Theophylline toxicity: Difference between revisions

Revision as of 04:22, 9 November 2018

See theophylline for general drug information.

Still used in patients with debilitating brochospastic disease
Studied for treatment of Acute Mountain Sickness and Contrast-Induced Nephropathy
PO in elixir, extended release, or controlled release forms but absorption erratic
IV as aminophylline
Adenosine antagonism, Increase catecholamines, and Phosphodiesterase inhibition

Supportive care
- Cardiac monitoring
- Ondansetron (Zofran) for antiemetic
- EEG for sedated and paralyzed patients
Cardiovascular
- IV Fluids for hypotension
- Beta blockers for tachyarrhymias
  - Esmolol particularly wise first-line agent
  - Controversial, involve a toxicologist
GI decontamination (Multidose Activated Charcoal, Whole Bowel Irrigation)
- Considered in life-threatening overdose
  - contraindications: unsecured airway, nausea, vomiting, ileus, Bowel Obstruction, or need for emergent endoscopy
Seizures
- Lorazepam (Ativan) 1st line
- Phenobarbital if lorazepam ineffective
- Phenytoin (Dilantin) contraindicated as increases seizure in animal studies
Dialysis
- Indicated in seizures, severe arrhythmias
- Theophylline level >90mcg/ml in acute ingestion
- Theophylline level >40mcg/ml in chronic ingestion

Authors:

@@ Line 45: / Line 45: @@
 #*[[IV Fluids]] for [[hypotension]]
 #*Beta blockers for [[tachyarrhymias]]
+#**[[Esmolol]] particularly wise first-line agent
 #**Controversial, involve a toxicologist
 #GI decontamination ([[Multidose Activated Charcoal]], [[Whole Bowel Irrigation]])