation and hydroxylation.
Babies are especially at risk for developing high levels of theophylline in the blood. So they need their blood levels checked regularly. Slow-release theophylline has an even greater risk for causing side effects than the short-acting medicine. Higher doses of adenosine may be required to achieve desired effect. General: The chronicity and pattern of Theophylline overdosage significantly influences clinical manifestations of toxicity, management and outcome. 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.
Excretion: In neonates, approximately 50% of the Theophylline dose is excreted unchanged in the urine. Beyond the first three months of life, approximately 10% of the Theophylline dose is excreted unchanged in the urine. Patients with more rapid metabolism, clinically identified by higher than average dose requirements, should receive a smaller dose more frequently to prevent breakthrough symptoms resulting from low trough concentrations before the next dose. A reliably absorbed slow-release formulation will decrease fluctuations and permit longer dosing intervals. To guide a dose increase, the blood sample should be obtained at the time of the expected peak serum Theophylline concentration; 12 hours after an evening dose or 9 hours after a morning dose at 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 have been taken at unequal intervals.
Blue No. 2 lake, hydroxypropyl cellulose NF, hydroxypropyl methylcellulose, stearate USP, polyethylene glycol, simethicone, sorbic acid, stearate emulsifiers, and titanium dioxide. COPD treatment: Theophylline is currently considered second-line intravenous therapy in the emergency department or hospital setting when there is inadequate or insufficient response to short acting bronchodilators Global Initiative for COPD Guidelines 2013. How should I take theophylline?