THEOPHYLLINE TOXICITY

Course overview

AROUND THE WORLD, THEOPHYLLINE (1,3-DIMETHYLXANTHINE) IS PRIMARILY USED AS A BRONCHODILATOR FOR PATIENTS WITH ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD). HOWEVER, IN THE UNITED STATES, ASTHMA AND COPD ARE MAINLY TREATED WITH OTHER AGENTS, AND THEOPHYLLINE IS PREDOMINANTLY USED TO TREAT BRADYCARDIA AND APNEA IN PREMATURE NEWBORNS. THEOPHYLLINE CAUSES THE ENDOGENOUS RELEASE OF CATECHOLAMINES VIA INDIRECT STIMULATION OF BETA-1 AND BETA-2 RECEPTORS, WHICH, AT THERAPEUTIC LEVELS LEAD TO BRONCHODILATION, THE GOAL OF TREATMENT. UNFORTUNATELY, THEOPHYLLINE HAS A NARROW THERAPEUTIC WINDOW, AND LEVELS EVEN SLIGHTLY ABOVE THE THERAPEUTIC RANGE CAN HAVE ADVERSE EFFECTS BOTH ACUTELY AND CHRONICALLY. THE EXCESS CIRCULATING CATECHOLAMINES ARE TO BLAME FOR THE DANGERS ASSOCIATED WITH THEOPHYLLINE TOXICITY. DEPENDING ON THE DOSE AND ROUTE OF ADMINISTRATION, THEOPHYLLINE CAN HAVE A WIDE RANGE OF CARDIOVASCULAR, NEUROLOGIC, METABOLIC, MUSCULOSKELETAL AND GASTROINTESTINAL MANIFESTATIONS. PROVIDERS SHOULD BECOME FAMILIAR WITH THE MANAGEMENT OF THEOPHYLLINE TOXICITY SINCE SERIOUS COMPLICATIONS SUCH AS ARRHYTHMIAS, SEIZURES, HYPERGLYCEMIA, AND RHABDOMYOLYSIS CAN ARISE. THIS ACTIVITY WILL REVIEW THE MOST COMMON CAUSES OF THEOPHYLLINE TOXICITY AND OUTLINE THE TREATMENT APPROACH ACCORDING TO CURRENT EVIDENCE. THIS ACTIVITY WILL HIGHLIGHT THE ROLE OF THE INTERPROFESSIONAL TEAM IN RECOGNIZING AND TREATING THEOPHYLLINE TOXICITY.