Because of the therapeutic index of this drug, monitoring of theophylline concentrations in plasma is essential. Like any other drugs, theophylline must be taken in its recommended dosage. Theophylline is an example of a xanthine derivative that stimulates the beta receptors of the body. Nonsteadystate concentrations may be indicated in selected situations. Evaluation of theophylline therapeutic drug monitoring. Theophylline was first identified as having potential for asthma as a bronchodilator in 1921 and 1922, but general use as a bronchodilator was not seen until the 1930s. Cks advise monitoring renal function and serum electrolytes 12 weeks after starting. Side effects of theo24 theophylline anhydrous capsule. Aug 14, 2019 serum theophylline concentration monitoring. Therapeutic drug monitoring of theophylline, salicylates, and acetaminophen. Frequent blood tests may be necessary to monitor the effect of this drug and to ensure safe and effective dosage. Theophylline is an older drug used to treat asthma or copd, it works as a bronchodilator. Such an approach is either unnecessary or unsuitable for most drug therapies, but for a limited number of drugs including lithium, digoxin and theophylline, measurement of serum or plasma concentration is the preferred method of.
In general, maintaining the average serum theophylline concentration between 10 and 15 mcgml will achieve most of the drugs potential therapeutic benefit while minimizing the risk of serious adverse events. Side effects include insomnia, restlessness, arrhythmias, and seizures. Therapeutic drug monitoring wirral medicines management. Therapeutic drug monitoring an overview sciencedirect. Adding a drug that inhibits theophylline metabolism e. Such an approach is either unnecessary or unsuitable for most drug therapies, but for a limited number of drugs including lithium, digoxin and theophylline, measurement of serum or plasma concentration is the preferred method of optimising dosage and preventing. Theophylline toxicity signs, symptoms, treatment, amount. Theophylline is used in the treatment of reversible airway obstruction due to chronic asthma, chronic bronchitis, or copd. Therapeutic drug monitoring is required for a small fraction of drugs used in pharmacotherapy, but for these drugs such monitoring is essential in order to achieve maximum efficacy of the drug as well as to avoid drug toxicity. Therapeutic drug monitoring of theophylline, salicylates, and. Monitoring should be done on trough specimens after steadystate has been reached. The combination of theophylline and ephedrine was described in a 1940 publication 2. Theophylline in dextrose food and drug administration. Theophylline is well absorbed when taken orally as a rapidrelease tablet or when administered as a liquid solution.
The use of theophylline has declined with the advent of potent steroid inhalants. Nov 20 page 1 of 10 medicines formulary therapeutic drug monitoring contents. Theophylline comes as an extendedrelease longacting tablet, extendedrelease capsule, and a solution liquid to take by mouth. The physiological effects of the antiasthmatic drug theophylline correlate better with the drugs concentration in serum than with dosage.
Both the bronchodilator and the adverse effects are closely related to drug concentration. It took an additional 20 years until it was first reported as an asthma treatment. Therapeutic monitoring of theophylline serum levels is required due to its narrow therapeutic range and marked interindividual pharmacokinetic variability. Therapeutic drug monitoring aims to promote optimum drug treatment by maintaining serum drug concentration within a therapeutic range. Such preparations, often with a mild sedative added, dominated the market for oral. Evaluation of theophylline therapeutic drug monitoring service article pdf available in international journal of clinical pharmacy 843. Mar 21, 2017 key learning topics the concept of therapeutic drug monitoring pharmacological action and clinical use of lithum, digoxin and theophylline adverse toxic effects of lithium, digoxin and theophylline how blood values are used to optimise lithium, digoxin and theophylline dose this chapter is concerned with how laboratory measurement of drug concentration in blood helps in determining. Evaluation of theophylline therapeutic drug monitoring service. Common side effects of theo24 include mild nausea, loss of appetite, stomach pain, diarrhea, upset stomach, weight loss, restlessness, tremor, sleep problems insomnia, headache, lightheadedness, dizziness, sweating, restlessness, nervousness, or irritability.
Webmd provides common contraindications for theophyllineguaifenesin oral. Therapeutic drug monitoring is also useful in avoiding adverse drug events. Oct 23, 2012 theophylline is an important antiasthmatic medication which has bronchodilator properties. The combination of theophylline and ephedrine was described in a 1940 publication.
Citalopram and fluoxetine have been shown only weakly to inhibit cyp1a2 in vitro. Theophylline metabolism is age dependent, with younger children having greater rates of metabolism than older children. Theophylline is the generic name for the prescription drugs uniphyl in canada and theo24. Theophylline, also known as 1,3dimethylxanthine, is a methylxanthine drug used in therapy for respiratory diseases such as chronic obstructive pulmonary disease copd and asthma under a variety of brand names. We provide a service for the monitoring of serum concentrations of a number of drugs. The monitoring of therapeutic drugs involves measuring drug concentrations in plasma, serum or blood. Apr 08, 2009 theo24 theophylline, anhydrous is a bronchodilator used to treat the symptoms of asthma, bronchitis, and emphysema. History the science of therapeutic drug monitoring grew out of the recognition that. Nausea, loss of appetite taking this drug with food may help if taking the immediaterelease or liquid dosage forms.
This information is used to individualise dosage so that drug concentrations can be maintained within a target range. This chapter is concerned with how laboratory measurement of drug concentration in blood helps in determining correct drug dose. Therapeutic drug monitoring of phenytoin is carried out to ensure effective and safe levels. Theophylline in 5% dextrose theophylline dose, indications. Dec 15, 2012 recent definition of the pharmacodynamics and pharmacokinetics of theophylline have increased the safety and efficacy of the drug for acute bronchodilator therapy and have greatly expanded its potential as a prophylactic agent in the management of chronic asthmatic symptoms. See below for a comprehensive list of adverse effects. Results for therapeutic drug monitoring theophylline 1 10 of 326 sorted by relevance date. Results for therapeutic drug monitoring theophylline 1 10 of 326 sorted by relevance date click export csv or ris to download the entire page or use the checkboxes to select a subset of records to download. The theophylline halflife in premature infants has been quoted as 14. The fraction f of the administered dose of the drug that.
Careful monitoring of side effects and drug blood levels is recommended. Theophylline anhydrous fda prescription drug recalls. Click export csv or ris to download the entire page or use the checkboxes to select a subset of records to download. Drug concentration monitoring is neither feasible nor warranted for all drugs. Therapeutic drug monitoring in most individuals, a plasmatheophylline concentration of 1020 mglitre 55110 micromollitre is required for satisfactory bronchodilation, although a lower plasmatheophylline concentration of 515 mglitre may be effective.
Therapeutic drug monitoring tdm can be defined as the measurement of drug. Sustained release theophylline preparations practical. Some of the factors complicating phenytoin dosing include a narrow therapeutic window, high degree of protein binding, and nonlinear pharmacokinetics. Tdm is required for effective patient care management it leads to optimizing pharmacological therapy therapeutic drug monitoring is a system of quality assurance of a drug management system, aiming that the right drug is given to the right patient in the right dose in order to obtain the right effect. Tdm is required for effective patient care management it leads to optimizing pharmacological therapy therapeutic drug monitoring is a system of quality assurance of a drug management system, aiming that the right drug is given to the right patient in. Specifically, benefit and risk from theophylline have been demonstrated to relate. Pdf evaluation of theophylline therapeutic drug monitoring. Results for therapeutic drug monitoring theophylline 1 30 of 326 sorted by relevance date click export csv or ris to download the entire page or use the checkboxes to select a subset of records to download. Therapeutic drug monitoringfinal dose biochemistry. A study in healthy subjects taking oral theophylline with citalopram, and a study in eight healthy subjects taking intravenous aminophylline with fluoxetine, did not show any changes in the pharmacokinetics of theophylline. Nausea, vomiting, diarrhea, headache, insomnia, irritability 75% of patients serum theophylline levels 3035 mcgml. Updated with approvals from wirral drug and therapeutics committee. The drug was prescribed in a syrup up to the 1970s as theostat 20 and theostat 80, and by the early 1980s in a tablet form called quibron.
Hyperglycemia, hypotension, cardiac arrhythmias, tachycardia 10 mcgml in premature newborns. With increased understanding of the relationships of serum theophylline concentration and effect, both adverse and beneficial, oral dosage forms were developed to provide consistent serum theophylline concentrations with the benefit of convenient dosage intervals for long term use. Therapeutic drug monitoring abbott core laboratory. Theophylline therapeutic drug monitoring in the case of a new sustainedrelease pellet formulation for oncedaily evening administration. Such preparations, often with a mild sedative added, dominated the market for oral theophylline.
This medication is used in the treatment of asthma. Since this drug has a narrow therapeutic range, it is important to monitor the patients plasma levels. Therapeutic drug monitoring of mycophenolic acid using serum or plasma is useful for avoiding rejection as well as toxicity such as neutropenia. Scribd is the worlds largest social reading and publishing site.
However, serum drug levels should only be taken when there is a clear indication to. Theophylline was first identified as having potential for asthma as a bronchodilator in 1921 and 1922 1, but general use as a bronchodilator was not seen until the 1930s. To reduce the chances of drug interactions, you should also tell your healthcare provider about all other drugs you are taking. Introduction therapeutic drug monitoring tdm is generally defined as the clinical laboratory measurement of a chemical parameter that, with appropriate medical interpretation, will directly influence drug prescribing procedures. Therapeutic drug monitoring theophylline evidence search.
Theophylline interactions learning article pharmaceutical. Theophylline theo24 is a methylxanthine that causes cns stimulation and bronchial smooth muscle relaxation. When signs or symptoms of theophylline toxicity are present. Specifically, benefit and risk from theophylline have been demonstrated to relate directly to serum theophylline. The benefits of theophylline may be recognized at lower serum levels than previously recommended a target range of 515 gml. To test your ability to monitor serum levels for drugs with a narrow therapeutic index. Steinijans vw1, trautmann h, sauter r, staudinger h. Commonly reported side effects of theophylline include. During pregnancy, this medication should be used only when clearly needed. Moderate ritonavir decreased theophylline auc and cmax by 43% and 52%, respectively, when the two drugs were coadministered. Since serious toxic effects of theophylline are related to the serum concentration and are not always preceded by minor adverse symptoms, serum theophylline monitoring helps to avoid serious toxicity. Therapeutic drug monitoring theophylline evidence search nice. Common side effects of theo24 include mild nausea, loss of appetite, stomach pain, diarrhea, upset stomach, weight loss, restlessness, tremor, sleep problems insomnia, headache, lightheadedness, dizziness, sweating, restlessness.
Loading dose should bepor eliminated if theophylline preparation has been used in preceding 24 hr. Bronchospasms are most common in people with asthma but can also occur in people with chronic obstructive pulmonary disease, which includes chronic bronchitis and emphysema. If these drugs are used together, therapeutic drug monitoring should be considered. Theophylline is an important antiasthmatic medication which has bronchodilator properties. It naturally occurs in black tea, and is degraded by the liver to caffeine. Jan 04, 2015 therapeutic drug monitoring aims to promote optimum drug treatment by maintaining serum drug concentration within a therapeutic range. Its used to treat airflow obstruction symptoms such as wheezing, shortness of breath, and chest. An overview of theophylline uses theophylline is a prescription medication used for the treatment of airway spasms called bronchospasms. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Suggestions for drug monitoring in adults in primary care.
As a member of the xanthine family, it bears structural and pharmacological similarity to theobromine and caffeine, and is readily found in nature, being. We evaluated therapeutic drug monitoring service for theophylline in slovenian clinical setting, which currently includes no pharmacokinetic evaluation of measured theophylline. At serum theophylline concentrations 20 mcgml, both the frequency and severity of adverse reactions increase. With increased understanding of the relationships of serum theophylline concentration and effect, both adverse and beneficial, oral dosage forms were developed to provide consistent serum theophylline concentrations with the benefit of convenient dosage intervals for long.
The serum theophylline concentration should be measured immediately upon presentation, 24 hours later, and then at sufficient intervals, e. Theo24 theophylline, anhydrous is a bronchodilator used to treat the symptoms of asthma, bronchitis, and emphysema. Therapeutic drug monitoring tdm is generally defined as the clinical laboratory measurement of a chemical parameter that, with appropriate medical interpretation, will directly influence drug prescribing procedures. Hendeles l, weinberger m, johnson g monitoring serum theophylline levels. Theophylline elixophyllin, theo24 is a bronchodilator prescribed for the treatment of asthma and other airway conditions. It requires monitoring of drug levels so is not often used anymore except in difficult to manage cases. Otherwise, tdm refers to the individualization of drug dosage by maintaining plasma or blood drug concentrations within a targeted therapeutic range or window. Theophylline warnings and precautions among the conditions that you should tell your healthcare provider about before you take theophylline are liver disease, low thyroid, and seizures or epilepsy. The drug theophylline is used as a treatment for several respiratory conditions. In general, predose concentration is measured, but better correlation exists between mycophenolic acid auc012 h and clinical efficacy as well as toxicity.
Theophylline and etofylline tablets 100mg150mg300mg retard. Therapeutic drug monitoring an overview sciencedirect topics. Dose should be determined by theophylline serum level monitoring. Guide for drug level monitoring of commonly used medications. Aminophylline is 80% theophylline 100 mg aminophylline 80 mg theophyl. To exemplify this concern, i will use the guidelines by the food and drug administration fda for theophylline dosing and monitoring. Therapeutic drug monitoring of theophylline, salicylates. Optimum use of therapeutic drug monitoring and pharmacokinetics. Find out what health conditions may be a health risk when taken with theophyllineguaifenesin oral. Then adjust dose and rate accordingly depending on th levels. Theophylline uniphyl and theo24 side effects, dosage.
We evaluated therapeutic drug monitoring service for theophylline in slovenian clinical setting, which currently includes no pharmacokinetic evaluation of measured theophylline serum concentrations. Theophylline and etofylline tablets 100mg150mg300mg. Results for therapeutic drug monitoring theophylline 1 30 of 326 sorted by relevance date. Therapeutic drug monitoringfinal free download as powerpoint presentation. Recent definition of the pharmacodynamics and pharmacokinetics of theophylline have increased the safety and efficacy of the drug for acute bronchodilator therapy and have greatly expanded its potential as a prophylactic agent in the management of chronic asthmatic symptoms. Theophylline therapeutic drug monitoring in the case of a new. Therapeutic drug monitoring tdm is the clinical practice of measuring specific drugs at designated intervals to maintain a constant concentration in a patients bloodstream, thereby optimizing.
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