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Theophylline Pregnancy and Breastfeeding Warnings

Theophylline is also known as: Aerolate III, Aerolate JR, Aerolate SR, Bronkodyl, Elixophyllin, Quibron-T/SR, Respbid, Slo-Bid Gyrocaps, Slo-Phyllin, Slo-Phyllin 125, T-Phyl, Theo-24, Theo-Dur, Theo-Time, Theo-X, Theobid, Theochron, Theoclear LA-130, Theoclear LA-260, Theolair, Theolair-SR, Theovent, Truxophyllin, Uni-Dur, Uniphyl

Theophylline Pregnancy Warnings

The Collaborative Perinatal Project monitored 193 women with first trimester exposure to theophylline or aminophylline and found no increased risk of malformations. Cord serum concentrations and infant serum concentrations have been reported to approximate the mother's serum concentrations immediately following birth. In 12 mothers receiving theophylline, at the time of delivery, maternal serum, cord serum, and infant serum theophylline concentrations averaged 10 mcg/mL. Cases of jitteriness, irritability, and vomiting have been reported in infants of mothers maintained on theophylline prior to delivery. Apnea has been reported in an infant born after 37.5 weeks gestation to a mother who had been maintained on theophylline throughout pregnancy for asthma. At approximately 48 hours after birth, the infants serum theophylline level was 15 mcg/mL. The infant was placed on theophylline when the concentration measured 2 mcg/mL. Apnea resolved when the theophylline concentration reached 17 mcg/mL. The pharmacokinetics of theophylline have been studied in women during pregnancy. Studies throughout pregnancy have noted a significant decrease in the clearance of theophylline during the third trimester. The clearance was only slightly decreased during the first and second trimester. The plasma protein binding of theophylline also has been shown to decrease in the later stages of pregnancy. It is important to closely monitor the theophylline serum concentration and the patient for signs of toxicity during pregnancy. One study has shown an increase in fetal breathing movements when theophylline was ingested by pregnant women at 33 to 38 weeks gestation. Since fetal breathing movements are routinely used to assess fetal status in late gestation, maternal theophylline intake should be taken into account.

Theophylline has been assigned to pregnancy category C by the FDA. Animal studies have revealed evidence of embryolethality and teratogenicity. There are no controlled data in human pregnancy. Theophylline is only recommended for use during pregnancy when there are no alternatives and benefit outweighs risk.

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Theophylline Breastfeeding Warnings

Theophylline is excreted into human milk and may cause irritability or other signs of mild toxicity. The concentration of theophylline in breast milk is approximately equivalent to the maternal serum concentration. The manufacturer states that serious adverse effects in the infant are unlikely unless the mother has toxic serum theophylline concentrations. The American Academy of Pediatrics considers theophylline to be compatible with breast-feeding.

In a study of five women given aminophylline, theophylline was detected in milk with a milk:serum ratio of 0.61 to 0.87. The peak milk concentration occurred between one and three hours after ingestion of the dose. Irritability was reported in one infant whose mother took aminophylline. Adverse effects were not reported in the infants of the other women participating in this study. Exposure to the infant can be minimized by administering nursing prior to administration of theophylline to avoid peak milk concentrations.

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References for pregnancy information

  1. Hernandez E, Angell CS, Johnson JW "Asthma in pregnancy: current concepts." Obstet Gynecol 55 (1980): 739-43
  2. Gardner MJ, Schatz M, Cousins L, Zeiger R, Middleton E, Jusko WJ "Longitudinal effects of pregnancy on the pharmacokinetics of theophylline." Eur J Clin Pharmacol 32 (1987): 289-95
  3. Dombrowski MP "Pharmacologic therapy of asthma during pregnancy." Obstet Gynecol Clin North Am 24 (1997): 559
  4. Ishikawa M, Yoneyama Y, Power GG, Araki T "Maternal theophylline administration and breathing movements in late-gestation human fetuses." Obstet Gynecol 88 (1996): 973-8
  5. Pratt WR "Allergic diseases in pregnancy and breast feeding." Ann Allergy 47 (1981): 355-60
  6. Frederiksen MC, Ruo TI, Chow MJ, Atkinson AJ, Jr "Theophylline pharmacokinetics in pregnancy." Clin Pharmacol Ther 40 (1986): 321-8
  7. Stenius-aarniala B, Riikonen S, Teramo K "Slow-release theophylline in pregnant asthmatics." Chest 109 (1996): 1668
  8. Schatz M, Zeiger RS, Harden K, Hoffman CC, Chilingar L, Petitti D "The safety of asthma and allergy medications during pregnancy." J Allergy Clin Immunol 100 (1997): 301-6
  9. Weinstein AM, Dubin BD, Podleski WK, Spector SL, Farr RS "Asthma and pregnancy." JAMA 241 (1979): 1161-5
  10. Yeh TF, Pildes RS "Transplacental aminophylline toxicity in a neonate." Lancet 1 (1977): 910
  11. Stenius-Aarniala B, Riikonen S, Teramo K "Slow-release theophylline in pregnant asthmatics." Chest 107 (1995): 42-7
  12. Heinonen O, Slone D, Shapiro S; Kaufman DW ed. "Birth Defects and Drugs in Pregnancy." Littleton, MA: Publishing Sciences Group, Inc. (1977): 297
  13. Carter BL, Driscoll CE, Smith GD "Theophylline clearance during pregnancy." Obstet Gynecol 68 (1986): 555-9
  14. Steniusaarniala B, Riikonen S, Teramo K "Slow-release theophylline in pregnant asthmatics." Chest 107 (1995): 642-7
  15. Turner ES, Greenberger PA, Patterson R "Management of the pregnant asthmatic patient." Ann Intern Med 6 (1980): 905-10
  16. Labovitz E, Spector S "Placental theophylline transfer in pregnant asthmatics." JAMA 247 (1982): 786-8
  17. Mcdonald CF, Burdon JGW "Asthma in pregnancy and lactation - a position paper for the thoracic society of australia and new zealand." Med J Aust 165 (1996): 485-8
  18. Horowitz DA, Jablonski W, Mehta KA "Apnea associated with theophylline withdrawal in a term neonate." Am J Dis Child 136 (1982): 73-4
  19. Arwood LL, Dasta JF, Friedman C "Placental transfer of theophylline: two case reports." Pediatrics 63 (1979): 844-6
  20. "Product Information. Theo-Dur (theophylline)." Schering Laboratories, Kenilworth, NJ.

References for breastfeeding information

  1. Yurchak AM, Jusko WJ "Theophylline secretion into breast milk." Pediatrics 57 (1976): 518-20
  2. Pratt WR "Allergic diseases in pregnancy and breast feeding." Ann Allergy 47 (1981): 355-60
  3. "Product Information. Theo-Dur (theophylline)." Schering Laboratories, Kenilworth, NJ.
  4. Stec GP, Greenberger P, Ruo TI, et al "Kinetics of theophylline transfer to breast milk." Clin Pharmacol Ther 28 (1980): 404-8
  5. Mcdonald CF, Burdon JGW "Asthma in pregnancy and lactation - a position paper for the thoracic society of australia and new zealand." Med J Aust 165 (1996): 485-8
  6. Bailey DN "Lidocaine, quinidine, and theophylline binding to human milk." Ann Clin Lab Sci 28 (1998): 289-92
  7. Committee on Drugs, 1992 to 1993 "The transfer of drugs and other chemicals into human milk." Pediatrics 93 (1994): 137-50

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