Home Drug Guide Theophylline

Drug Guide

Generic Name

Theophylline

Brand Names Dicurin Procaine

Classification

Therapeutic: Bronchodilator, Methylxanthine

Pharmacological: Adenosine receptor antagonist, Phosphodiesterase inhibitor

FDA Approved Indications

  • Asthma
  • Chronic obstructive pulmonary disease (COPD)

Mechanism of Action

Theophylline relaxes airway smooth muscle by inhibiting phosphodiesterase enzymes, leading to increased cAMP levels, resulting in bronchodilation and anti-inflammatory effects.

Dosage and Administration

Adult: Initial dose: 400-600 mg per day, divided into multiple doses; titrate based on response and serum levels.

Pediatric: Dose based on weight or body surface area, typically 6-12 mg/kg/day in divided doses.

Geriatric: Start at lower doses due to decreased clearance; monitor serum levels closely.

Renal Impairment: Reduce dosage; monitor serum levels.

Hepatic Impairment: Use with caution; reduced metabolism may increase levels.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed, including across the placenta.

Metabolism: Hepatic metabolism via demethylation and conjugation.

Excretion: Renally excreted, primarily as metabolites.

Half Life: Typically 8-10 hours in adults; longer in elderly and those with hepatic or renal impairment.

Contraindications

  • History of hypersensitivity to theophylline or methylxanthines.
  • Peptic ulcer disease.

Precautions

  • Cardiac arrhythmias, epilepsy, hepatic or renal impairment, congestive heart failure, pregnancy, lactation.

Adverse Reactions - Common

  • Nausea, vomiting (Common)
  • Insomnia, nervousness (Common)
  • Gastrointestinal upset (Common)

Adverse Reactions - Serious

  • Arrhythmias (Rare)
  • Seizures (Rare)

Drug-Drug Interactions

  • Increased toxic levels with cimetidine, erythromycin, fluoroquinolones.
  • Decreased effectiveness with barbiturates, phenytoin.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor respiratory status, serum theophylline levels, heart rate, and rhythm.

Diagnoses:

  • Ineffective airway clearance
  • Risk for toxicity.

Implementation: Administer with food if GI upset occurs; monitor serum levels regularly to keep within therapeutic range (10-20 mcg/mL).

Evaluation: Assess for relief of symptoms, monitor for adverse effects.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Avoid caffeine and other methylxanthines.
  • Report signs of toxicity: nausea, vomiting, insomnia, palpitations, seizures.

Special Considerations

Black Box Warnings:

  • Potential for severe cardiovascular and cerebrovascular events in certain populations.

Genetic Factors: Metabolism influenced by CYP1A2 polymorphisms.

Lab Test Interference: May cause interference with certain lab tests, including those measuring serum drug levels.

Overdose Management

Signs/Symptoms: Seizures, severe nausea, vomiting, tachycardia, hypotension, arrhythmias.

Treatment: Activated charcoal, gastric lavage, anticonvulsants for seizures, supportive care, magnesium sulfate in severe arrhythmias.

Storage and Handling

Storage: Store at room temperature away from light and moisture.

Stability: Stable under recommended conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.