Theophylline

General

• Type: Bronchodilator
• Dosage Forms: Oral
• Common Trade Names: Elixophyllin, Theo-24, Uniphyl

Adult Dosing

• 300-600mg PO q6-8h (immediate-release) or q12h (ER)
• IV theophylline no longer recommended for use inpatient or in the ED due to lack of added benefit over other treatments and high risk of adverse events

Pediatric Dosing

• Apnea in neonate: 4 mg/kg IV load, then 2 mg/kg IV q12h
• Pediatric theophylline doses for asthma are very complicated, and with the narrow therapeutic window, probably not even worth trying it!

Special Populations

• Pregnancy Rating: C
• Lactation: Probably Safe
• Renal Dosing
  • Adult: no adjustment
  • Pediatric: <3 mo: decrease dose amount not defined; >3 mo: no adjustment
• Hepatic Dosing
  • Adult: decrease dose amount not defined
  • Pediatric: decrease dose amount not defined

Contraindications

• Allergy to class/drug
• Known allergy to corn or corn products (IV form)
• caution if PUD, active
• caution if seizure disorder
• caution if arrhythmias
• caution if CHF
• caution if pulmonary edema, acute
• caution if cor pulmonale
• caution if hepatic impairment
• caution if hypothyroidism
• caution if febrile
• caution if sepsis with multi-organ failure
• caution if shock
• caution if smoking habit changes
• caution if neonates or infants
• caution in elderly patients

Adverse Reactions

See theophylline toxicity for overdose information

Serious

• seizures
• arrhythmias
• hypotension, shock
• exfoliative dermatitis

Common

• nausea/vomiting, diarrhea
• headache
• insomnia, irritability, restlessness, tremor
• diuresis, transient

Pharmacology

• Half-life: 8h
• Metabolism: liver; CYP450: 1A2, 2E1, 3A3
• Excretion: urine (10% unchanged)
• Mechanism of Action: exact mechanism unknown; increases cAMP; antagonizes adenosine receptors (methylxanthine)

See Also

• Theophylline toxicity
• Bronchodilators