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Primatene Dual Action and Alcohol/Food Interactions

There are 5 alcohol/food/lifestyle interactions with Primatene Dual Action (ephedrine / guaifenesin / theophylline).


Theophylline Caffeine

Moderate Drug Interaction

Ask your doctor before using theophylline together with caffeine. Using these medications together may increase some of the side effects of theophylline. This can cause nausea, vomiting, insomnia, tremors, restlessness, uneven heartbeats, and seizure (convulsions). Avoid drinks or foods that contain caffeine, such as coffee, tea, cola, and chocolate. You may need a dose adjustment or special test if you use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Ephedrine Caffeine

Moderate Drug Interaction

Both ePHEDrine and caffeine can increase blood pressure and heart rate, and combining them may enhance these effects. Talk to your doctor before using these medications, especially if you have a history of high blood pressure or heart disease. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Contact your doctor if your condition changes or you experience increased side effects. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

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Theophylline Caffeine

Minor Drug Interaction

Information for this minor interaction is available on the professional version.


Theophylline Food

Moderate Food Interaction

Consumer information for this interaction is not currently available.

GENERALLY AVOID: Coadministration with caffeine may increase the serum concentrations of theophylline. The proposed mechanism involves competitive inhibition of theophylline metabolism via CYP450 1A2, as well as metabolic conversion of caffeine to theophylline in vivo and saturation of theophylline metabolism at higher serum concentrations. In six healthy male volunteers (all smokers), serum concentrations of theophylline (administered as aminophylline 400 mg single oral dose) were significantly higher following consumption of caffeine (2 to 7 cups of instant coffee over 24 hours, equivalent to approximately 120 to 630 mg of caffeine) than after caffeine deprivation for 48 hours. Caffeine consumption also increased the apparent elimination half-life of theophylline by an average of 32% and reduced its total body clearance by 23%. In another study, steady-state concentration and area under the concentration-time curve of theophylline (1200 mg intravenously over 24 hours) increased by 23% and 40%, respectively, in eight healthy volunteers following administration of caffeine (300 mg orally three times a day).

MANAGEMENT: Given the narrow therapeutic index of theophylline, patients should limit or avoid significant fluctuations in their intake of pharmacologic as well as dietary caffeine.

ADJUST DOSING INTERVAL: Administration of theophylline with continuous enteral nutrition may reduce the serum levels or the rate of absorption of theophylline. The mechanism has not been reported. In one case, theophylline levels decreased by 53% in a patient receiving continuous nasogastric tube feedings and occurred with both theophylline tablet and liquid formulations, but not with intravenous aminophylline.

MANAGEMENT: When administered to patients receiving continuous enteral nutrition , some experts recommend that the tube feeding should be interrupted for at least 1 hour before and 1 hour after the dose of theophylline is given; rapid-release formulations are preferable, and theophylline levels should be monitored.


  1. Jonkman JH, Sollie FA, Sauter R, Steinijans VW (1991) "The influence of caffeine on the steady-state pharmacokinetics of theophylline." Clin Pharmacol Ther, 49, p. 248-55
  2. Sato J, Nakata H, Owada E, Kikuta T, Umetsu M, Ito K (1993) "Influence of usual intake of dietary caffeine on single-dose kinetics of theophylline in healthy human subjects." Eur J Clin Pharmacol, 44, p. 295-8
  3. Wohlt PD, Zheng L, Gunderson S, Balzar SA, Johnson BD, Fish JT (2009) "Recommendations for the use of medications with continuous enteral nutrition." Am J Health Syst Pharm, 66, p. 1438-67

Theophylline High Blood Pressure (Hypertension)

Moderate Potential Hazard, Moderate plausibility

methylxanthines - tachyarrhythmias

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.


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

Primatene Dual Action drug interactions

There are 447 drug interactions with Primatene Dual Action (ephedrine / guaifenesin / theophylline).

Primatene Dual Action disease interactions

There are 12 disease interactions with Primatene Dual Action (ephedrine / guaifenesin / theophylline) which include:

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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.