Bahls FH, Ma KK, Bird TD "Theophylline-associated seizures with "therapeutic" or low toxic serum concentrations: risk factors for serious outcome in adults. The dosage is based on your medical condition, response to treatment, age, weight, lab tests theophylline blood levels and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use including prescription drugs, nonprescription drugs, and herbal products. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully. purchase cheapest phenazopyridine pharmacy uk phenazopyridine
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.
The steady-state peak serum Theophylline concentration is a function of the dose, the dosing interval, and the rate of Theophylline absorption and clearance in the individual patient. Gender: Gender differences in Theophylline clearance are relatively small and unlikely to be of clinical significance. Significant reduction in Theophylline clearance, however, has been reported in women on the 20th day of the menstrual cycle and during the third trimester of pregnancy. Monitor the patient and obtain a serum Theophylline concentration in 2-4 hours to insure that the concentration is not increasing.
Avoid drinks or foods that contain caffeine, such as coffee, tea, cola, and chocolate. Note: Serum Theophylline concentrations may continue to increase after presentation of the patient for medical care. For a given population there is no single Theophylline dose that will provide both safe and effective serum concentrations for all patients. Administration of the median Theophylline dose required to achieve a therapeutic serum Theophylline concentration in a given population may result in either sub-therapeutic or potentially toxic serum Theophylline concentrations in individual patients. McIvor RA, et al. 2011. COPD, search date April 2010. canada triamterene mastercard
Decrease in Theophylline plasma concentrations. Ask your doctor or pharmacist if a new medicine will affect how much theophylline you take. Fed conditions were the same as those previously cited. Both the N-demethylation and hydroxylation pathways of Theophylline biotransformation are capacity-limited. Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. Berlinger WG, Spector R, Goldberg MJ, Johnson GF, Quee CK, Berg MJ. Enhancement of theophylline clearance by oral activated charcoal. The dose of your medicine may need to be adjusted. The chronicity and pattern of theophylline overdosage significantly influences clinical manifestations of toxicity, management and outcome. Barry M, Feely J. Allopurinol influences aminophenazone elimination. Congestive Heart Failure CHF Theophylline clearance is decreased by 50% or more in patients with CHF. The extent of reduction in theophylline clearance in patients with CHF appears to be directly correlated to the severity of the cardiac disease. Since theophylline clearance is independent of liver blood flow, the reduction in clearance appears to be due to impaired hepatocyte function rather than reduced perfusion. What are the uses for theophylline? The treatment of asthma exacerbations with aminophylline is not supported or recommended by current clinical practice guidelines GINA 2016; NAEPP 2007. The treatment of acute COPD exacerbations with aminophylline is not recommended by current clinical practice guidelines Global Initiative for COPD Guidelines 2017. About 6% of a theophylline dose is N-methylated to caffeine. Be sure your back is covered. Wear a shirt or blouse, or cover your back with a towel.
Prakash M, Washburne JD "Theophylline and urinary retention. Theophylline, prior to this multiple-dose study. Note: Doses should be adjusted to maintain the peak steady state serum concentrations. The time to reach steady state will vary based on age and the presence of risk factors which may affect theophylline clearance. The time of peak serum level varied from subject to subject, occurring from 4 to 14 hours after dosing. However, 92% of the subjects had serum levels at least 75% of the maximum value at 4 to 8 hours after dosing, during each phase. Monitor the patient and obtain a serum theophylline concentration in 2-4 hours to insure that the concentration is not increasing. The mechanism of theophylline-induced seizures has not been determined. Seizures are generally focal with secondary generalization. Permanent neurologic deficits have been reported and morbidity may be high, especially in the elderly, patients with severe underlying disease, and patients with prolonged, uncontrolled seizure activity. The onset of seizures is not always preceded by less severe symptoms of aminophylline toxicity. Patients with an abnormal neurologic history, including a history of seizures, cerebral infarct, or head trauma, may be predisposed to seizure activity. If theophylline is used in these types of patients, serum concentrations should be monitored closely and maintained in the low, therapeutic range. The steady-state peak serum theophylline concentration is a function of the dose, the dosing interval, and the rate of theophylline absorption and clearance in the individual patient. One popular FDA-approved laser treatment is called Cellulaze. The doctor injects numbing solution into the area, then puts a laser under your skin. It shoots heat in three directions. You can expect about a 75% improvement in your cellulite for about a year. Demethylation to 1-methylxanthine appears to be catalyzed either by cytochrome P-450 1A2 or a closely related cytochrome. In neonates, the N-demethylation pathway is absent while the function of the hydroxylation pathway is markedly deficient. The activity of these pathways slowly increases to maximal levels by one year of age. Short-acting bronchodilators provide quick relief and can be used in conjunction for -induced symptoms. Albuterol Proventil, Ventolin, ProAir, Maxair, Xopenex is a short-acting bronchodilator. Other manifestations of theophylline toxicity include increases in serum calcium, creatine kinase, myoglobin and leukocyte count, decreases in serum phosphate and magnesium, acute myocardial infarction, and urinary retention in men with obstructive uropathy. Cyproterone: May decrease the serum concentration of CYP1A2 Substrates. General: The chronicity and pattern of Theophylline overdosage significantly influences clinical manifestations of toxicity, management and outcome. Higher doses of theophylline may be required to achieve desired effect. Store theophylline at room temperature, away from moisture, heat, and light. Enoxacin is a potent inhibitor of the cytochrome P-450 isozymes responsible for the of methylxanthines. In a multiple-dose study, enoxacin caused a dose-related increase in the mean elimination half-life of caffeine, thereby decreasing the clearance of caffeine by up to 80% and leading to a five-fold increase in the AUC and the half-life of caffeine. Trough enoxacin levels were also 20% higher when caffeine and enoxacin were administered concomitantly. Caffeine-related adverse effects have occurred in patients consuming caffeine while on therapy with enoxacin. acyclovir
If symptoms are controlled and current dosage is tolerated, maintain dose and recheck serum concentration at 6-12 month intervals. If symptoms are not controlled and current dosage is tolerated consider adding additional medications to treatment regimen. Get medical help right away if your asthma symptoms worsen or if you are using your quick-relief inhaler more than usual or more often than prescribed. Increase Theophylline clearance by increasing demethylation and hydroxylation. Decreases renal clearance of Theophylline. Theophylline can cause side effects that may impair your thinking or reactions. Transient caffeine-like adverse effects and excessive serum concentrations in slow metabolizers can be avoided in most patients by starting with a sufficiently low dose and slowly increasing the dose, if judged to be clinically indicated, in small increments see Table V. Dose increases should only be made if the previous dosage is well tolerated and at intervals of no less than 3 days to allow serum Theophylline concentrations to reach the new steady state. Do I need a prescription for theophylline? Take the missed dose as soon as you remember. CYP1A2 Inhibitors Moderate: May decrease the metabolism of CYP1A2 Substrates. Table VI. Dosage adjustment guided by serum Theophylline concentration. At the high dose, systemic toxicity was observed in both species including decreases in testicular weight.
When these two medicines are taken together, your body may not process theophylline properly. Theo-24 theophylline anhydrous is supplied in extended-release capsules containing 100, 200, 300 or 400 mg of anhydrous theophylline. Why do people take guarana? 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? 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. 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. 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. Treatment with broad-spectrum antibacterial agents alters the normal of the and may permit overgrowth of clostridia. Besides the guarana seed itself, there are no natural food sources of guarana. It has become a common additive to some foods and drinks. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company. purchase astonin price
Allopurinol: May increase the serum concentration of Theophylline Derivatives. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist. Monitor the patient and obtain serial theophylline concentrations every 2-4 hours to gauge the effectiveness of therapy and to guide further treatment decisions. Consider extracorporeal removal even if the patient has not experienced a seizure see OVERDOSAGE, Extracorporeal Removal. Patients with more rapid metabolism, clinically identified by higher than average dose requirements, should receive a smaller dose more frequently to prevent breakthrough symptoms resulting from low trough concentrations before the next dose. A reliably absorbed slow-release formulation will decrease fluctuations and permit longer dosing intervals. Marchlinski FE, Miller JM "Atrial arrhythmias exacerbated by theophylline: response to verapamil and evidence for triggered activity in man. Jain R, Tholl DA. Activated charcoal for theophylline toxicity in a premature infant on the second day of life. How should I take ZYFLO? Bittar G, Friedman HS "The arrhythmogenicity of theophylline: a multivariate analysis of clinical determinants. Stopping St. John's Wort may result in theophylline toxicity. Gal P, Miller A, McCue JD. Oral activated charcoal to enhance theophylline elimination in an acute overdose. Enoxacin is approximately 40% bound to plasma in healthy subjects and is approximately 14% bound to plasma proteins in patients with impaired renal function. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Always consult your doctor or healthcare specialist for medical advice. Dosage reduction may alleviate the caffeine-like adverse effects in these patients, however, persistent adverse effects should result in a reevaluation of the need for continued Theophylline therapy and the potential therapeutic benefit of alternative treatment. Monitor the patient and obtain a serum theophylline concentration in 2 - 4 hours to insure that the concentration is not increasing.
CloZAPine: CYP1A2 Inhibitors Weak may increase the serum concentration of CloZAPine. Theophylline can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Beta-Blockers Beta1 Selective: May diminish the bronchodilatory effect of Theophylline Derivatives. Management: Monitor for reduced theophylline efficacy during concomitant use with any beta-blocker. Beta-1 selective agents are less likely to antagonize theophylline than nonselective agents, but selectivity may be lost at higher doses. If the serum sample is drawn more than two hours after the dose, the results must be interpreted with caution since the concentration may not be reflective of the peak concentration. In contrast, when signs or symptoms of theophylline toxicity are present, the serum sample should be obtained as soon as possible, analyzed immediately, and the result reported to the clinician without delay. Pediatrics: 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. Theophylline or another drug or occurrence of adverse effects without a change in serum Theophylline concentration. Pediatric Use: Safety and effectiveness in pediatric patients and adolescents below the age of 18 years have not been established. Enoxacin causes arthropathy in animals. Some believe that the effects of guarana are less intense and longer-lasting than caffeine. Studies have not established this. How much guarana should you take? Decreases theophylline clearance by inhibiting hydroxylation and demethylation. Decrease dose by 25% even if no adverse effects are present. Recheck serum concentration after 3 days to guide further dosage adjustment. apetamin-p elixir generic
Maintain dosage if tolerated. Recheck serum theophylline concentration at 24-hour intervals for acute IV dosing or at 6- to 12-month intervals for oral dosing. Finer adjustments in dosage may be needed for some patients. Fever 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. Other medications can affect the removal of theophylline from your body, which may affect how theophylline works. Shannon M "Predictors of major toxicity after theophylline overdose. Moderate. These medicines may cause some risk when taken together. Interpretation involves the correlation of the diameter obtained in the disk test with the minimum inhibitory concentration MIC for enoxacin. Propafenone: May increase the serum concentration of Theophylline Derivatives. Phenobarbital may cause respiratory depression, particularly in elderly patients and patients with COPD. Elderly patients are at a significantly greater risk of experiencing serious toxicity from theophylline than younger patients due to pharmacokinetic and pharmacodynamic changes associated with aging. Increases Theophylline clearance by induction of microsomal enzyme activity. Stiripentol: May increase the serum concentration of Theophylline. DexPak are often used during asthma flares to provide prompt relief for patients. Although very effective, these medications have many side effects and are only used when absolutely necessary. Some patients with severe asthma, however, may require oral steroids frequently or even on a daily basis. Several studies have described the clinical manifestations of Theophylline overdose and attempted to determine the factors that predict life-threatening toxicity. Drug Interactions Theophylline interacts with a wide variety of drugs.
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. 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. So a person with COPD who continues to smoke may need larger doses of the medicine. 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. What is the most important information I should know about theophylline Elixophyllin, Theo-24? The symptoms of asthmatic bronchitis are a combination of the symptoms of bronchitis and asthma. Theophylline also strengthens right heart function and movement. Theophylline was approved by the FDA in April 1979. 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. Bernstein JE, Lorincz AL "Ethylenediamine-induced exfoliative erythroderma. Most of the side effects of aminophylline theophylline have been dependent on serum concentrations. Administer a single dose of oral activated charcoal. Serious and occasionally fatal hypersensitivity anaphylactoid or anaphylactic reactions, some following the first dose, have been reported in patients receiving quinolone therapy. An overdose of caffeine can cause and convulsions. artane
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Teratogenic effects were observed in animal reproduction studies. Theophylline crosses the placenta; adverse effects may be seen in the newborn. Every effort has been made to ensure that the information provided by Cerner Multum, Inc. 'Multum' is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. omeprazole vs store brand omeprazole
Saliva concentrations of theophylline cannot be used reliably to adjust dosage without special techniques. Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Theophylline Oral Solution USP is a clear red solution with a berry flavor. Each tablespoonful 15 mL contains 80 mg theophylline anhydrous. Helliwell M, Berry D. Theophylline absorption by effervescent activated charcoal Medicoal. Theophylline concentrations should be monitored at 6 month intervals for rapidly growing children and at yearly intervals for all others.
Gastrointestinal side effects have included anorexia, nausea, vomiting, and abdominal pain. Aminophylline may also cause locally-mediated gastrointestinal upset. Disclaimer: The indications, uses and warnings for individual medications outside the USA are determined by local regulatory bodies in each country or region. The Drugs. Patel AK, Skatrud JB, Thomsen JH "Cardiac arrhythmias due to oral aminophylline in patients with chronic obstructive pulmonary disease. filc.info clavaseptin
Exceptions: Gemifloxacin; LevoFLOXacin Systemic; Lomefloxacin; Moxifloxacin Systemic; Nalidixic Acid; Sparfloxacin. Olodaterol. Theophylline Derivatives may enhance the hypokalemic effect of Olodaterol. Decrease your cellulite using the latest science. Wort may result in Theophylline toxicity. May lower theophylline seizure threshold.