Xanthines

Daniel J. Kranitz Charles L. Emerman

Pharmacology ToxicEffects

Cardiovascular Neurologic Metabolic GastroMestina.!

Treatment

Indications, .forireatment., ..a.n.d..Admi.,ss.i.on prevention

Chapter., References

Theophylline use is complicated by its narrow therapeutic window, with a metabolism that depends on the patient's coincident medical problems and use of other medications. The 1996 Annual Report of the American Association of Poison Control Centers Toxic Exposure Surveillance System reported 3100 exposures to aminophylline or theophylline, resulting in major toxicity in 76 patients and death in 11. There were 7316 exposures to caffeine, resulting in major toxicity in 16 patients with 2 deaths.1 Most consider a theophylline level greater than 20 pg/mL (110 pmol/L) toxic, although side effects may be seen at lower levels. 2 Recent changes in the US Food and Drug Administration dosing guidelines have been aimed at reducing the likelihood of developing toxic levels. Life-threatening toxicity from theophylline poisoning can result in significant cardiac, neurologic, and metabolic abnormalities. 3 Toxic side effects of caffeine have many similarities to those of theophylline, but serious side effects are rare. Several modalities are available for treating theophylline toxicity, but indications for their use in patients without life-threatening symptoms is controversial.

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