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Theophylline Poisoning

Theophylline Poisoning is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Theophylline causes:
    • Release of endogenous catecholamines resulting in stimulation of β1- and β2-receptors
    • Adenosine antagonism
    • Inhibition of phosphodiesterase (at supratherapeutic levels)
  • Available in immediate- and sustained-release formulations
  • Peak absorption is 60–90 min with immediate-release and 6–10 hr with sustained-release formulations
  • Acute overdose:
    • Ingestion within an 8-hr interval in a patient with no prior theophylline use
  • Acute-on-chronic overdose:
    • Single excessive dose in a patient previously receiving usual therapeutic doses for ≥24 hr
  • Chronic intoxication:
    • Accumulation of theophylline >20 μg/mL associated with prior therapeutic use for ≥24 hr secondary to:
      • Drug–drug, drug–diet, or drug–disease interactions
    • Use of serial excessive doses

Etiology

  • Acute ingestions require larger concentrations to achieve specific toxic effects compared with acute-on-chronic or chronic overdoses.
  • Drug–drug interactions:
    • Inhibiting theophylline metabolism (leads to toxicity when started):
      • H2-receptor antagonists
      • Macrolide antibiotics
      • Fluoroquinolones
      • Allopurinol
      • Influenza vaccine
      • Interferons
    • Enhances theophylline metabolism (leads to toxicity when discontinued):
      • Carbamazepine
      • Barbiturates
      • Smoking
      • Rifampin
  • Chronic theophylline accumulation:
    • Uncontrolled CHF
    • Liver disease (cirrhosis or severe hepatitis)
    • Acute viral infections

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Citation

Rosen, Peter, et al., editors. "Theophylline Poisoning." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307520/all/Theophylline_Poisoning.
Theophylline Poisoning. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307520/all/Theophylline_Poisoning. Accessed April 22, 2019.
Theophylline Poisoning. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307520/all/Theophylline_Poisoning
Theophylline Poisoning [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 22]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307520/all/Theophylline_Poisoning.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Theophylline Poisoning ID - 307520 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307520/all/Theophylline_Poisoning PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -