Inpatient theophylline toxicity: preventable factors

Article Abstract:

The drug theophylline, used to treat asthma, has a narrow range of therapeutic benefit and produces toxic effects at blood levels only slightly over its therapeutic level. Some of the signs and symptoms of theophylline toxicity include abnormal heart rhythms, frequently rapid rhythms, nausea, vomiting and diarrhea, tremors, nervousness, seizures, and in severe cases a toxic level can cause death. A study was done assessing the frequency of theophylline toxicity, the likelihood of its being recognized, and whether appropriate actions were taken to correct the problem. Of 40 patients identified by a review of their charts as having theophylline toxicity, 13 had high levels on arrival at the hospital, and 27 developed their high levels in the hospital or the emergency room. Errors of medical management led to many of these episodes of theophylline toxicity. These included giving too much of the drug to patients with liver disease or congestive heart failure (both groups generally require less theophylline to achieve therapeutic levels), missing symptoms of toxicity and thus continuing the same dose of the drug, giving other drugs known to interact with theophylline and raise its level, and discharging patients on the same doses that had produced the toxic effects. Some solutions proposed and enacted to prevent unrecognized theophylline toxicity were improving the method by which the laboratory reported the toxic levels, adopting a standardized format for ordering the dosage of the drug, and encouraging the use of alternative drugs for asthma that have less toxicity. (Consumer Summary produced by Reliance Medical Information, Inc.)

Asthma

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Theophylline for the treatment of atrioventricular block after myocardial infarction

Article Abstract:

Theophylline may be an effective alternative therapy to restore an abnormal heart rhythm back to a normal rhythm after a heart attack. Doctors administered theophylline intravenously to eight patients who developed an abnormal heart rhythm within 4 hours following a heart attack. These patients had not responded to routine atropine treatment. A normal heart rhythm reappeared within 3 minutes of theophylline treatment in all 8 patients. Symptoms of low blood flow such as fatigue, dizziness, and impaired mental capabilities improved in all patients. Chest pain in all the patients remained either the same or decreased following theophylline treatment.

Evaluation, Complications and side effects, Heart attack, Heart block

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Treatment of the Systemic Capillary Leak Syndrome with Terbutaline and Theophylline

Article Abstract:

The risk of death in systemic capillary leak syndrome may be greatly reduced in patients treated with terbutaline and theophylline. The syndrome causes fluid to rapidly shift out of the blood vessels into the surrounding tissues, and mortality from the condition is 75% in the five years after diagnosis. Researchers treated eight patients with the two drugs. Two patients died. Of the remaining patients, the frequency and severity of capillary leak episodes dropped by a factor of 30.

United States, Syndromes, Terbutaline

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