Theophylline
Rx
Generic NameTheophylline
Therapeutic ClassMethylxanthine Bronchodilator
Max / 24h900 mg (adult)
Common Dose200–400 mg daily in divided doses
PregnancyUse only if benefit outweighs risk
Indications ▼
Bronchial asthma (chronic and nocturnal asthma control)
Chronic obstructive pulmonary disease (COPD)
Chronic bronchitis with reversible airway obstruction
Emphysema associated with airflow limitation
Apnea of prematurity (specialist use)
Adjunct therapy when inhaled bronchodilators are insufficient
Mechanism & Pharmacokinetics ▼
Mechanism: Inhibits phosphodiesterase leading to increased intracellular cAMP, resulting in bronchial smooth muscle relaxation. Also antagonizes adenosine receptors and improves diaphragmatic contractility.
Pharmacokinetics: Well absorbed orally. Peak level within 1–2 hours (immediate release). Metabolized in liver mainly via CYP1A2. Half-life 8–9 hours in adults. Excreted mainly in urine as metabolites.
Dosage & Administration ▼
| Indication | Dose | Frequency |
|---|---|---|
| Adult asthma / COPD | 200–400 mg | 2–3 times daily |
| Extended-release forms | 400–600 mg | Once or twice daily |
| IV (acute bronchospasm) | Loading 5–6 mg/kg | Slow IV infusion |
| Children | 10–20 mg/kg/day | Divided doses |
Note: Therapeutic plasma level 10–20 mcg/mL. Regular monitoring recommended due to narrow therapeutic index.
Side Effects ▼
Nausea, vomiting, abdominal pain
Headache, insomnia, restlessness
Tachycardia, palpitations
Tremor
Seizures and arrhythmia (toxicity)
Contraindications ▼
Hypersensitivity to theophylline or other xanthines
Uncontrolled cardiac arrhythmias
Active peptic ulcer disease
Seizure disorders (use with caution)
Drug Interaction ▼
Erythromycin, ciprofloxacin: increase theophylline level
Smoking: reduces plasma concentration
Phenytoin, rifampicin: decrease effect
Caffeine: additive CNS stimulation
Pregnancy & Lactation ▼
Category C; use only if clearly needed
Excreted in breast milk; monitor infant for irritability
Clinical / Research Summary ▼
Clinical Role: Oral bronchodilator for chronic airway diseases.
Effectiveness: Improves airflow and reduces nocturnal asthma symptoms.
Safety: Narrow therapeutic window; requires plasma monitoring.
Research Focus: Safer dosing strategies and reduced toxicity formulations.
Patient Counseling Points ▼
Take medicine at the same time every day
Avoid excess caffeine intake
Do not crush extended-release tablets
Report palpitations, vomiting, or tremor immediately
Storage & Handling ▼
Store below 30°C
Protect from moisture and light
Keep out of reach of children
Brand Names (Bangladesh & Global) ▼
Medical Disclaimer: For educational use only. Not a substitute for medical advice.
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