Demographic and Clinical Characteristics of Theophylline Exposures between 1993 and 2011

Abstract

Theophylline, a member of the xanthine family, has been used in the treatment of asthma, chronic obstructive pulmonary disease and apnoea (1, 2). Because of the narrow therapeutic index of theophylline, therapeutic drug monitoring is indicated for safe and effective treatment (3). Clinical manifestations of theophylline toxicity include nausea, vomiting, hypokalaemia, hyperglycaemia, metabolic acidosis, tachycardia, cardiac arrhythmias, and seizures (3, 4). Although its clinical use has decreased remarkably because safer and more effective drugs have been introduced, theophylline use continues to result in potentially life-threatening toxicity (1, 4).The aim of this study was to investigate aetiological, demographic and clinical characteristics of the patients with theophylline exposure reported to the Dokuz Eylül University Drug and Poison Information Center (DPIC), in Turkey, in a 19-year period. There is no comprehensive descriptive research study available concerning theophylline toxicity in Turkey. The results of our study may therefore improve cliniBackground: Acute and chronic exposure to theophylline can cause serious signs and symptoms of poisoning. Additionally, with a narrow therapeutic range, toxicity could be observed even with therapeutic doses of theophylline. Epidemiological data on theophylline exposures in our country are extremely limited. The results of our study may improve the clinical management of theophylline poisoning in our country and elsewhere. Aims: To present aetiological and demographic features, clinical findings and treatment attempts with regard to theophylline exposures reported to Dokuz Eylül University Drug and Poison Information Center (DPIC), between 1993 and 2011. Study Design: Descriptive study. Methods: The data regarding demographics, date, time, type of exposure, route of and reason for exposure, signs and symptoms upon admission, clinical management and outcome were retrospectively evaluated. Results:The DPIC recorded 88,562 poisoning calls between 1993 and 2011; 354 (0.4%) of them were due to theophylline exposure. The mean age of all cases was 24.1±15.4 (range between 1 month and 90 years). Females dominated all age groups (72.6%, 257 females). Intentional exposure was significantly higher in women than in men (88.2% vs. 68.2% for all age groups; p<0.001 for children; p<0.001 for adults; p<0.001 for all age groups). While 60.5% of the cases had no symptoms, severe signs of toxicity were present in 1.9% of theophylline exposure cases during the telephone inquiry. Signs and symptoms were found to be significantly more prevalent in adults than in children (p<0.01). The serum theophylline level was regarded as toxic in 74% (65 toxic levels) of theophylline measured cases. Clinical signs and symptoms were found to be significantly prevalent in cases with toxic theophylline levels (p<0.001). The rate of gastrointestinal decontamination procedures was higher than that of recommended gastrointestinal decontamination procedures by DPIC (83% and 66%, respectively). There wer...

Exposure to potential drug-antimicrobial agent interactions in primary health care

“…Finally, there was no pharmacokinetic interaction between orally administered levofloxacin and intravenously administered theophylline , 30 . When theophylline toxicity was studied in a 19-year period concomitant drug and/or substance exposure was positive in 87.8% of patients admitted to the Department of Emergency Medicine, and antimicrobials were among commonly coadministered medicines 31 . The choice of therapeutic alternative without or with a limited potential for interaction with theophylline as well as monitoring its plasma concentration and clinical response can prevent adverse effects.…”