Theophylline toxicity

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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

Clinical Features

Differential Diagnosis


  • ECG
  • Chem
  • CK
  • Theophylline level


  1. Supportive care
    • Cardiac monitoring
    • Ondansetron (Zofran) for antiemetic
    • EEG for sedated and paralyzed patients
  2. Cardiovascular
  3. GI decontamination (Multidose Activated Charcoal, Whole Bowel Irrigation)
  4. Seizures
    • Lorazepam (Ativan) 1st line
    • Phenobarbital if lorazepam ineffective
    • Phenytoin (Dilantin) contraindicated as increases seizure in animal studies
  5. Dialysis
    • Indicated in seizures, severe arrhythmias
    • Theophylline level >90mcg/ml in acute ingestion
    • Theophylline level >40mcg/ml in chronic ingestion


Immediate release

  • Home after 6 hours if:
    • nontoxic
    • asymptomatic
    • and, normal vital sign

Sustained release

  • Home after 12 hours if:
    • nontoxic
    • asymptomatic
    • and, normal vital sign

See Also

External Links