They relieve cough, wheezing, shortness of breath, and troubled breathing … 2 Wirkmechanismus. Monitor therapy, Iohexol: Agents With Seizure Threshold Lowering Potential may enhance the adverse/toxic effect of Iohexol. COPD Treatment. Consider therapy modification, CYP1A2 Inhibitors (Weak): May increase the serum concentration of Theophylline Derivatives. Days 4 to 6: 16 mg/kg/day; maximum daily dose: 400 mg/day. Management: Consider avoiding erythromycin and troleandomycin in patients receiving theophylline derivatives. If you take extended-release tablets: Take the medicine as soon as you can, but skip the missed dose if your next dose is due in less than 8 hours.. Do not take two doses at one time. 12-hour formulation: May be administered as once daily dosing in non-smokers (with appropriate total body clearance) and patients with low dosage requirements; consider only after titrated to therapeutic levels. What special dietary instructions should I follow? Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. COPD treatment: The treatment of acute COPD with theophylline IV is not supported or recommended by current clinical practice guidelines due to significant side effects (GOLD 2019). Consider therapy modification, Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iohexol. Oral: Oral (solution and immediate release): Rapid and complete. Do not stop taking theophylline without talking to your doctor. Find everything you need to know about Theophylline (Theo-24), including what it is used for, warnings, reviews, side effects, and interactions. If used together, monitor for decreased concentrations/effects of phenytoin or theophylline if the other agent is initiated/dose increased, or increased concentrations/effects if the other is discontinued/dose decreased. If symptoms are not controlled and current dose is tolerated, consider adding additional medications. Adults >60 years: 0.3 mg/kg/hour; maximum: 400 mg/day unless serum levels indicate need for larger dose. Note: Loading dose intended to achieve a serum level of ~10 mcg/mL (range: 5 to 16 mcg/mL). the client started to become restless and complains of palpitations. Avoid large amounts of these substances while you are taking theophylline. The client may require higher doses of theophylline than a nonsmoker Smoking cigarettes may decrease serum theophylline levels. Cardiac decompensation, cor pulmonale, sepsis with multiorgan failure, shock: Refer to adult dosing. Instead, the best way to dispose of your medication is through a medicine take-back program. Patients who have COPD are experiencing limited airflow due to obstructive pulmonary disease. Pregnancy. Infants: Total daily dose (mg/day) = [(0.2 x age in weeks) + 5] x (weight in kg); frequency is based on age. Theophylline Derivatives may diminish the neuromuscular-blocking effect of Pancuronium. Due to pregnancy-induced physiologic changes, some pharmacokinetic properties of theophylline are altered. Learn more: Mayo Clinic facts about coronavirus disease 2019 (COVID-19) Our COVID-19 patient and visitor guidelines, plus trusted health information Latest on COVID-19 vaccination by site: Arizona patient vaccination updates Arizona, Florida patient vaccination … However, it … This chapter is concerned with how laboratory measurement of drug concentration in blood helps in determining correct drug dose. "I need to drink at least 2 liters of fluid per day." Management: Seek alternatives when possible. Brief Profile - Last updated: 13/01/2021 Print. The molecular formula of anhydrous theophylline is C 7 H 8 N 4 O 2 with a molecular weight of 180.17.. Theo-24 (theophylline anhydrous capsule) ® is available as capsules intended for oral administration, containing 100 mg, 200 mg, 300 mg, or 400 mg of anhydrous theophylline per capsule, in an extended-release formulation which allows a 24-hour dosing interval for … [DSC] = Discontinued product, Theo-24: 100 mg [contains fd&c yellow #6 (sunset yellow)], Theo-24: 200 mg [contains fd&c yellow #10 (quinoline yellow)], Theo-24: 300 mg [contains brilliant blue fcf (fd&c blue #1), fd&c red #40], Elixophyllin: 80 mg/15 mL (473 mL) [contains alcohol, usp, fd&c red #40, saccharin sodium; mixed fruit flavor], Theochron: 100 mg, 200 mg, 300 mg [scored], Generic: 100 mg [DSC], 200 mg [DSC], 300 mg, 450 mg. Theophylline has two distinct actions; smooth muscle relaxation (ie, bronchodilation) and suppression of the response of the airways to stimuli (ie, non-bronchodilator prophylactic effects). Reversal of adenosine should rarely be required given adenosine's short half-life [ASNC [Henzlova 2016]]. They treat asthma, COPD, allergies, and other breathing problems. Theophylline comes as an extended-release (long-acting) tablet, extended-release capsule, and a solution (liquid) to take by mouth. NUR 292 986) A client with a prescription to take theophylline daily has been given medication instructions by the nurse. The company stopped distributing 300mg tablets to veterinarians while it awaits the Food and Drug Administration's (FDA) final approval of its new production facility, Inwood spokeswoman Loraine Perotta says. However, you should not flush this medication down the toilet. • Hepatic impairment: Use with caution in patients with hepatic impairment (eg, cirrhosis, acute hepatitis, cholestasis); risk of severe and potentially fatal theophylline toxicity is increased; theophylline clearance is decreased ≥50% in these patients. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. Consider therapy modification, Isoniazid: May increase the serum concentration of Theophylline Derivatives. What should I know about storage and disposal of this medication? • Cardiovascular disease: Use with caution in patients with cardiac arrhythmias (excluding bradyarrhythmias); use may exacerbate arrhythmias. Monitor therapy, Methotrimeprazine: Products Containing Ethanol may enhance the adverse/toxic effect of Methotrimeprazine. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect: • Low potassium like muscle pain or weakness, muscle cramps, or an abnormal heartbeat, • High blood sugar like confusion, fatigue, increased thirst, increased hunger, passing a lot of urine, flushing, fast breathing, or breath that smells like fruit, • Acidosis like confusion, fast breathing, fast heartbeat, abnormal heartbeat, severe abdominal pain, nausea, vomiting, fatigue, shortness of breath, or loss of strength and energy. >26 weeks: Divide in 4 equal doses and administer every 6 hours. Enteral feedings deliver nourishment through a tube directly into the GI tract. It is used for the treatment of pulmonary conditions, including asthma and chronic obstructive pulmonary disease (COPD). Monitor therapy, Regadenoson: Theophylline may enhance the neuroexcitatory and/or seizure-potentiating effect of Regadenoson. We comply with the HONcode standard for trustworthy health information -, 2018 American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) Guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay, Phosphodiesterase Enzyme Inhibitor, Nonselective. Do not crush or chew. Smaller doses given more frequently may be used in patients with a more rapid metabolism to prevent breakthrough symptoms which could occur due to low trough concentration prior to the next dose. What statement by the client indicates the need for further education regarding the prescription? Schedule your appointment now for safe in-person care. Theophylline may favorably impact functional impairment in COPD patients, but exact effects are unclear. Consider benefits versus risks and the need for more intensive monitoring in these patients; reduced infusion rate required. If a patient develops signs and symptoms of theophylline toxicity (eg, nausea or persistent, repetitive vomiting), a serum theophylline level should be measured immediately and subsequent doses withheld. • Theophylline toxicity: Severe and potentially fatal theophylline toxicity may occur if reduced theophylline clearance occurs. Theophylline may cause side effects. Add small portions of a 1:1 mixture of Ora-Sweet and Ora-Plus and mix to a uniform paste; mix while adding the vehicle in equal proportions to almost 60 mL; transfer to a calibrated bottle, rinse mortar with vehicle, and add sufficient quantity of vehicle to make 60 mL. Sympathomimetics may enhance the tachycardic effect of Solriamfetol. It relaxes and opens air passages in the lungs, making it easier to breathe. The codes reflect our interpretation of CPT coding requirements based upon AMA guidelines published annually. Loading dose: Note: Doses presented intended to achieve a serum level of approximately 10 mcg/mL; loading doses should be given intravenously (preferred) or with a rapidly absorbed oral product (not an extended release product). Monitor therapy, Linezolid: May enhance the hypertensive effect of Sympathomimetics. Recheck serum concentrations. Patients who have not received theophylline in the previous 24 hours: 4.6 mg/kg/dose IV (preferred route) or 5 mg/kg orally (immediate release only [oral solution]). Monitor therapy, Allopurinol: May increase the serum concentration of Theophylline Derivatives. Theophylline works by relaxing the smooth muscles of the airways while relieving inflammation and a… Sub. Theophylline Derivatives may enhance the hypokalemic effect of Formoterol. Theophylline may decrease adenosine efficacy and higher adenosine doses may be required. If you become pregnant while taking theophylline, call your doctor. Plasma glucose, uric acid, free fatty acids, total cholesterol, HDL, HDL/LDL ratio, and urinary free cortisol excretion may be increased by theophylline. Infants 6 to 52 weeks: Dose (mg/kg/hour) = (0.008 x age in weeks) + 0.21. Theophylline crosses the placenta, resulting in potentially dangerous serum theophylline concentrations in the neonate (SEDA-5, 3). tell your doctor and pharmacist what prescription, nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. description Substance description Substance description. Recheck serum concentrations. Monitor therapy, Cannabis: May decrease the serum concentration of CYP1A2 Substrates (High risk with Inducers). The nurse determines that the client is experiencing theophylline toxicity in which of the following? Label "shake well". Guideline recommendations: Asthma: The 2020 Global Initiative for Asthma Guidelines (GINA) and the 2007 National Heart, Lung and Blood Institute Asthma Guidelines recommend against theophylline for the treatment of asthma exacerbations due to poor efficacy and safety concerns (GINA 2020; NAEPP 2007). Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away: WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. All drugs may cause side effects. Theophylline, also known as dimethylxanthine, is a methylxanthine drug used in therapy for respiratory diseases such as COPD or asthma under a variety of brand names. What statement by the client indicates the need for further education regarding his prescription? Specifically, the risk for seizures may be increased. Days 4 to 6: 16 mg/kg/day in divided doses every 4 to 6 hours; maximum daily dose: 400 mg/day. Highly variable and dependent upon age, hepatic function, cardiac function, lung disease, and smoking history (Hendeles 1995): Premature infants, postnatal age 3 to 15 days: 30 hours (range: 17 to 43 hours), Premature infants, postnatal age 25 to 57 days: 20 hours (range: 9.4 to 30.6 hours), Term infants, postnatal age 1 to 2 days: 25.7 hours (range: 25 to 26.5 hours), Term infants, postnatal age 3 to 30 weeks: 11 hours (range: 6 to 29 hours), Children 1 to 4 years: 3.4 hours (range: 1.2 to 5.6 hours), Children and Adolescents 6 to 17 years: 3.7 hours (range: 1.5 to 5.9 hours), Adults ≥18 years to ≤60 years (nonsmoking, asthmatic, otherwise healthy): 8.7 hours (range: 6.1 to 12.8 hours), Elderly >60 years (nonsmoking, healthy): 9.8 hours (range: 1.6 to 18 hours), ~40%, primarily to albumin; decreased in neonates (due to a greater percentage of fetal albumin), hepatic cirrhosis, acidemia (uncorrected), third trimester of pregnancy, and elderly. Theophylline may diminish the vasodilatory effect of Regadenoson. In the given example, reacting N,N-dimethylurea with cyanoacetic ether in the presence of acetic anhydride gives cyanoacetylmethylurea (23.3.1), which cyclizes into 6-amino-1,3-dimethyluracil (23.3.2). Jackson Gastroenterology's Web Site includes office information and paient education material on digestive and liver disorders, and nutrition. Theophylline increases the force of contraction of diaphragmatic muscles through enhancement of calcium uptake through adenosine-mediated channels. Inwood, N.Y. — Bureaucratic red tape has slowed Inwood Laboratory's distribution of theophylline. In geringer Menge kommt Theophyllin auch in Kaffeebohnen,[2] Kolanüssen und Guaraná vor und ist ein Abbauprodukt des Coffeins i… Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. 1. Other brands: Quibron-T/SR, Theo-24, Elixophyllin, Theolair, ... +2 more, albuterol, dexamethasone, hydrocortisone, Symbicort, Breo Ellipta, Ventolin HFA, Ventolin, Dulera, Xopenex, caffeine. difficulty falling asleep or staying asleep. Adolescents 12 to <16 years (otherwise healthy, nonsmokers): 0.5 mg/kg/hour; maximum daily dose: 900 mg/day unless serum concentrations indicate need for larger dose. It is typically taken by mouth for the long-term control and maintenance of asthma, COPD (including emphysema and chronic bronchitis), and other chronic lung diseases. 987) A client with tuberculosis (TB) has a prescription for rifampin. Theophylline (1,3-dimethylxanthins) can indirectly stimulate both β1 and β2 receptors through release of endogenous catecholamines. View All Manufacturers & Suppliers of Theophylline API with Drug Master Files (DMF), CEP/COS, Japanese DMFs, Written Confirmation (WC) details listed on PharmaCompass.com Avoid combination, Adalimumab: May decrease the serum concentration of Theophylline Derivatives. Oral: Treatment of symptoms and reversible airflow obstruction associated with chronic asthma, or other chronic lung diseases (eg, emphysema, chronic bronchitis). Recheck serum theophylline concentrations. Specifically, concentrations of 1-methylxanthine, a metabolite of unknown clinical importance, may become elevated. Management: Seek alternatives when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Monitor therapy, Adenosine: Theophylline Derivatives may diminish the therapeutic effect of Adenosine. 10 to 14.9 mcg/mL: If symptoms controlled and current dose tolerated, maintain dose and recheck serum concentrations at 24-hour intervals (IV) or 6- to 12-month intervals (oral); if symptoms are not controlled and current dose is tolerated, consider adding additional medications. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information. Extended release (without risk factors for impaired clearance): 12-hour formulation (tablets): Initial: 300 mg/day in divided doses every 12 hours; if tolerated, after 3 days increase to 400 mg/day in divided doses every 12 hours; if tolerated, after 3 days, increase to 600 mg/day in divided doses every 12 hours. Theophylline — Theophylline (Slo-bid, Theo-Dur, and others) has been used for many years during pregnancy without any apparent complications, suggesting that it is safe during pregnancy. 20 to 24.9 mcg/mL: Withhold next dose, decrease dose by ~25% even if no adverse effect present. The nurse determines that the client is experiencing theophylline toxicity in which of the following? BSAVA library: We promote excellence in small animal practice through education and science. Online Library contains Manuals, Guides, Formularies and other content from the BSAVA. (See Indications for enteral feeding.) Maintenance: 600 mg/day in divided doses every 12 hours. Independent Medical Education. Cigarette smoking may decrease the effectiveness of theophylline. Based on the 2018 American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) Guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay and the 2010 International Society of Heart and Lung Transplantation guidelines for the care of heart transplant recipients, theophylline is recommended and may be effective for the treatment of sinus bradycardia following heart transplantation. Heart rate, CNS effects (insomnia, irritability); respiratory rate (COPD patients often have resting controlled respiratory rates in low 20s); arterial or capillary blood gases (if applicable); fluid balance, electrolyte concentrations, and acid-base balance during prolonged IV therapy. Accessed 5/14/2018. Reversible airflow obstruction, chronic conditions: Oral: Starting doses in older adults should be reduced by 25% compared to younger adult populations (Brodeur 2015). A client is receiving theophylline intravenously. Duplication for commercial use must be authorized by ASHP. Don't delay your care at Mayo Clinic. Consider therapy modification, CYP1A2 Inhibitors (Strong): May increase the serum concentration of Theophylline Derivatives. Endoscopic procedures that help in diagnosis and treatment are also described. The kinetic interaction of microparticles in solutions is induced by binding of drug-conjugate to the antibody on the microparticles and is inhibited by the presence of theophylline … CPT codes are provided only as guidance to assist clients with billing. As you will recall, Lovenox is used to prevent deep venous thrombosis by preventing clots from forming. An Anti-Inflammatory Diet Plan Diabetes Smart Tips Living Well with Rheumatoid Arthritis Living Well with Colitis or Crohn's Manage Your Child's ADHD Managing Relapsing Multiple Sclerosis Talking to Your Doctor About Hepatitis C Talking to Your Doctor About Psoriasis Talking to Your Doctor About Rheumatoid Arthritis Your Guide to Diabetes Management Your Guide to … You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Protect from freezing. Beta-1 selective agents are less likely to antagonize theophylline than nonselective agents, but selectivity may be lost at higher doses. Patients maintained with oral therapy should be reassessed at 6- to 12-month intervals, when clinically indicated, or if concomitant medication is added which may affect theophylline serum concentration. • Seizure disorder: Use with caution in patients with seizure disorders; use may exacerbate seizure disorder. Management: Avoid products containing alcohol in patients treated with methotrimeprazine. Inwood, N.Y. — Bureaucratic red tape has slowed Inwood Laboratory's distribution of theophylline. Monitor therapy, Broccoli: May decrease the serum concentration of CYP1A2 Substrates (High risk with Inducers). Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iomeprol. The effect of ciprofloxaicn on theophylline pharmacokinetics in healthy subjects. Monitor therapy, Tedizolid: May enhance the hypertensive effect of Sympathomimetics. tell your doctor if you have or have ever had seizures, ulcers, heart disease, an overactive or underactive thyroid gland, high blood pressure, or liver disease or if you have a history of alcohol abuse. Monitor therapy, Amifampridine: Agents With Seizure Threshold Lowering Potential may enhance the neuroexcitatory and/or seizure-potentiating effect of Amifampridine. Management: Consider avoidance of this combination. Lower initial doses may be required in patients with reduced theophylline clearance. There are 3 types of bronchodilators used to treat asthma. Children ≥6 years and Adolescents, weighing >45 kg or Adolescents ≥16 years: 12-hour extended-release tablets: Children ≥6 years and Adolescents, weighing >45 kg or Adolescents ≥16 years: Days 1 to 3: 300 mg/day in divided doses every 12 hours. • Pediatric: Select dose with caution and with frequent monitoring of concentrations (especially <1 year); rate of clearance is highly variable in these patients. They’re ordered for patients with a functioning GI tract who can’t ingest enough nutrition orally to meet their needs. COPD: Based on the Global Initiative for Chronic Obstructive Lung Disease Guidelines (2019), use of theophylline in patients with COPD is controversial and lacks data. COPD Foundation. Don't delay your care at Mayo Clinic. Consider lowering dose or using a slower titration if caffeine-like adverse events occur. Monitor therapy, Barbiturates: May decrease the serum concentration of Theophylline Derivatives. In Meyler's Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions (Fifteenth Edition), 2006. Theophylline Derivatives may decrease the serum concentration of CarBAMazepine. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. ER capsule and tablet should be swallowed. Consider therapy modification, Alcohol (Ethyl): May increase the serum concentration of Theophylline. Do not let anyone else take your medication. Other macrolides appear to have little to no effect. Children and Adolescents ≤15 years and ≤45 kg: Days 1 to 3: 12 to 14 mg/kg/day in divided doses every 4 to 6 hours; maximum daily dose: 300 mg/day. Use of low-dose oral theophylline as an adjunct to inhaled corticosteroids in preventing exacerbations of chronic obstructive pulmonary disease: study protocol for a randomised controlled trial. 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'S condition long-term control medication in the airways by relaxing muscles, opening breathing passages, and a solution liquid.