Have persistent nighttime symptoms. 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%. Cardiovascular disease: Use with caution in patients with cardiac arrhythmias excluding bradyarrhythmias; use may exacerbate arrhythmias. 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. cheap uk escitalopram suppliers
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. 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. Theo-24, like other extended-release theophylline products, is intended for patients with relatively continuous or recurring symptoms who have a need to maintain therapeutic serum levels of theophylline. It is not intended for patients experiencing an acute episode of bronchospasm associated with asthma, chronic bronchitis, or emphysema. Such patients require rapid relief of symptoms and should be treated with an immediate-release or intravenous theophylline preparation or other bronchodilators and not with extended-release products.
Larger diazepam doses may be required to produce desired level of sedation. Discontinuation of Theophylline without reduction of diazepam dose may result in respiratory depression. Anticipate Need for Anticonvulsants. Charcoal may decrease the amount of theophylline your body absorbs. Estrogen containing oral contraceptives decrease Theophylline clearance in a dose-dependent fashion. The effect of progesterone on Theophylline clearance is unknown.
Patients should be instructed not to continue any dosage that causes adverse effects and to withhold subsequent doses until the symptoms have resolved, at which time the healthcare professional may instruct the patient to resume the drug at a lower dosage see Dosing Guidelines, Table VI. The molecular formula of anhydrous theophylline is C 7H 8N 4O 2 with a molecular weight of 180. 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.
Do not crush or chew the capsules or tablets. 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. Cardiovascular side effects have included increased heart rate which has progressed to atrial tachycardia or ventricular tachycardia. Patients with a history of arrhythmias may be predisposed to this effect. Hypotension has occurred with rapid intravenous administration. Measure liquid medicine with a special dose-measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one. Warning: The facts and figures contained in these reports are accurate to the best of our capability; however, our metrics are only meant to augment your medical knowledge, and should never be used as the sole basis for selecting a new medication. As with any medical decision, be sure to work with your doctor to ensure the best choices are made for your condition. Absorption Theophylline is rapidly and completely absorbed after oral administration in solution or immediate-release solid oral dosage form. 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. 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. Hyperthyroidism: Use with caution in patients with hyperthyroidism; use may exacerbate this condition.
Shannon M "Predictors of major toxicity after theophylline overdose. Stop infusion for 24 hours and decrease subsequent infusion rate at least 25%. If symptomatic, stop infusion and consider whether overdose treatment is indicated. Table III. Drugs that have been documented not to interact with theophylline or drugs that produce no clinically significant interaction with theophylline. Refer to PRECAUTIONS, Drug Interactions for information regarding table. The listing of drugs in Tables II and III are current as of February 9, 1995. New interactions are continuously being reported for Theophylline, especially with new chemical entities. Theophylline only rarely alters the pharmacokinetics of other drugs. The drugs listed in Table II have the potential to produce clinically significant pharmacodynamic or pharmacokinetic interactions with theophylline. The information in the "Effect" column of Table II assumes that the interacting drug is being added to a steady-state theophylline regimen. Peritoneal dialysis is ineffective for theophylline removal; exchange transfusions in neonates have been minimally effective. Treat overdose as indicated see recommendations for chronic overdosage. If Theophylline is subsequently resumed, decrease dose by at least 50% and recheck serum concentration after 3 days to guide further dosage adjustment. You might wonder, is asthmatic bronchitis contagious? Refer to PRECAUTIONS, Drug Interactions for further information regarding table. Average effect on steady state theophylline concentration or other clinical effect for pharmacologic interactions. Individual patients may experience larger changes in serum theophylline concentration than the value listed. Following are general instructions for chest physiotherapy and postural drainage. levothroid
Peptic ulcer disease: Use with caution in patient with peptic ulcer disease; use may exacerbate this condition. Enoxacin did not induce point mutations in cells or conversion in cells, with or without activation. Enoxacin did not induce sister chromatid exchanges or structural chromosomal aberrations in mammalian cells in vitro, with or without metabolic activation. In addition, enoxacin did not induce chromosomal aberrations in mice. Talk to your doctor if you have any questions about ZYFLO. Hurst 2004; elevate extremity. Overdose symptoms may include severe forms of some of the side effects listed in this medication guide. What should I avoid while taking theophylline? Mild cases of pseudomembranous colitis usually respond to discontinuation of the drug alone. In moderate to severe cases, consideration should be given to management with fluids and electrolytes, supplementation, and treatment with an antibacterial drug clinically effective against colitis. 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. Use ideal body weight for obese patients. The respective AUC 0-inf. Gal P, Miller A, McCue JD. Oral activated charcoal to enhance theophylline elimination in an acute overdose. 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. urim.info zanaflex
Table IV. Manifestations of Theophylline toxicity. Increasing the rate of theophylline clearance by extracorporeal methods may rapidly decrease serum concentrations, but the risks of the procedure must be weighed against the potential benefit. Charcoal hemoperfusion is the most effective method of extracorporeal removal, increasing theophylline clearance up to six fold, but serious complications, including hypotension, hypocalcemia, platelet consumption and bleeding diatheses may occur. Hemodialysis is about as efficient as multiple-dose oral activated charcoal and has a lower risk of serious complications than charcoal hemoperfusion. Hemodialysis should be considered as an alternative when charcoal hemoperfusion is not feasible and multiple-dose oral charcoal is ineffective because of intractable emesis. However, the incidence of drug-related adverse reactions was comparable between age groups. Theophylline at least twofold by absorption of Theophylline secreted into gastrointestinal fluids. Charcoal must be retained in, and pass through, the gastrointestinal tract to be effective; emesis should therefore be controlled by administration of appropriate antiemetics. Alternatively, the charcoal can be administered continuously through a nasogastric tube in conjunction with appropriate antiemetics. A single dose of sorbitol may be administered with the activated charcoal to promote stooling to facilitate clearance of the adsorbed Theophylline from the gastrointestinal tract. Sorbitol alone does not enhance clearance of Theophylline and should be dosed with caution to prevent excessive stooling which can result in severe fluid and electrolyte imbalances. Commercially available fixed combinations of liquid charcoal and sorbitol should be avoided in young children and after the first dose in adolescents and adults since they do not allow for individualization of charcoal and sorbitol dosing. In patients with intractable vomiting, extracorporeal methods of Theophylline removal should be instituted see OVERDOSAGE, Extracorporeal Removal. Most serum theophylline assays in clinical use are immunoassays which are specific for theophylline. Other xanthines such as caffeine, dyphylline, and pentoxifylline are not detected by these assays. The drugs listed in Table II have the potential to produce clinically significant pharmacodynamic or pharmacokinetic interactions with theophylline. The information in the "Effect " column of Table II assumes that the interacting drug is being added to a steady-state theophylline regimen. Additionally, GINA guidelines do not recommend oral theophylline for asthma in children 6 to 11 years of age. Alterman P, Spiegel D, Feldman J, Yaretzky A "Histamine h2-receptor antagonists and chronic theophylline toxicity. Recent studies suggest that dosing of extended-release theophylline products at night after the evening meal results in serum concentrations of theophylline which are not identical to those recorded during waking hours and may be characterized by early trough and delayed peak levels. This appears to occur whether the drug is given as an immediate-release, extended-release, or intravenous product. To avoid this phenomenon when two doses per day are prescribed, it is recommended that the second dose be given 10 to 12 hours after the morning dose and before the evening meal. The dose of your medicine may need to be adjusted. Iobenguane I 123: Sympathomimetics may diminish the therapeutic effect of Iobenguane I 123. 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. valsartan purchase online uk
Theophylline is used to treat such as and , . It must be used regularly to prevent and shortness of breath. This belongs to a class of drugs known as xanthines. It works in the airways by relaxing muscles, opening breathing passages, and decreasing the lungs' response to irritants. Controlling symptoms of can decrease time lost from work or school. Inhaled corticosteroids are preferred. It is also considered an alternative addition to inhaled corticosteroids in moderate persistent and adults. Long-acting inhaled beta2-agonists are the preferred addition to inhaled corticosteroids. Ask your doctor or pharmacist if a new medicine will affect how much theophylline you take. If symptoms are not controlled and current dosage is tolerated, increase dose about 25%. Recheck serum concentration after three days for further dosage adjustment. 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: Enoxacin is a potent inhibitor of the cytochrome P-450 isozymes responsible for the metabolism of methylxanthines. Enoxacin interferes with the metabolism of theophylline resulting in a 42% to 74% dose-related decrease in theophylline clearance and a subsequent 260% to 350% increase in serum theophylline levels. Theophylline-related adverse effects have occurred in patients when theophylline and enoxacin were coadministered. While the mechanisms of action of theophylline are not known with certainty, studies in animals suggest that bronchodilation is mediated by the inhibition of two isozymes of phosphodiesterase PDE III and, to a lesser extent, PDE IV while non-bronchodilator prophylactic actions are probably mediated through one or more different molecular mechanisms that do not involve inhibition of PDE III or antagonism of adenosine receptors. Recheck serum concentration after three days for further dosage adjustment. Pentoxifylline: May increase the serum concentration of Theophylline Derivatives. Phenobarbital may cause respiratory depression, particularly in elderly patients and patients with COPD. ziprasidone buy store uk
Store theophylline at room temperature, away from moisture, heat, and light. Saliva concentrations of theophylline cannot be used reliably to adjust dosage without special techniques. What are the specific controller medications for asthma? 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. LTB4, LTC4, LTD4, and LTE4 formation. This medication may interfere with certain lab tests such as blood sugar, cholesterol, uric acid, dipyridamole-thallium imaging tests possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug. 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? Quinolone-class adverse reactions: Although not reported in completed clinical studies with enoxacin, a variety of adverse events have been reported with other quinolones. 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.
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. Iopamidol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iopamidol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic anticonvulsants. Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Reduce initial doses of sympathomimetic agents, and closely monitor for enhanced pressor response, in patients receiving linezolid. Specific dose adjustment recommendations are not presently available. Generally, these products offer little benefit alone, but they may add some value when combined with other treatments. Stop infusion for 12 hours and decrease subsequent infusion rate at least 25%. If symptomatic, stop infusion and consider whether overdose treatment is indicated. For each position, your caregiver claps your back quickly and rhythmically. Your caregiver bends his or her hand at the knuckles to form a cup. The arrows and ovals in the above illustrations show where to clap. 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. nexium
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. Children 12-15 years and adults 16-60 years without risk factors for impaired clearance. Cigarette smoking may decrease the effectiveness of theophylline. Table II are added or discontinued. What happens if I miss a dose? Shannon M, Amitai Y, Lovejoy FH Jr. Multiple dose activated charcoal for theophylline poisoning in young infants. Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution AAP, 1997; Zar 2007. Table III. Drugs that have been documented not to interact with theophylline or drugs that produce no clinically significant interaction with theophylline. Theo-24 theophylline anhydrous is supplied in extended-release capsules containing 100, 200, 300 or 400 mg of anhydrous theophylline. ZYFLO and terfenadine is not recommended. Enoxacin interferes with the of theophylline, resulting in a dose-related decrease in theophylline clearance. Elevated theophylline concentrations may increase the risk of theophylline-related adverse reactions. P-450 1A2 and 3A3 activity. RD, Stevenson HC "Generalized dermatitis to aminophylline. Deferasirox: May increase the serum concentration of CYP1A2 Substrates. CYP1A2 Inducers Strong: May increase the metabolism of CYP1A2 Substrates. Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. cheap budecort uk
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However, it can actually make the dimpled fat left behind look worse. The symptoms of asthmatic bronchitis are a combination of the symptoms of bronchitis and asthma. Similarly, a patient with decreased Theophylline binding may have a sub-therapeutic total drug concentration while the pharmacologically active unbound concentration is in the therapeutic range. If only total serum Theophylline concentration is measured, this may lead to an unnecessary and potentially dangerous dose increase. In patients with reduced protein binding, measurement of unbound serum Theophylline concentration provides a more reliable means of dosage adjustment than measurement of total serum Theophylline concentration. cheapest paxil order store australia
Monitor the patient and obtain a serum Theophylline concentration in 2-4 hours to insure that the concentration is not increasing. Theophylline from the tissue compartment. Peritoneal dialysis is ineffective for Theophylline removal; exchange transfusions in neonates have been minimally effective. Elderly: Use extreme caution in the elderly; these patients are at greater risk of serious theophylline toxicity. Your doctor will work with you to help find the number and dose of medicines that work best.
Theophylline clearance is altered by another drug resulting in increased or decreased serum Theophylline concentrations. Theophylline only rarely alters the pharmacokinetics of other drugs. Children may be more sensitive to the side effects of this drug. Careful monitoring of side effects and drug levels is recommended. What happens if I overdose? Refer to adult dosing.
When dosing was done under fed conditions, the subjects received a standard breakfast consisting of 2 fried eggs, 2 strips of bacon, 4 oz. hash brown potatoes, 1 slice of toast with a pat of butter, and 8 oz. whole milk 15 minutes pre-dosing. No food was allowed for five hours post-dosing, then a standard lunch was served; at ten hours post-dosing a standard supper was served. Theophylline clearance see or if it is not feasible to monitor serum Theophylline concentrations. HPLC techniques. Caffeine and xanthine metabolites in neonates or patients with renal dysfunction may cause the reading from some dry reagent office methods to be higher than the actual serum theophylline concentration.