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What is theophylline toxicity

A person with theophylline toxicity has symptoms caused by abnormally high levels of theophylline in
the bloodstream. Theophylline is used to treat asthma and chronic obstructive pulmonary disease.
The dose of theophylline is adjusted to maintain blood levels within a certain range. Theophylline
toxicity may occur when a person take too much of the medication, or when another medication
.interrupts the normal breakdown of theophylline

?What are the symptoms of theophylline toxicity

Symptoms of theophylline toxicity include diarrhea, poor appetite, dizziness, fatigue, headache,
insomnia, nausea, and palpitations. Symptoms of worsening theophylline toxicity include tremor,
.vomiting, difficulty breathing, rapid pulse, confusion, or seizures

?How does the doctor treat theophylline toxicity

Treatment for theophylline toxicity includes stopping theophylline, medication for an abnormal heart
rhythm, medication for seizures. Additional treatment may include activated charcoal, which absorbs
the drug in the intestine

Risk factors for theophylline toxicity include:

 Elderly
 Congestive heart failure
 Liver disease
 Hypoalbuminemia
 Drugs that interfere with theophylline metabolism:
o Alcohol
o Allopurinol
o Erythromycin
o Azithromycin
o Clarithromycin
o Cimetidine
o Cortisone
o Quinolone antibiotics

Oral contraceptivesSymptoms of theophylline toxicity include:

 Abdominal pain:
o Abdominal cramps
 Anorexia
 Confusion
 Diarrhea
 Dizziness
 Excessive fatigue
 Facial flushing
 Shortness of breath
 Rapid breathing
 Headache
 Increased urination
 Insomnia
 Lightheadedness
 Muscle twitching
  Nausea
 Vomiting
 Palpitations
 Rapid pulse
 Tremor
 Loss of consciousness
 Seizures

Home care for theophylline toxicity includes:

 Take prescribed medications as directed:

o Don't skip doses of your medication. This makes them less effective.
o Be aware of the common side effects that may be caused by your medication.
 Ask your doctor about medications that may interact with theophylline.
 Avoid caffeine.
 Stop smoking
 Avoid exposure to secondary smoke

Notify your doctor if you take theophylline and develop any of the following:

 Worsening muscle twitching

 Worsening palpitations
 Rapid pulse
 Worsening abdominal pain
 Hallucinations:
o Visual hallucinations: seeing things that do not exist
o Auditory hallucinations: hearing sounds or voices that do not exist
 Repeated vomiting
 Confusion
 Fainting
 Seizures

Notify your doctor if you take theophylline and develop any of the following:

 Worsening muscle twitching

 Worsening palpitations
 Rapid pulse
 Worsening abdominal pain
 Hallucinations:
o Visual hallucinations: seeing things that do not exist
o Auditory hallucinations: hearing sounds or voices that do not exist
 Repeated vomiting
 Confusion
 Fainting
 Seizures
Aminophylline overdose
URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/002572.htm

Aminophylline or theophylline are medicines used to prevent and treat wheezing and
other breathing difficulties caused lung diseases such as asthma.

Aminophylline or theophylline overdose occurs when someone accidentally or

intentionally takes more than the normal or recommended amount of these
medications.

This is for information only and not for use in the treatment or management of an
actual poison exposure. If you have an exposure, you should call your local
emergency number (such as 911) or the National Poison Control Center at 1-800-222-
1222.

Poisonous Ingredient
 Aminophylline
 Theophylline

Where Found
 Aminophylline
 Theophylline (Theo-Dur, Slo-Phyllin, Theolair, Slo-Bid)
 Various asthma medications

Note: This list may not be all-inclusive.

Symptoms
The major life-threatening events of theophylline intoxication are seizures and heart
rhythm disturbances.

Symptoms in adults may include:

 Gastrointestinal
o Increased appetite
o Increased thirst
o Nausea
o Vomiting (possibly with blood)
 Heart and blood
o High or low blood pressure
o Irregular heartbeat
o Rapid heart rate
 o Pounding heartbeat (palpitations)
 Lungs
o Breathing difficulty
 Muscles and joints
o Muscle twitching and cramping
 Nervous system
o Confusion
o Convulsions
o Dizziness
o Fever
o Hallucinations (thinking something is there, but it's not)
o Headache
o Irritability
o Psychosis
o Restlessness
o Sweating
o Trouble sleeping

Symptoms in babies may include:

 Gastrointestinal
o Nausea
o Vomiting
 Heart and blood
o Irregular heartbeat
o Low blood pressure
o Rapid heartbeat
o Shock
 Lungs
o Rapid, deep breathing
 Muscles and joints
o Muscle cramps
o Twitching
 Nervous system
o Convulsions
o Irritability
o Tremors

Home Care
Seek immediate medical help. Do NOT make a person throw up unless told to do so
by poison control or a health care professional.

Before Calling Emergency

Determine the following information:

 Patient's age, weight, and condition

 Name of the product (ingredients and strengths, if known)
  Time it was swallowed
 Amount swallowed

Poison Control
The National Poison Control Center (1-800-222-1222) can be called from anywhere
in the United States. This national hotline number will let you talk to experts in
poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United
States use this national number. You should call if you have any questions about
poisoning or poison prevention. It does NOT need to be an emergency. You can call
for any reason, 24 hours a day, 7 days a week.

Take the container with you to the hospital, if possible.

See: Poison control center - emergency number

What to Expect at the Emergency Room

The health care provider will measure and monitor the patient's vital signs, including
temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as
appropriate. The patient may receive:

 Activated charcoal
 Breathing support (artificial respiration)
 Kidney dialysis (in severe cases)
 Laxative
 Tube through the nose into the stomach to wash out the stomach (gastric lavage)

Outlook (Prognosis)
Convulsions and irregular heartbeats may be difficult to control. Some symptoms may
occur up to 12 hours after the overdose.

Alternative Names
Theophylline overdose; Xanthine overdose

Theophylline toxicity: clinical features of 116 consecutive cases.

Sessler CN.

Department of Medicine, Medical College of Virginia, Richmond 23298-0050.

Abstract

PURPOSE: To examine the predisposing factors, clinical and laboratory characteristics, management,

course, and outcome of consecutive cases of theophylline toxicity in an outpatient setting.

PATIENTS AND METHODS: Toxicology records and hospital charts of consecutive patients with a

serum theophylline concentration (STC) greater than 30 mg/L (167 mumol/L) identified in the

emergency departments (EDS) of a University Medical Center and a Veterans Administration Medical

Center were reviewed.

RESULTS: Ten percent and 2.8% of 5,557 consecutive STCs measured in the EDs over 2 years were

greater than 20 mg/L (111 mumol/L) and greater than 30 mg/L (167 mumol/L), respectively. One

hundred sixteen cases with STC greater than 30 mg/L were identified. Fourteen (12%) and 102 (88%)

were due to acute overdose and chronic overmedication, respectively. Principal predisposing factors

included patient and/or physician dosing errors and conditions or medications that reduce theophylline

clearance. One or more toxic manifestations were present in 109 (94%) cases. Fifty percent of patients

had mild toxicity, 38% had moderate toxicity, and 7% had severe or life-threatening toxicity. Seven (6%)

patients died when STC was still in the toxic range and/or as a result of toxicity. Acute overdose was

associated with higher peak STC (p less than 0.001), younger age (p less than 0.01), and greater

mortality (p less than 0.05) than chronic overmedication. Peak STC correlated significantly with the

severity of toxicity for patients with acute overdose (p less than 0.01) but not for patients with chronic

overmedication. All three patients with acute overdose and fatal toxicity had peak STCs greater than

100 mg/L (555 mumol/L) and fulminant toxicity, whereas the four patients with chronic overmedication

who died during toxicity had peak STCs in the 40 to 60 mg/L (222 to 333 mumol/L) range and most died

of respiratory failure rather than directly from toxicity. Patients with acute overdose who had the delayed

onset of severe or life-threatening toxicity and/or died from toxicity were accurately identified using

previously published criteria for prophylactic charcoal hemoperfusion. In contrast, the predictive value of

the criteria applied to patients with chronic overmedication was poor. Two patients with acute overdose

underwent charcoal hemoperfusion, but died. No patient with chronic overmedication received charcoal

hemoperfusion.

CONCLUSION: Toxic-range STCs are relatively common in the ED population, occur primarily as a

result of patient and physician dosing errors, and cause a broad range of toxic manifestations of varying

severity. Peak STC correlates with the severity of toxicity and outcome for acute overdose but not
chronic overmedication intoxication. Previously published criteria for prophylactic charcoal

hemoperfusion accurately identify patients with acute overdose but not patients with chronic

overmedication at risk for serious complications and death.

A case of fatal poisoning caused by theophylline toxicity (serum level 127 μg/ml) is
presented. At external examination, skin blisters on regions exposed to pressure were
distinctive. Histologic examination demonstrated subepidermal bullae with
eosinophilic necrosis of the eccrine sweat gland coil but no epidermal necrosis,
vascular changes, or inflammatory infiltrate. To the authors’ knowledge, this is the
first description of coma blisters in a case of theophylline intoxication.