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Theophylline Disease Interactions

There are 7 disease interactions with theophylline.

Major

Methylxanthines (applies to theophylline) PUD

Major Potential Hazard, High plausibility. Applicable conditions: Peptic Ulcer

Methylxanthines are known to stimulate peptic acid secretion. Therapy with products containing methylxanthines should be administered with extreme caution in patients with active peptic ulcer disease. Some manufacturers consider their use to be contraindicated under such circumstance.

References

  1. Stoller JL "Oesophageal ulceration and theophylline." Lancet 2 (1985): 328-9
  2. "Product Information. Theo-Dur (theophylline)." Schering Corporation (2001):
  3. Alterman P, Spiegel D, Feldman J, Yaretzky A "Histamine h2-receptor antagonists and chronic theophylline toxicity." Am Fam Physician 54 (1996): 1473
  4. "Product Information. Lufyllin (dyphylline)." Wallace Laboratories (2001):
View all 4 references
Major

Methylxanthines (applies to theophylline) renal dysfunction

Major Potential Hazard, Moderate plausibility.

The metabolites of theophylline, which are generally undetectable in patients with normal renal function, may accumulate in patients with renal impairment and contribute to the toxicity of theophylline. In addition, the plasma protein binding of theophylline may be significantly decreased in renal impairment, resulting in elevated free drug concentrations and further increasing the risk of toxicity. Therapy with theophyllines should be administered cautiously in patients with impaired renal function. Dosage adjustments and more intensive monitoring of serum theophylline concentrations may be required.

References

  1. Reidenberg MM, Restivo K "The binding of theophylline to serum proteins of hemodialysis patients." J Dial 3 (1979): 375-81
  2. Bauer LA, Bauer SP, Blouin RA "The effect of acute and chronic renal failure on theophylline clearance." J Clin Pharmacol 22 (1982): 65-8
  3. Shaw LM, Fields L, Mayock R "Factors influencing theophylline serum protein binding." Clin Pharmacol Ther 32 (1982): 490-6
  4. Leakey TE, Elias-Jones AC, Coates PE, Smith KJ "Pharmacokinetics of theophylline and its metabolites during acute renal failure: a case report." Clin Pharmacokinet 21 (1991): 400-8
  5. Nicot G, Charmes JP, Lachatre G, et al. "Theophylline toxicity risks and chronic renal failure." Int J Clin Pharmacol Ther Toxicol 27 (1989): 398-401
  6. Vanholder R, Van Landschoot N, De Smet R, Schoots A, Ringoir S "Drug protein binding in chronic renal failure: evaluation of nine drugs." Kidney Int 33 (1988): 996-1004
  7. Leopold D, Webb D, Buss DC, Fifield RA, Smith AP, Routledge PA "The ex vivo plasma protein binding of theophylline in renal disease." Br J Clin Pharmacol 19 (1985): 823-5
  8. Kraan J, Jonkman JH, Koeter GH, et al. "The pharmacokinetics of theophylline and enprofylline in patients with liver cirrhosis and in patients with chronic renal disease." Eur J Clin Pharmacol 35 (1988): 357-62
View all 8 references
Major

Methylxanthines (applies to theophylline) seizure disorders

Major Potential Hazard, High plausibility. Applicable conditions: Seizures, Head Injury, Cerebral Vascular Disorder

The use of theophyllines is considered by some manufacturers to be contraindicated in patients with underlying seizure disorders unless they are receiving adequate anticonvulsant therapy. Theophyllines may cause seizures, which have generally been associated with toxic drug levels but have also been reported at therapeutic concentrations in patients with head trauma or cerebral infarct. If theophylline therapy is administered in patients with these or other risk factors for seizures, serum drug levels should be monitored closely and maintained in the low therapeutic range. Intractable seizures and death have been reported during acute theophylline toxicity.

References

  1. Hendeles L, Weinberger M, Johnson G "Monitoring serum theophylline levels." Clin Pharmacokinet 3 (1978): 294-312
  2. Sessler CN "Theophylline toxicity: clinical features of 116 consecutive cases." Am J Med 88 (1990): 567-76
  3. Schiff GD, Hegde HK, LaCloche L, Hryhorczuk DO "Inpatient theophylline toxicity: preventable factors." Ann Intern Med 114 (1991): 748-53
  4. Nakada T, Kwee IL, Lerner AM, Remler MP "Theophylline-induced seizures: clinical and pathophysiologic aspects." West J Med 138 (1983): 371-4
  5. Aderka D, Shavit G, Garfinkel D, et al. "Life-threatening theophylline intoxication in a hypothyroid patient." Respiration 44 (1983): 77-80
  6. Covelli HD, Knodel AR, Heppner BT "Predisposing factors to apparent theophylline-induced seizures." Ann Allergy 54 (1985): 411-5
  7. Bahls FH, Ma KK, Bird TD "Theophylline-associated seizures with "therapeutic" or low toxic serum concentrations: risk factors for serious outcome in adults." Neurology 41 (1991): 1309-12
  8. Albert S "Aminophylline toxicity." Pediatr Clin North Am 34 (1987): 61-73
  9. Milgrom H, Bender B "Current issues in the use of theophylline." Am Rev Respir Dis 147 (1993): s33-9
  10. "Product Information. Theo-Dur (theophylline)." Schering Corporation (2001):
  11. Stewart JT "Prolongation of ECT-induced seizures with theophylline." J Am Geriatr Soc 44 (1996): 475
View all 11 references
Moderate

Methylxanthines (applies to theophylline) GERD

Moderate Potential Hazard, High plausibility. Applicable conditions: Gastroesophageal Reflux Disease

Methylxanthines increase gastric acidity and may also relax lower esophageal sphincter, which can lead to gastric reflux into the esophagus. Therapy with products containing methylxanthines should be administered cautiously in patients with significant gastroesophageal reflux.

References

  1. Stoller JL "Oesophageal ulceration and theophylline." Lancet 2 (1985): 328-9
  2. American Medical Association, Division of Drugs and Toxicology "Drug evaluations annual 1994." Chicago, IL: American Medical Association; (1994):
  3. Alterman P, Spiegel D, Feldman J, Yaretzky A "Histamine h2-receptor antagonists and chronic theophylline toxicity." Am Fam Physician 54 (1996): 1473
  4. "Product Information. Lufyllin (dyphylline)." Wallace Laboratories (2001):
View all 4 references
Moderate

Methylxanthines (applies to theophylline) hemodialysis

Moderate Potential Hazard, High plausibility.

Theophylline is removed by hemodialysis. Doses should either be scheduled for administration after dialysis or supplemental doses be given after dialysis.

References

  1. Levy G, Gibson TP, Whitman W, Procknai J "Hemodialysis clearance of theophylline." JAMA 237 (1977): 1466-7
  2. Lee CS, Marbury TC, Perrin JH, Fuller TJ "Hemodialysis of theophylline in uremic patients." J Clin Pharmacol April (1979): 219-26
  3. Kradjan WA, Martin TR, Delaney CJ, et al. "Effect of hemodialysis on the pharmacokinetics of theophylline in chronic renal failure." Nephron 32 (1982): 40-4
  4. Anderson JR, Poklis A, McQueen RC, Purtell JN, Slavin RG "Effects of hemodialysis on theophylline kinetics." J Clin Pharmacol 23 (1983): 428-32
  5. Lee CS, Peterson JC, Marbury TC "Comparative pharmacokinetics of theophylline in peritoneal dialysis and hemodialysis." J Clin Pharmacol 23 (1983): 274-80
  6. Vaziri ND, Barton CH, Ness R, Clark D "Dialysability of theophylline." J Dial 2 (1978): 243-9
  7. Slaughter RL, Green L, Kohli R "Hemodialysis clearance of theophylline." Ther Drug Monit 4 (1982): 191-3
  8. Blouin RA, Bauer LA, Bustrack JA, Record KE, Bivins BA "Theophylline hemodialysis clearance." Ther Drug Monit 2 (1980): 221-3
View all 8 references
Moderate

Methylxanthines (applies to theophylline) reduced clearance

Moderate Potential Hazard, High plausibility. Applicable conditions: Congestive Heart Failure, Pulmonary Edema, Cor Pulmonale, Liver Disease, Shock, Influenza, Fever, Hypothyroidism, Panhypopituitarism

Certain conditions have been identified as causes of reduced theophylline clearance. They include age (neonates and infants < 1 year as well as elderly patients > 60 years) and the following concurrent diseases: acute pulmonary edema; decompensated heart failure; cor pulmonale; fever (>= 102 degrees for 24 hours or more, or lesser temperature elevations for longer periods); influenza; untreated or uncontrolled hypothyroidism; liver disease, cirrhosis or acute hepatitis; reduced renal function in infants < 3 months of age; sepsis with multi-organ failure; and shock. Therapy with theophyllines should be administered cautiously in patients presenting with one or more of these risk factors, and the dosage should be appropriately reduced to prevent toxicity. More intensive monitoring of serum theophylline concentrations may be required. Toxicity is most likely to occur when levels exceed 20 mcg/mL. Severe cases, sometimes without previous warning, have led to cardiac arrhythmias, intractable seizures, and death.

References

  1. Piafsky KM, Sitar DS, Rangno RE, Ogilvie RI "Theophylline disposition in patients with hepatic cirrhosis." N Engl J Med 296 (1977): 1495-7
  2. Hendeles L, Weinberger M, Johnson G "Monitoring serum theophylline levels." Clin Pharmacokinet 3 (1978): 294-312
  3. Ogilvie RJ "Clinical pharmacokinetics of theophylline." Clin Pharmacokinet 3 (1978): 267-93
  4. Sessler CN "Theophylline toxicity: clinical features of 116 consecutive cases." Am J Med 88 (1990): 567-76
  5. Amodio P, Lauro S, Rondana M, et al. "Theophylline pharmacokinetics and liver function indexes in chronic liver disease." Respiration 58 (1991): 106-11
  6. Schiff GD, Hegde HK, LaCloche L, Hryhorczuk DO "Inpatient theophylline toxicity: preventable factors." Ann Intern Med 114 (1991): 748-53
  7. Aderka D, Shavit G, Garfinkel D, et al. "Life-threatening theophylline intoxication in a hypothyroid patient." Respiration 44 (1983): 77-80
  8. Clark BG, Vestal RE "Adverse drug reactions in the elderly: case studies." Geriatrics 39 (1984): 53-4,60-3,66
  9. Covelli HD, Knodel AR, Heppner BT "Predisposing factors to apparent theophylline-induced seizures." Ann Allergy 54 (1985): 411-5
  10. Vozeh S, Otten M, Staub JJ, Follath F "Influence of thyroid function on theophylline kinetics." Clin Pharmacol Ther 36 (1984): 634-40
  11. Shin SG, Juan D, Rammohan M "Theophylline pharmacokinetics in normal elderly subjects." Clin Pharmacol Ther 44 (1988): 522-30
  12. Au WY, Dutt AK, DeSoyza N "Theophylline kinetics in chronic obstructive airway disease in the elderly." Clin Pharmacol Ther 37 (1985): 472-8
  13. Jenne JW "Effect of disease states on theophylline elimination." J Allergy Clin Immunol 78 (1986): 727-35
  14. Kuntz HD, Straub H, May B "Theophylline elimination in congestive heart failure." Klin Wochenschr 61 (1983): 1105-6
  15. Jackson SH, Johnston A, Woollard R, Turner P "The relationship between theophylline clearance and age in adult life." Eur J Clin Pharmacol 36 (1989): 29-34
  16. Kraan J, Jonkman JH, Koeter GH, et al. "The pharmacokinetics of theophylline and enprofylline in patients with liver cirrhosis and in patients with chronic renal disease." Eur J Clin Pharmacol 35 (1988): 357-62
  17. Pokrajac M, Simic D, Varagic VM "Pharmacokinetics of theophylline in hyperthyroid and hypothyroid patients with chronic obstructive pulmonary disease." Eur J Clin Pharmacol 33 (1987): 483-6
  18. Blouin RA, Erwin WG, Foster TS, Scott S "Pharmacokinetics of theophylline in young and elderly subjects." Gerontology 28 (1982): 323-7
  19. Staib AH, Schuppan D, Lissner R, Zilly W, von Bomhard G, Richter E "Pharmacokinetics and metabolism of theophylline in patients with liver diseases." Int J Clin Pharmacol Ther Toxicol 18 (1980): 500-2
  20. Dal Negro R, Turco P, Pomari C, Monici-Preti P "Effect of various disease states on theophylline plasma levels and on pulmonary function in patients with chronic airway obstruction treated with a sustained release theophylline preparation." Int J Clin Pharmacol Ther Toxicol 25 (1987): 401-5
  21. Albert S "Aminophylline toxicity." Pediatr Clin North Am 34 (1987): 61-73
  22. Milgrom H, Bender B "Current issues in the use of theophylline." Am Rev Respir Dis 147 (1993): s33-9
  23. Vicuna N, McNay JL, Ludden TM, Schwertner H "Impaired theophylline clearance in patients with cor pumonale." Br J Clin Pharmacol 7 (1979): 33-7
  24. Shannon M "Predictors of major toxicity after theophylline overdose." Ann Intern Med 119 (1993): 1161-7
  25. "Product Information. Theo-Dur (theophylline)." Schering Corporation (2001):
  26. Jeong CS, Hwang SC, Jones DW, Ryu HS, Sohn K, Sands CD "Theophylline disposition in korean patients with congestive heart failure." Ann Pharmacother 28 (1994): 396-401
  27. O'Connor P, Feely J "Clinical pharmacokinetics and endocrine disorders. Therapeutic implications." Clin Pharmacokinet 13 (1987): 345-64
View all 27 references
Moderate

Methylxanthines (applies to theophylline) tachyarrhythmias

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Angina Pectoris, Myocardial Infarction, Post MI Syndrome, Hypertension, Hyperthyroidism

The use of theophyllines is associated with an increase in heart rate which may progress to supraventricular tachycardia or ventricular arrhythmia at high serum drug concentrations. Appearance of cardiac adverse effects is generally an indication of theophylline toxicity, although patients with a history of tachyarrhythmias may be more susceptible to the chronotropic effect of these drugs. Therapy with theophyllines should be administered cautiously in such patients. Caution is also advised in patients with hypertension, hyperthyroidism, angina pectoris, or recent myocardial infarction, since high dosages of the drugs are associated with positive inotropic as well as chronotropic effects. Clinical monitoring of serum drug concentrations is recommended to prevent toxicity.

References

  1. Hendeles L, Weinberger M, Johnson G "Monitoring serum theophylline levels." Clin Pharmacokinet 3 (1978): 294-312
  2. Sessler CN "Theophylline toxicity: clinical features of 116 consecutive cases." Am J Med 88 (1990): 567-76
  3. Schiff GD, Hegde HK, LaCloche L, Hryhorczuk DO "Inpatient theophylline toxicity: preventable factors." Ann Intern Med 114 (1991): 748-53
  4. Marchlinski FE, Miller JM "Atrial arrhythmias exacerbated by theophylline: response to verapamil and evidence for triggered activity in man." Chest 88 (1985): 931-4
  5. Levine JH, Michael JR, Guarnieri T "Multifocal atrial tachycardia: a toxic effect of theophylline." Lancet 1 (1985): 12-4
  6. Taniguchi A, Ohe T, Shimorura K "Theophylline-induced ventricular tachycardia in a patient with chronic lung disease: sensitivity to verapamil." Chest 96 (1989): 958-9
  7. Bittar G, Friedman HS "The arrhythmogenicity of theophylline: a multivariate analysis of clinical determinants." Chest 99 (1991): 1415-20
  8. Patel AK, Skatrud JB, Thomsen JH "Cardiac arrhythmias due to oral aminophylline in patients with chronic obstructive pulmonary disease." Chest 80 (1981): 661-5
  9. Albert S "Aminophylline toxicity." Pediatr Clin North Am 34 (1987): 61-73
  10. Milgrom H, Bender B "Current issues in the use of theophylline." Am Rev Respir Dis 147 (1993): s33-9
  11. Chazan R, Karwat K, Tyminska K, Tadeusiak W, Droszcz W "Cardiac arrhythmias as a result of intravenous infusions of theophylline in patients with airway obstruction." Int J Clin Pharmacol Ther 33 (1995): 170-5
  12. Mccarthy M "Theophylline, beta-agonists, and cardiovascular death." Lancet 349 (1997): 33
View all 12 references

Theophylline drug interactions

There are 274 drug interactions with theophylline.

Theophylline alcohol/food interactions

There are 3 alcohol/food interactions with theophylline.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.