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Theophylline

1 3 Dimethylxanthine


Presentation

  • This was perpetuated by delay in diagnosis due to presentation with generalised symptoms including tachycardia, vomiting and neurological symptoms.[ncbi.nlm.nih.gov]
  • Abstract Optimizing the management of children presenting with acute severe asthma is of utmost importance to minimize hospital stays, morbidity, and mortality.[ncbi.nlm.nih.gov]
  • BACKGROUND: Theophylline (TP) is a bronchodilator used orally to treat chronic obstructive pulmonary disease (COPD) that has been associated with multiple side effects, tempering its present use.[ncbi.nlm.nih.gov]
  • When theophylline is not present, RNA probes are stable and their conformations remain unchanged.[ncbi.nlm.nih.gov]
  • We present a case of acute theophylline overdose treated with esmolol under haemodynamic control. Haemodynamic monitoring was useful in determining the appropriate duration of administration of esmolol and in deciding on treatment with fluids.[ncbi.nlm.nih.gov]
Fever
  • In infants with idiopathic low seizure threshold and fever, theophylline administration might possibly trigger a seizure.[ncbi.nlm.nih.gov]
  • PRECAUTIONS: Tell your doctor your medical history, especially of: heart disease, stomach/intestinal ulcers, liver disease, recent fever, thyroid problems, seizures, drug or food allergies.[web.archive.org]
  • Notify your doctor if you have a fever of 100 degrees F or more for 24 hours. May need a blood test to monitor levels in the blood. This information has been approved by Ronina Covar, MD and Ann Mullen, RN, MSN, CNS, AE-C (December, 2012).[nationaljewish.org]
  • Fever Acute illnesses associated with fever have been reported to prolong theophylline half-life. If fever is high and sustained, e.g., 102 for 24 hours, dosage should be reduced.[rxkinetics.com]
  • Factors that influence this level include additional medical problems (such as congestive heart failure and liver disease), concurrent medications, high fevers, certain viral infections and cigarette smoking.[theasthmacenter.org]
Vomiting
  • Clinical features common to severe theophylline toxicity include nausea and vomiting, tachydysrhythmias, metabolic disturbances, seizures, and cardiovascular collapse. Several reports have described these manifestations and their treatments.[ncbi.nlm.nih.gov]
  • He was prescribed fluvoxamine for a depressive disorder and within a week complained of severe headaches, tiredness and vomiting.[ncbi.nlm.nih.gov]
  • Abstract A 5-year-old boy presented with abdominal pain, nausea and vomiting of blood.[ncbi.nlm.nih.gov]
  • Invasive methods have known complications and oral medications might be problematic when nausea and vomiting occurs with severe headaches.[ncbi.nlm.nih.gov]
  • This was perpetuated by delay in diagnosis due to presentation with generalised symptoms including tachycardia, vomiting and neurological symptoms.[ncbi.nlm.nih.gov]
Nausea
  • Clinical features common to severe theophylline toxicity include nausea and vomiting, tachydysrhythmias, metabolic disturbances, seizures, and cardiovascular collapse. Several reports have described these manifestations and their treatments.[ncbi.nlm.nih.gov]
  • Abstract A 5-year-old boy presented with abdominal pain, nausea and vomiting of blood.[ncbi.nlm.nih.gov]
  • Invasive methods have known complications and oral medications might be problematic when nausea and vomiting occurs with severe headaches.[ncbi.nlm.nih.gov]
  • Side effects are related to plasma concentrations and include nausea, vomiting, and headaches due to PDE inhibition and at higher concentrations to cardiac arrhythmias and seizures due to adenosine A1-receptor antagonism.[ncbi.nlm.nih.gov]
  • Serious adverse events in the theophylline and placebo groups included cardiac, 2.4% vs 3.4%; gastrointestinal, 2.7% vs 1.3%; and adverse reactions such as nausea (10.9% vs 7.9%) and headaches (9.0% vs 7.9%).[ncbi.nlm.nih.gov]
Diarrhea
  • Elevated theophylline levels can cause extreme headaches, stomach aches, diarrhea, seizures, heart rhythm irregularities, irritability and tremors. At times, you may have a high serum level of theophylline and no adverse symptoms.[theasthmacenter.org]
  • Tell your doctor if any of these symptoms are severe or do not go away. upset stomach stomach pain diarrhea headache restlessness insomnia irritability If you experience any of the following symptoms, call your doctor immediately: vomiting increased or[web.archive.org]
  • In large amounts, theophylline can cause nausea, diarrhea, arrhythmia, headache, insomnia, irritability and dizziness, according to the “PDR Guide to Drug Interactions, Side Effects and Indications.”[livestrong.com]
  • Common side effects are: nausea, vomiting, diarrhea, headaches, irritability, flushing and palpitations. Other important and more serious side effects include seizures and heart arrhythmias.[medicinenet.com]
Tachycardia
  • An electrocardiogram showed a sinus tachycardia. Arterial blood gas analysis revealed a mixed metabolic acidosis and respiratory alkalosis. Serum lactate level was 51 mmol/L (normal 0.7-2.1 mmol/L).[ncbi.nlm.nih.gov]
  • The case is presented of a 6-month-old girl with theophylline-induced focal seizures associated with tachycardia, tremor and irritability.[ncbi.nlm.nih.gov]
  • The patient developed the typical clinical picture of a symptomatic theophylline poisoning with flush, tremor, tachycardia, hyperventilation, hypotonia, and hyperglycaemia.[ncbi.nlm.nih.gov]
  • Drug poisoning was suspected on the basis of persistent tachycardia in the absence of other signs of dehydration. Salicylate intoxication was excluded, and theophylline was finally incriminated.[ncbi.nlm.nih.gov]
  • A 59-year-old Japanese man who was receiving theophylline for emphysema experienced stimulation, insomnia, and tachycardia due to theophylline toxicity after clarithromycin and levofloxacin were added to the regimen.[ncbi.nlm.nih.gov]
Hypotension
  • In overdose, it causes hypotension, bradycardia and drowsiness. The natriuretic, kaliuretic and vasodilatory effects of indapamide are exaggerated in overdose, resulting in diuresis, hypokalaemia and hypotension.[ncbi.nlm.nih.gov]
  • The systemic capillary leak syndrome is a rare idiopathic disorder characterized by recurrent episodes of hypotension and hemoconcentration due to sudden transient extravasation of 10% to 70% of plasma.[ncbi.nlm.nih.gov]
  • KEYWORDS: Intracranial hypotension; Post dural puncture headache; Post-lumbar puncture headache; Teophylline[ncbi.nlm.nih.gov]
  • These observations suggest a potent hypotensive action of oral theophylline via Cheyne-Stokes respiration with CSA elimination. Our data suggest that CSA may be a mechanism that raises BP even during the daytime.[ncbi.nlm.nih.gov]
  • The life-threatening multisystem effects – especially cardiac dysrhythmia, hypotension, and seizures – tend to be refractory to other treatment measures and supportive care alone will not prevent death.[lifeinthefastlane.com]
Orthostatic Hypotension
  • Its effects on blood pressure are inconsistent, but subjects have experienced orthostatic hypotension and/or syncope upon abrupt standing [see WARNINGS AND PRECAUTIONS ].[rxlist.com]
Blurred Vision
  • Symptoms of excess caffeine use Some examples of the symptoms that may occur in people who consume too much caffeine include: Anxiety Confusion Irritability Suppressed appetite Sleeplessness Dizziness Blurred vision Dry mouth Increased thirst Flushed[web.archive.org]
  • vision, weight loss ).[emedicinehealth.com]
Psychomotor Retardation
  • Patients whose seizures represented their first episode were selected, while patients with cerebrospinal fluid abnormalities including pleocytosis and protein elevation, present illness of head trauma, epilepsy, febrile convulsion or any psychomotor retardation[ncbi.nlm.nih.gov]
Seizure
  • The records of seven patients taking theophylline during nine courses of ECT were reviewed to ascertain whether inordinately long seizures occurred. In 77 documented seizures, there was one 190-second seizure as measured by EEG.[ncbi.nlm.nih.gov]
  • Eight patients (89%) with abortive seizures and 4 (80%) with missed seizures achieved a seizure duration of greater than 15 seconds with theophylline.[ncbi.nlm.nih.gov]
  • In infants with idiopathic low seizure threshold and fever, theophylline administration might possibly trigger a seizure.[ncbi.nlm.nih.gov]
  • Among the 54 cases of TAS, 36 experienced generalized tonic–clonic seizures, with the remainder experiencing partial seizures.[oadoi.org]
Tremor
  • The case is presented of a 6-month-old girl with theophylline-induced focal seizures associated with tachycardia, tremor and irritability.[ncbi.nlm.nih.gov]
  • The patient developed the typical clinical picture of a symptomatic theophylline poisoning with flush, tremor, tachycardia, hyperventilation, hypotonia, and hyperglycaemia.[ncbi.nlm.nih.gov]
  • Elevated theophylline levels can cause extreme headaches, stomach aches, diarrhea, seizures, heart rhythm irregularities, irritability and tremors. At times, you may have a high serum level of theophylline and no adverse symptoms.[theasthmacenter.org]
  • Potential side effects include: Nausea, vomiting Poor appetite Palpitations, tremors, muscle twitching Nervousness, restlessness, difficulty sleeping Note: The side effects listed are the most common.[my.clevelandclinic.org]
Excitement
  • CONCLUSION: A single dose of theophylline is well-tolerated by patients with chronic stroke, but does not alter cortical excitability.[ncbi.nlm.nih.gov]
  • CONCLUSION: Theophylline inhibits capsaicin-induced cough under both normal and "disease" conditions by decreasing the excitability of sensory nerves through activation of small- and intermediate-conductance calcium-activated potassium channels.[ncbi.nlm.nih.gov]
  • It can also cause nausea, diarrhea, increase in heart rate, abnormal heart rhythms, and CNS excitation (headaches, insomnia, irritability, dizziness and lightheadedness).[en.wikipedia.org]
Agitation
  • Abstract Several drugs and natural compounds are known to be highly neurotoxic, triggering epileptic convulsions or seizures, and causing headaches, agitations, as well as other neuronal symptoms.[ncbi.nlm.nih.gov]
  • All newborns experienced sinus tachycardia and agitation. Sequential theophylline and caffeine serum levels were obtained periodically for 62 to 100 hours.[ncbi.nlm.nih.gov]
  • Theophylline toxicity can cause nausea, vomiting, insomnia, seizures, agitation and life- threatening heart rhythm abnormalities. St.[medicinenet.com]
  • Symptoms of overdose may include: nausea / vomiting that doesn't stop, seizures , muscle cramps , fast/irregular heartbeat, mental/mood changes (such as agitation, confusion), vomit that looks like coffee grounds.[webmd.com]

Workup

EEG Normal
  • The spasms stopped and the EEG normalized when theophylline was discontinued and nitrazepam therapy started. On follow-up over the next 3 years there was no recurrence of seizures and the child's neurodevelopment has been normal.[ncbi.nlm.nih.gov]
Staphylococcus Aureus
  • Compounds 11, 21 and 26 have exhibited significant minimum inhibitory concentrations (MIC) against Staphylococcus aureus, Bacillus cereus, Escherichia coli and Pseudomonas aeruginosa.[ncbi.nlm.nih.gov]

Treatment

  • RESULTS: Oral theophylline treatment improved taste and smell acuity in 6 patients after 2 to 12 months of treatment.[ncbi.nlm.nih.gov]
  • We hypothesized that theophylline would be beneficial for the treatment of ADHD and report results of a trial of theophylline compared with methylphenidate for the treatment of ADHD.[ncbi.nlm.nih.gov]
  • We used pharmacokinetic data from a patient and from case reports to generate a formula for predicting treatment time.[ncbi.nlm.nih.gov]
  • Several reports have described these manifestations and their treatments.[ncbi.nlm.nih.gov]

Prognosis

  • Dysrhythmias and seizures are late features of severe theophyline toxicity and suggest a very poor prognosis. Q5. Should this man be transferred to another hospital? If so, why and how? This is a life-threatening acute ingestion of theophylline.[lifeinthefastlane.com]
  • Thomas D Rea and Valentine L Paredes , Quality of life and prognosis among survivors of out-of-hospital cardiac arrest , Current Opinion in Critical Care , 10 , 3 , (218) , (2004) .[doi.org]

Etiology

  • Nasal mucus Shh levels were found significantly diminished in untreated hyposmic patients of multiple etiologies.[ncbi.nlm.nih.gov]
  • The etiology for altered pharmacokinetics of theophylline may be due to the interface between normal developmental changes and pharmacogenetic differences associated with DS and/or the secondary disease states and concomitant drug therapy.[ncbi.nlm.nih.gov]
  • Our case suggests that a possibility of theophylline-associated metabolic abnormalities should be considered when an asthmatic patient given the usual theophylline dose presents with lactic acidosis, hypokalemia and hyperglycemia of unknown etiology.[ncbi.nlm.nih.gov]
  • DESIGN: Shh was measured in parotid saliva of both normal subjects and patients with taste dysfunction of multiple etiologies by use of a sensitive spectrophotometric ELISA assay.[ncbi.nlm.nih.gov]
  • This pattern was present for both Alzheimer’s disease–related dementia and cerebrovascular disease etiologies, and persisted in analyses restricted to nonsmokers.[atsjournals.org]

Epidemiology

  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.com]
  • Descriptive epidemiology of asthma. Lancet 1997 ; 350 (Suppl 11): 1 -4. Holgate ST . The cellular and mediator basis of asthma in relation to natural history. Lancet 1997 ; 350 (Suppl 11): 5 -9. Lipworth BJ . Treatment of acute asthma.[clinchem.aaccjnls.org]
Sex distribution
Age distribution

Pathophysiology

  • […] are useful primarily for patients with asthma because bronchospasm is a key component of that disease state. 1 The use of theophylline in patients with chronic obstructive pulmonary disease is more controversial because these diseases have different pathophysiologic[accesspharmacy.mhmedical.com]
  • Useful For Suggests clinical disorders or settings where the test may be helpful Assessing and adjusting dosage for optimal therapeutic level Assessing toxicity Clinical Information Discusses physiology, pathophysiology, and general clinical aspects,[mayomedicallaboratories.com]
  • We used a nonspecific phosphodiesterase inhibitor, PTX, in the present study because it has been used clinically in the treatment of a variety of conditions in which inflammation is an important component of the pathophysiology of the disease process.[doi.org]

Prevention

  • This drug ameliorates kidney dysfunction and prophylaxis given early after birth, preventing vasomotor nephropathy.[ncbi.nlm.nih.gov]
  • The use of theophylline for prevention of CIN has yielded conflicting results. This study aimed at examining the effectiveness of theophylline in prevention of CIN when added to IV hydration and N-acetylcysteine (NAC).[ncbi.nlm.nih.gov]
  • Examples: Theo-dur, Slo-phylline, Theo-24, Quibron and other generics Controller Medications: Prevent asthma symptoms from occurring Can reduce and/or prevent: Inflammation and scarring in the airways Tightening of the muscle bands around the airways[pamf.org]
  • OBJECTIVE: To examine the effect of prophylactic theophylline for the prevention of severe renal dysfunction in post-asphyxiated term and post-term infants.[ncbi.nlm.nih.gov]

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