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Pronunciation
(thee OFF i lin)
Generic Available (U.S.)
Yes: Extended release tablet, infusion, solution
Index Terms
U.S. Brand Names
Canadian Brand Names
Pharmacologic Category
Use: Labeled Indications
Treatment of symptoms and reversible airway obstruction due to chronic asthma, or other chronic lung diseases; apnea of prematurity
Note: The Global Initiative for Asthma Guidelines (2009) and the National Heart, Lung and Blood Institute Guidelines (2007) do not recommend oral theophylline as a long-term control medication for asthma in children ≤5 years of age; use has been shown to be effective as an add-on (but not preferred) agent in older children and adults with severe asthma treated with inhaled or oral glucocorticoids. The guidelines do not recommend theophylline for the treatment of exacerbations of asthma.
The Global Initiative for Chronic Obstructive Lung Disease Guidelines (2009) suggest that while higher doses of slow release formulations of theophylline have been proven to be effective for use in COPD, it is not a preferred agent due to its potential for toxicity.
Pregnancy Risk Factor
C
Pregnancy Considerations
Teratogenic effects were observed in animal reproduction studies. Theophylline crosses the placenta; adverse effects may be seen in the newborn. Use is generally safe when used at the recommended doses (serum concentrations 5-12 mcg/mL) however maternal adverse events may be increased and efficacy may be decreased in pregnant women. Theophylline metabolism may change during pregnancy; the half-life is similar to that observed in otherwise healthy, nonsmoking adults with asthma during the first and second trimesters (~8.7 hours), but may increase to 13 hours (range: 8-18 hours) during the third trimester. The volume of distribution is also increased during the third trimester. Monitor serum levels. The recommendations for the use of theophylline in pregnant women with asthma are similar to those used in nonpregnant adults (National Heart, Lung, and Blood Institute Guidelines, 2004).
Lactation
Enters breast milk/compatible (AAP rates “compatible”; AAP 2001 update pending)
Breast-Feeding Considerations
The concentration of theophylline in breast milk is similar to the maternal serum concentration. Irritability may be observed in the nursing infant. Serious adverse events in the infant are unlikely unless toxic serum levels are present in the mother.
Contraindications
Hypersensitivity to theophylline or any component of the formulation; premixed injection may contain corn-derived dextrose and its use is contraindicated in patients with allergy to corn-related products
Warnings/Precautions
Concerns related to adverse effects:
• Theophylline toxicity: If a patient develops signs and symptoms of theophylline toxicity (eg, persistent, repetitive vomiting), a serum level should be measured and subsequent doses held. Theophylline clearance may be decreased in patients with acute pulmonary edema, congestive heart failure, cor pulmonale, fever, hepatic disease, acute hepatitis, cirrhosis, hypothyroidism, sepsis with multiorgan failure, and shock; clearance may also be decreased in neonates, infants <3 months of age with decreased renal function, children <1 year of age, the elderly >60 years of age, and patients following cessation of smoking. Note: Elderly >75 years of age have a 16-fold greater risk of death from theophylline overdose than do 25-year-olds due to reduced clearance in the elderly patient.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with tachyarrhythmias (eg, sinus tachycardia, atrial fibrillation) since use may exacerbate these arrhythmias.
• Hyperthyroidism: Use with caution in patients with hyperthyroidism; use may exacerbate this condition.
• Peptic ulcer disease: Use with caution in patient with peptic ulcer disease; use may exacerbate this condition.
• Seizure disorder: Use with caution in patients with a history of seizure disorder; use may exacerbate this condition.
Other warnings/precautions:
• Monitoring: Frequent continued monitoring of serum theophylline after therapeutic levels have been achieved may not be required as long as there is no apparent risk of decreased theophylline metabolism due to concurrent drug therapies or disease states. Monitoring serum theophylline concentrations at yearly intervals should be adequate in such cases.
Adverse Reactions
Frequency not defined. Adverse events observed at therapeutic serum levels:
Cardiovascular: Flutter, tachycardia
Central nervous system: Headache, hyperactivity (children), insomnia, restlessness, seizures
Endocrine & metabolic: Hypercalcemia (with concomitant hyperthyroid disease)
Gastrointestinal: Nausea, reflux or ulcer aggravation, vomiting
Genitourinary: Difficulty urinating (elderly males with prostatism)
Neuromuscular & skeletal: Tremor
Renal: Diuresis (transient)
Metabolism/Transport Effects
Substrate of CYP1A2 (major), 2C9 (minor), 2D6 (minor), 2E1 (major), 3A4 (major); Inhibits CYP1A2 (weak)
Drug Interactions
Abiraterone Acetate: May increase the serum concentration of CYP1A2 Substrates. Risk C: Monitor therapy
Adenosine: Theophylline Derivatives may diminish the therapeutic effect of Adenosine. Risk D: Consider therapy modification
Allopurinol: May increase the serum concentration of Theophylline Derivatives. Risk C: Monitor therapy
Aminoglutethimide: May increase the metabolism of Theophylline Derivatives. Risk C: Monitor therapy
Atomoxetine: May enhance the hypertensive effect of Sympathomimetics. Atomoxetine may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
Barbiturates: May decrease the serum concentration of Theophylline Derivatives. Risk C: Monitor therapy
Benzodiazepines: Theophylline Derivatives may diminish the therapeutic effect of Benzodiazepines. Risk D: Consider therapy modification
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. Risk C: Monitor therapy
Beta-Blockers (Nonselective): May diminish the bronchodilatory effect of Theophylline Derivatives. Risk D: Consider therapy modification
Cannabinoids: May enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy
CarBAMazepine: Theophylline Derivatives may decrease the serum concentration of CarBAMazepine. CarBAMazepine may decrease the serum concentration of Theophylline Derivatives. Risk C: Monitor therapy
Cimetidine: May decrease the metabolism of Theophylline Derivatives. Risk D: Consider therapy modification
Conivaptan: May increase the serum concentration of CYP3A4 Substrates. Management: Upon completion/discontinuation of conivaptan, allow at least 7 days before initiating therapy with drugs that are CYP3A4 substrates. Risk D: Consider therapy modification
Contraceptives (Estrogens): May increase the serum concentration of Theophylline Derivatives. Risk C: Monitor therapy
CYP1A2 Inducers (Strong): May increase the metabolism of CYP1A2 Substrates. Risk C: Monitor therapy
CYP1A2 Inhibitors (Moderate): May decrease the metabolism of CYP1A2 Substrates. Risk C: Monitor therapy
CYP1A2 Inhibitors (Strong): May decrease the metabolism of CYP1A2 Substrates. Risk D: Consider therapy modification
CYP3A4 Inducers (Strong): May increase the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
CYP3A4 Inhibitors (Moderate): May decrease the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
CYP3A4 Inhibitors (Strong): May decrease the metabolism of CYP3A4 Substrates. Risk D: Consider therapy modification
Dasatinib: May increase the serum concentration of CYP3A4 Substrates. Risk C: Monitor therapy
Deferasirox: May increase the serum concentration of Theophylline. Risk X: Avoid combination
Disulfiram: May increase the serum concentration of Theophylline Derivatives. Risk C: Monitor therapy
Febuxostat: May increase serum concentrations of the active metabolite(s) of Theophylline Derivatives. Specifically, concentrations of 1-methylxanthine, a metabolite of unknown clinical importance, may become elevated. Management: The U.S. febuxostat labeling recommends using caution in patients receiving concomitant theophylline due to risks of increased theophylline metabolite exposure. The Canadian febuxostat labeling contraindicates its use with theophylline. Risk C: Monitor therapy
FluvoxaMINE: May decrease the metabolism of Theophylline Derivatives. Risk D: Consider therapy modification
Formoterol: Theophylline Derivatives may enhance the adverse/toxic effect of Formoterol. Theophylline Derivatives may enhance the hypokalemic effect of Formoterol. Risk C: Monitor therapy
Fosphenytoin: Theophylline Derivatives may decrease the serum concentration of Fosphenytoin. Fosphenytoin may decrease the serum concentration of Theophylline Derivatives. Risk C: Monitor therapy
Herbs (CYP3A4 Inducers): May increase the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
Interferons: May decrease the metabolism of Theophylline Derivatives. Risk C: Monitor therapy
Iobenguane I 123: Sympathomimetics may diminish the therapeutic effect of Iobenguane I 123. Risk X: Avoid combination
Isoniazid: May increase the serum concentration of Theophylline Derivatives. Risk C: Monitor therapy
Isoproterenol: May decrease the serum concentration of Theophylline Derivatives. Risk C: Monitor therapy
Lithium: Theophylline Derivatives may decrease the serum concentration of Lithium. Risk C: Monitor therapy
Macrolide Antibiotics: May decrease the metabolism of Theophylline Derivatives. Exceptions: Azithromycin; Azithromycin (Systemic); Spiramycin; Telithromycin. Risk D: Consider therapy modification
Methotrexate: May increase the serum concentration of Theophylline Derivatives. Risk C: Monitor therapy
Mexiletine: May decrease the metabolism of Theophylline Derivatives. Risk D: Consider therapy modification
Pancuronium: Theophylline Derivatives may enhance the adverse/toxic effect of Pancuronium. Theophylline Derivatives may diminish the neuromuscular-blocking effect of Pancuronium. Management: Pancuronium dosage adjustment may be necessary to induce paralysis in patients receiving concomitant theophylline derivatives. Monitor closely for adverse effects (e.g., cardiac effects) with concomitant use of these agents. Risk D: Consider therapy modification
Pentoxifylline: May increase the serum concentration of Theophylline Derivatives. Risk C: Monitor therapy
Phenytoin: Theophylline Derivatives may decrease the serum concentration of Phenytoin. Phenytoin may decrease the serum concentration of Theophylline Derivatives. Risk C: Monitor therapy
Propafenone: May increase the serum concentration of Theophylline Derivatives. Risk C: Monitor therapy
Protease Inhibitors: May decrease the serum concentration of Theophylline Derivatives. Exceptions: Fosamprenavir. Risk C: Monitor therapy
QuiNINE: May increase the serum concentration of Theophylline Derivatives. Risk C: Monitor therapy
Quinolone Antibiotics: May decrease the metabolism of Theophylline Derivatives. Ciprofloxacin and enoxacin are of greatest concern. Theophylline/quinolone therapy might augment the seizure-producing potential of each of the individual agents. Exceptions: Gemifloxacin; Levofloxacin; Levofloxacin (Systemic); Lomefloxacin; Moxifloxacin; Moxifloxacin (Systemic); Nalidixic Acid; Sparfloxacin. Risk D: Consider therapy modification
Regadenoson: Theophylline may diminish the vasodilatory effect of Regadenoson. Risk D: Consider therapy modification
Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Risk C: Monitor therapy
Thiabendazole: May decrease the metabolism of Theophylline Derivatives. Risk D: Consider therapy modification
Thyroid Products: May increase the metabolism of Theophylline Derivatives. Risk C: Monitor therapy
Ticlopidine: May decrease the metabolism of Theophylline Derivatives. Risk C: Monitor therapy
Tocilizumab: May decrease the serum concentration of CYP3A4 Substrates. Risk C: Monitor therapy
Zafirlukast: Theophylline Derivatives may decrease the serum concentration of Zafirlukast. Zafirlukast may increase the serum concentration of Theophylline Derivatives. Risk C: Monitor therapy
Zileuton: May increase the serum concentration of Theophylline. Risk D: Consider therapy modification
Ethanol/Nutrition/Herb Interactions
Food: Food does not appreciably affect the absorption of liquid, fast-release products, and most sustained release products; however, food may induce a sudden release (dose-dumping) of once-daily sustained release products resulting in an increase in serum drug levels and potential toxicity. Avoid excessive amounts of caffeine. Avoid extremes of dietary protein and carbohydrate intake. Changes in diet may affect the elimination of theophylline; charbroiled foods may increase elimination, reducing half-life by 50%.
Storage
Tablet, premixed infusion, solution: Store at controlled room temperature of 25°C (77°F).
Compatibility
Stable in D5W.
Y-site administration: Compatible: Acyclovir, ampicillin, ampicillin/sulbactam, aztreonam, bivalirudin, cefazolin, cefotetan, ceftriaxone, cimetidine, cisatracurium, clindamycin, clonidine, dexamethasone sodium phosphate, dexmedetomidine, diltiazem, dobutamine, dopamine, doxycycline, erythromycin lactobionate, famotidine, fenoldopam, fluconazole, gentamicin, haloperidol, heparin, hydrocortisone sodium succinate, hetastarch in lactated electrolyte injection, lidocaine, linezolid, methyldopate, methylprednisolone sodium succinate, metronidazole, micafungin, midazolam, milrinone, nafcillin, nitroglycerin, oxaliplatin, penicillin G potassium, piperacillin, potassium chloride, ranitidine, remifentanil, sodium nitroprusside, ticarcillin, ticarcillin/clavulanate potassium, tigecycline, tobramycin, vancomycin. Incompatible: Cefepime, hetastarch in NS, phenytoin.
Compatibility when admixed: Compatible: Cefepime, chlorpromazine, fluconazole, furosemide, hydrocortisone hemisuccinate, lidocaine, methylprednisolone sodium succinate, papaverine, verapamil. Incompatible: Ascorbic acid injection, ceftriaxone.
Mechanism of Action
Causes bronchodilatation, diuresis, CNS and cardiac stimulation, and gastric acid secretion by blocking phosphodiesterase which increases tissue concentrations of cyclic adenine monophosphate (cAMP) which in turn promotes catecholamine stimulation of lipolysis, glycogenolysis, and gluconeogenesis and induces release of epinephrine from adrenal medulla cells
Pharmacodynamics/Kinetics
Absorption: Oral: Dosage form dependent
Distribution: 0.45 L/kg (range: 0.3-0.7 L/kg) based on ideal body weight; distributes poorly into body fat; Vd may increase in premature neonates, patients with hepatic cirrhosis, acidemia (uncorrected), the elderly
Metabolism: Children >1 year and Adults: Hepatic; involves CYP1A2, 2E1 and 3A4; forms active metabolites (caffeine and 3-methylxanthine)
Protein binding: 40%, primarily to albumin
Half-life elimination: Highly variable and dependent upon age, liver function, cardiac function, lung disease, and smoking history
Premature infants, postnatal age 3-15 days: 30 hours (range: 17-43 hours)
Premature infants, postnatal age 25-57 days: 20 hours (range: 9.4-30.6 hours)
Children 6-17 years: 3.7 hours (range: 1.5-5.9 hours)
Adults 16-60 years with asthma, nonsmoking, otherwise healthy: 8.7 hours (range: 6.1-12.8 hours)
Time to peak, serum:
Oral: Liquid: 1 hour
I.V.: Within 30 minutes
Excretion: Urine
Neonates: 50% as unchanged theophylline
Children >3 months and Adults: ~10% as unchanged theophylline
Dosage
Doses should be individualized based on steady-state serum concentrations and ideal body weight.
Acute symptoms: Loading dose:
Children and Adults: Oral, I.V.:
Asthma exacerbations: While theophylline may be considered for relief of asthma symptoms, the role of treating exacerbations is not supported by current practice.
COPD treatment: Theophylline is currently considered second-line intravenous therapy in the emergency department or hospital setting when there is inadequate or insufficient response to short acting bronchodilators (Global Initiative for COPD Guidelines, 2009).
If no theophylline received within the previous 24 hours: 4.6 mg/kg loading dose (~5.8 mg/kg hydrous aminophylline) I.V. or 5 mg/kg orally. Loading dose 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). Note: On the average, for every 1 mg/kg theophylline given, blood levels will rise 2 mcg/mL.
If theophylline has been administered in the previous 24 hours: A loading dose is not recommended without obtaining a serum theophylline concentration. The loading dose should be calculated as follows:
Dose = (desired serum theophylline concentration - measured serum theophylline concentration) (Vd)
Acute symptoms: Maintenance dose:
Children and Adults: I.V.: Note: To achieve a target concentration of 10 mcg/mL unless otherwise noted. Lower initial doses may be required in patients with reduced theophylline clearance. Dosage should be adjusted according to serum level measurements during the first 12- to 24-hour period.
Neonates ≤24 days: 1 mg/kg every 12 hours to achieve a target concentration of 7.5 mcg/mL for apnea of prematurity
Neonates >24 days: 1.5 mg/kg every 12 hours to achieve a target concentration of 7.5 mcg/mL for apnea of prematurity
Infants 6-52 weeks: mg/kg/hour = (0.008) (age in weeks) + 0.21
Children 1-9 years: 0.8 mg/kg/hour
Children 9-12 years: 0.7 mg/kg/hour
Adolescents 12-16 years (cigarette or marijuana smokers): 0.7 mg/kg/hour
Adolescents 12-16 years (nonsmokers): 0.5 mg/kg/hour; maximum 900 mg/day unless serum levels indicate need for larger dose
Adults 16-60 years (otherwise healthy, nonsmokers): 0.4 mg/kg/hour; maximum 900 mg/day unless serum levels indicate need for larger dose
Adults >60 years: 0.3 mg/kg/hour; maximum 400 mg/day unless serum levels indicate need for larger dose
Treatment of chronic conditions:
With newer guidelines suggesting lower therapeutic theophylline ranges, it is unlikely that doses larger than >10 mg/kg/day will be required in children ≥1 year or adults.
Oral solution:
Infants <1 year: 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.
Premature Neonates <24 days postnatal age: 1 mg/kg/dose every 12 hours
Premature Neonates ≥24 days postnatal age: 1.5 mg/kg/dose every 12 hours
Full-term Infants and Infants <26 weeks: Total daily dose (mg)= [(0.2 x age in weeks) +5] x (weight in kg); divide dose into 3 equal amounts and administer at 8-hour intervals
Full-term Infants and Infants ≥26 weeks and <52 weeks: Total daily dose (mg) = [(0.2 x age in weeks) +5] x (weight in kg); divide dose into 4 equal amounts and administer at 6-hour intervals
Children ≥1 year and <45 kg: Initial dose: 10-14 mg/kg/day (maximum 300 mg/day) administered in divided doses every 4-6 hours; Maintenance: Up to 20 mg/kg/day (maximum: 600 mg/day)
Children >45 kg and Adults: Initial dose: 300 mg/day administered in divided doses every 6-8 hours; Maintenance: 400-600 mg/day (maximum: 600 mg/day)
Oral extended release formulations:
Children ≥1 year and <45 kg: Initial: 10-14 mg/kg once daily (maximum 300 mg/day); Maintenance up to 20 mg/kg/day (maximum: 600 mg/day)
Children >45 kg and Adults: Initial dose: 300-400 mg once daily; Maintenance: 400-600 mg once daily (maximum: 600 mg/day)
Dosage adjustment after serum theophylline measurement: Asthma: Within normal limits: Children: 5-10 mcg/mL; Adults: 5-15 mcg/mL: Maintain dosage if tolerated. Recheck serum theophylline concentration at 24-hour intervals (for acute I.V. dosing) or at 6- to 12-month intervals (for oral dosing). Finer adjustments in dosage may be needed for some patients. If levels ≥15 mcg/mL, consider 10% dose reduction to improve safety margin.
Note: Recheck serum theophylline levels after 3 days when using oral dosing, or after 12 hours (children) or 24 hours (adults) when dosing intravenously. Patients maintained with oral therapy may be reassessed at 6- to 12-month intervals.
Administration: Oral
Long-acting preparations should be taken with a full glass of water, swallowed whole, or cut in half if scored. Do not crush. Extended release capsule forms may be opened and the contents sprinkled on soft foods; do not chew beads.
Administration: I.V.
Administer loading dose over 30 minutes; follow with a continuous infusion as appropriate.
Administration: I.V. Detail
pH: 4.3
Monitoring Parameters
Monitor 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)
Theophylline levels: Serum theophylline levels should be monitored prior to making dose increases; in the presence of signs or symptoms of toxicity; or when a new illness, worsening of a present illness, or medication changes occur that may change theophylline clearance
I.V. loading dose: Measure serum concentrations 30 minutes after the end of an I.V. loading dose
I.V. infusion: Measure serum concentrations one half-life after starting a continuous infusion, then every 12-24 hours
Reference Range
Therapeutic levels: Asthma:
Children: 5-10 mcg/mL
Adults: 5-15 mcg/mL
Test Interactions
Plasma glucose, uric acid, free fatty acids, total cholesterol, HDL, HDL/LDL ratio, and urinary free cortisol excretion may be increased by theophylline. Theophylline may decrease triiodothyronine.
Dietary Considerations
Should be taken with water 1 hour before or 2 hours after meals. Premixed injection may contain corn-derived dextrose and its use is contraindicated in patients with allergy to corn-related products.
Patient Education
Preferable to take on empty stomach, 1 hour before or 2 hours after meals, with a full glass of water. Do not chew of crush sustained release forms; capsules may be opened and contents sprinkled on soft food (do not chew beads). Avoid dietary stimulants (eg, caffeine, tea, colas, or chocolate). You may experience nausea, vomiting, or loss of appetite. Report acute insomnia or restlessness, chest pain or rapid heartbeat, emotional lability or agitation, muscle tremors or cramping, acute headache, persistent and repetitive vomiting, abdominal pain and cramping, blackened stool, or worsening of respiratory condition.
Geriatric Considerations
Although there is a great intersubject variability for half-lives of methylxanthines (2-10 hours), elderly as a group have slower hepatic clearance. Therefore, use lower initial doses and monitor closely for response and adverse reactions. Additionally, elderly are at greater risk for toxicity due to concomitant disease (eg, CHF, arrhythmias), and drug use (eg, cimetidine, ciprofloxacin).
Cardiovascular Considerations
Theophylline results in significant tachycardia and, at higher doses, may impair ventricular rate control in patients with atrial fibrillation. This is particularly a concern since patients with underlying chronic obstructive lung disease often have coexisting atrial fibrillation. A theophylline derivative can be used to treat patients who have adverse hemodynamic responses to adenosine or dipyridamole during cardiovascular stress testing. Theophylline has been used for neurocardiogenic (vasovagal) syncope.
Dental Health: Effects on Dental Treatment
Prescribe erythromycin products with caution to patients taking theophylline products. Erythromycin will delay the normal metabolic inactivation of theophyllines leading to increased blood levels; this has resulted in nausea, vomiting, and CNS restlessness. Azithromycin does not cause these effects in combination with theophylline products.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
May cause nervousness and restlessness; may rarely cause insomnia and irritability
Mental Health: Effects on Psychiatric Treatment
Barbiturates and carbamazepine may decrease serum levels while disulfiram, propranolol, and fluvoxamine may increase theophylline levels
Nursing: Physical Assessment/Monitoring
Monitor effectiveness of therapy (respiratory rate, lung sounds, characteristics of cough and sputum). For inpatient care, monitor vital signs prior to and periodically during therapy.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Capsule, extended release, oral:
Theo-24®: 100 mg, 200 mg, 300 mg, 400 mg [24 hours]
Infusion, premixed in D5W: 200 mg (100 mL [DSC]); 400 mg (250 mL [DSC], 500 mL); 800 mg (250 mL [DSC], 500 mL, 1000 mL)
Solution, oral: 80 mg/15 mL (15 mL)
Elixophyllin® Elixir: 80 mg/15 mL (473 mL) [contains ethanol 20%; mixed fruit flavor]
Tablet, extended release, oral: 100 mg, 200 mg, 300 mg, 400 mg, 450 mg, 600 mg
Theochron™: 100 mg, 200 mg, 300 mg, 450 mg [scored; 12-24 hours]
Pricing: U.S. (www.drugstore.com)
Capsule, 24-hour (Theo-24)
100 mg (60): $60.99
200 mg (60): $85.99
300 mg (60): $99.99
400 mg (60): $135.98
Elixir (Elixophyllin)
80 mg/15 mL (480): $91.99
Tablet, 12-hour (Theophylline CR)
100 mg (60): $17.99
200 mg (60): $21.99
200 mg (60): $22.99
300 mg (60): $25.99
450 mg (60): $47.24
Tablet, 24-hour (Theophylline)
400 mg (100): $118.99
Tablet, 24-hour (Uniphyl)
400 mg (60): $86.65
600 mg (60): $122.84
Extemporaneously Prepared
Note: An alcohol-containing commercial oral solution is available (80 mg/15mL).
A 5 mg/mL oral suspension may be made with tablets. Crush one 300 mg extended release tablet in a mortar and reduce to a fine powder. 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. Label "shake well". Stable for 90 days at room temperature.
Johnson CE, VanDeKoppel S, and Myers E, "Stability of Anhydrous Theophylline in Extemporaneously Prepared Alcohol-Free Oral Suspensions," Am J Health-Syst Pharm, 2005, 62(23):2518-20.
References
“American Academy of Pediatrics Committee on Drugs. The Transfer of Drugs and Other Chemicals Into Human Milk,” Pediatrics, 2001, 108(3):776-89.
Expert Panel Report 3, “Guidelines for the Diagnosis and Management of Asthma,” Clinical Practice Guidelines, National Institutes of Health, National Heart, Lung, and Blood Institute, NIH Publication No. 08-4051, prepublication 2007. Available at http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm
Global Initiative for Asthma, Global Strategy for Asthma Management and Prevention, 2009. Available at http://www.ginasthma.com/GuidelinesResources.asp
Global Initiative for Chronic Obstructive Lung Disease, Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease. Available at http://www.goldcopd.com
National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program Asthma and Pregnancy Working Group, “NAEPP Expert Panel Report. Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment - 2004 Update,” J Allergy Clin Immunol, 2005, 115(1):34-46.
International Brand Names
Lexi-Comp.com
Last full review/revision May 2011
Content last modified May 2011
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