Isoniazid: May increase the serum concentration of Theophylline Derivatives. The most frequently reported events in single-dose trials, without regard to drug relationship, were and vomiting 2%. Events that occurred in less than 1% of patients are listed below. Charcoal must be retained in, and pass through, the gastrointestinal tract to be effective; emesis should therefore be controlled by administration of appropriate antiemetics. Alternatively, the charcoal can be administered continuously through a nasogastric tube in conjunction with appropriate antiemetics. A single dose of sorbitol may be administered with the activated charcoal to promote stooling to facilitate clearance of the adsorbed theophylline from the gastrointestinal tract. Sorbitol alone does not enhance clearance of theophylline and should be dosed with caution to prevent excessive stooling which can result in severe fluid and electrolyte imbalances. Commercially available fixed combinations of liquid charcoal and sorbitol should be avoided in young children and after the first dose in adolescents and adults since they do not allow for individualization of charcoal and sorbitol dosing.
Regadenoson: Theophylline may diminish the vasodilatory effect of Regadenoson. What other drugs will affect theophylline Uniphyl? Warning: The facts and figures contained in these reports are accurate to the best of our capability; however, our metrics are only meant to augment your medical knowledge, and should never be used as the sole basis for selecting a new medication. As with any medical decision, be sure to work with your doctor to ensure the best choices are made for your condition. RD, Stevenson HC "Generalized dermatitis to aminophylline. Hall RC, Beresford TP, Stickney SK, et al "Psychiatric reactions produced by respiratory drugs.
Clinical, Cosmetic and Investigational Dermatology: “Cryolipolysis for noninvasive body contouring: clinical efficacy and patient satisfaction. What should I avoid while talking ZYFLO? The listing of drugs in Table II is current as of June 2004. The listing of drugs in Table III is current as of January 2, 1996. New interactions are continuously being reported for theophylline, especially with new chemical entities. doxazosin
Theophylline clearance see or if it is not feasible to monitor serum Theophylline concentrations. What happens if I overdose? Metabolic side effects have included hypokalemia, hyperglycemia, respiratory alkalosis, hypophosphatemia, and hypomagnesemia. The magnitude of these abnormalities have been correlated with theophylline concentrations. Peak expiratory flow. A test that measures the force of air you breathe out exhale into the mouthpiece of a device called a peak expiratory flow meter.
Alterman P, Spiegel D, Feldman J, Yaretzky A "Histamine h2-receptor antagonists and chronic theophylline toxicity. Propafenone: May increase the serum concentration of Theophylline Derivatives. CloZAPine: CYP1A2 Inhibitors Weak may increase the serum concentration of CloZAPine. The dosage is based on your medical condition, response to treatment, age, weight, lab tests theophylline blood levels and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use including prescription drugs, nonprescription drugs, and herbal products. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully. With less air getting in, you can feel short of breath. You may wheeze and in an attempt to draw in more oxygen through tightened passageways.
There are several factors which may predispose a patient to higher serum concentrations and, thus, toxicity. These factors may include increased age, concomitant drugs which reduce the clearance of theophylline, hypothyroidism, congestive heart failure, liver disease, renal failure, and alterations in smoking habits. One series of patients with theophylline intoxication had recent upper respiratory tract infections. Most of the side effects of aminophylline theophylline have been dependent on serum concentrations. Increased frequency of nausea, nervousness, and insomnia. Table III. Drugs that have been documented not to interact with theophylline or drugs that produce no clinically significant interaction with theophylline. Refer to PRECAUTIONS, Drug Interactions for information regarding table. However, dose reduction and frequent monitoring of serum theophylline concentration are required in patients with decreased hepatic function eg, cirrhosis, acute hepatitis, cholestasis. There are no adequate and well-controlled studies in pregnant women. Theophylline should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Theophylline: Enoxacin is a potent inhibitor of the cytochrome P-450 isozymes responsible for the metabolism of methylxanthines. Enoxacin interferes with the metabolism of theophylline resulting in a 42% to 74% dose-related decrease in theophylline clearance and a subsequent 260% to 350% increase in serum theophylline levels. Theophylline-related adverse effects have occurred in patients when theophylline and enoxacin were coadministered. How should I take theophylline Uniphyl? AUC and consequent increased beta-blocker activity. Transient caffeine-like adverse effects and excessive serum concentrations in slow metabolizers can be avoided in most patients by starting with a sufficiently low dose and slowly increasing the dose, if judged to be clinically indicated, in small increments see . Dose increases should only be made if the previous dosage is well tolerated and at intervals of no less than 3 days to allow serum theophylline concentrations to reach the new steady-state. This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment. In selected patients at high risk for theophylline-induced seizures, consideration should be given to the administration of prophylactic anticonvulsant therapy. FDA product labels and may differ in countries outside the USA. Every effort has been made to ensure that the information provided on this page is accurate, up-to-date and complete, but no guarantee is made to that effect. Drugs. Doses should be individualized based on steady-state serum concentrations and ideal body weight. Estrogen containing oral contraceptives decrease Theophylline clearance in a dose-dependent fashion. The effect of progesterone on Theophylline clearance is unknown. avlocardyl
In studies in which pregnant mice, rats and rabbits were dosed during the period of organogenesis, theophylline produced teratogenic effects. Theophylline concentration than the value listed. Numerous new medications are being studied, but none are currently commercially available for routine therapy of asthma. Tell your doctor if you smoke or if you have recently stopped smoking. Saliva concentrations of Theophylline cannot be used reliably to adjust dosage without special techniques. Consider extracorporeal removal, even if the patient has not experienced a seizure see OVERDOSAGE, Extracorporeal Removal. Be sure your back is covered. Wear a shirt or blouse, or cover your back with a towel. Off-label use: For reversal of adenosine-, dipyridamole-, or regadenoson-induced adverse events during nuclear cardiac stress testing, administer IV undiluted over 30 to 60 seconds, repeat as necessary. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company. Aminophylline is very similar to theophylline. Do not take containing theophylline while using aminophylline. purchase nimodipine junior nimodipine
If symptoms are not controlled and current dosage is tolerated consider adding additional medications to treatment regimen. Inform your doctor if your condition persists or worsens. THE SAFETY AND EFFECTIVENESS OF ENOXACIN IN PATIENTS AND ADOLESCENTS UNDER THE AGE OF 18 YEARS WOMEN, AND LACTATING WOMEN HAVE NOT BEEN ESTABLISHED. Erythromycin metabolite decreases theophylline clearance by inhibiting cytochrome P450 3A3. Larger diazepam doses may be required to produce desired level of sedation. Discontinuation of Theophylline without reduction of diazepam dose may result in respiratory depression. Theophylline throughout the gastrointestinal tract, even when administered several hours after ingestion. If the patient is vomiting, the charcoal should be administered through a nasogastric tube or after administration of an antiemetic. Phenothiazine antiemetics such as prochlorperazine or perphenazine should be avoided since they can lower the seizure threshold and frequently cause dystonic reactions. A single dose of sorbitol may be used to promote stooling to facilitate removal of Theophylline bound to charcoal from the gastrointestinal tract. Sorbitol, however, should be dosed with caution since it is a potent purgative which can cause profound fluid and electrolyte abnormalities, particularly after multiple doses. Commercially available fixed combinations of liquid charcoal and sorbitol should be avoided in young children and after the first dose in adolescents and adults since they do not allow for individualization of charcoal and sorbitol dosing. Ipecac syrup should be avoided in Theophylline overdoses. Although ipecac induces emesis, it does not reduce the absorption of Theophylline unless administered within 5 minutes of ingestion and even then is less effective than oral activated charcoal. Moreover, ipecac induced emesis may persist for several hours after a single dose and significantly decrease the retention and the effectiveness of oral activated charcoal. If the serum sample is drawn more than two hours after the dose, the results must be interpreted with caution since the concentration may not be reflective of the peak concentration. In contrast, when signs or symptoms of theophylline toxicity are present, the serum sample should be obtained as soon as possible, analyzed immediately, and the result reported to the clinician without delay. Dosage reduction may alleviate the caffeine-like adverse effects in these patients, however, persistent adverse effects should result in a reevaluation of the need for continued theophylline therapy and the potential therapeutic benefit of alternative treatment. Dose reduction and frequent monitoring of serum theophylline concentrations are required. Helliwell M, Berry D. Theophylline absorption by effervescent activated charcoal Medicoal. Institute supportive care, including establishment of intravenous access, maintenance of the airway, and electrocardiographic monitoring. Serum theophylline concentration measurements are readily available and should be used to determine whether the dosage is appropriate. Quinolone-class adverse reactions: Although not reported in completed clinical studies with enoxacin, a variety of adverse events have been reported with other quinolones. Breo. These medications are available for delivery by inhaler. Mahutte CK, True RJ, Michiels TM, Berman JM, Light RW. Increased serum theophylline clearance with orally administered activated charcoal. Many strains of species and anaerobes are usually resistant to enoxacin.
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose. Recently, two medications have been approved that bind to a chemical messenger in the body, called interleukin 5 IL-5. Mepolizumab Nucala is administered subcutaneously, and reslizumab Cinqair is administered intravenously. IL-5 promotes activation and development of eosinophils, a type of white blood cell that is known to contribute to asthma in certain patients. These medications are indicated in patients with asthma not controlled by first line medications who also have an elevated eosinophil count in their blood. If you do not have a dose-measuring device, ask your pharmacist for one. No food or liquid other than water was allowed for 4 hours after which a standard lunch was served. Your doctor or may already be aware of any possible and may be monitoring you for them. not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first. Ask your doctor or pharmacist if a new medicine will affect how much theophylline you take. CYP1A2 Inhibitors Moderate: May decrease the metabolism of CYP1A2 Substrates. Theophylline is rapidly and completely absorbed after oral administration in solution or immediate-release solid oral dosage form. Theophylline does not undergo any appreciable pre-systemic elimination, distributes freely into fat-free tissues and is extensively metabolized in the liver. Table II. Clinically significant drug interactions with theophylline. Higher doses of theophylline may be required to achieve desired effect. Decreases theophylline clearance by inhibiting hydroxylation and demethylation. Do I need a prescription for theophylline? Theophylline also strengthens right heart function and movement. Theophylline was approved by the FDA in April 1979. Zyloprim azithromycin Zithromax carbamazepine Tegretol cimetidine Tagamet ciprofloxacin Cipro clarithromycin Biaxin diuretics 'water pills' erythromycin, lithium Eskalith, Lithobid oral contraceptives, phenytoin Dilantin prednisone Deltasone propranolol Inderal rifampin Rifadin tetracycline Sumycin and other medications for infections or heart disease. Case reports of theophylline overdose in humans and animal studies suggest that phenytoin is ineffective in terminating theophylline-induced seizures. The doses of benzodiazepines and phenobarbital required to terminate theophylline-induced seizures are close to the doses that may cause severe respiratory depression or respiratory arrest; the clinician should therefore be prepared to provide assisted ventilation. Elderly patients and patients with COPD may be more susceptible to the respiratory depressant effects of anticonvulsants. Barbiturate-induced coma or administration of general anesthesia may be required to terminate repetitive seizures or status epilepticus. General anesthesia should be used with caution in patients with theophylline overdose because fluorinated volatile anesthetics may sensitize the myocardium to endogenous catecholamines released by theophylline. Enflurane appears less likely to be associated with this effect than halothane and may, therefore, be safer. Neuromuscular blocking agents alone should not be used to terminate seizures since they abolish the musculoskeletal manifestations without terminating seizure activity in the brain. eulexin purchase now mastercard canada eulexin
The molecular formula of anhydrous theophylline is C 7H 8N 4O 2 with a molecular weight of 180. The drugs listed in Table II have the potential to produce clinically significant pharmacodynamic or pharmacokinetic interactions with theophylline. The information in the "Effect" column of Table II assumes that the interacting drug is being added to a steady-state theophylline regimen. Ipecac syrup should be avoided in theophylline overdoses. Caution is advised when using this drug in children because they may be more sensitive to its effects. Careful monitoring of side effects, drug levels, and dose adjustment is recommended. ZYFLO is taken four times a day with or without food. Due to the immaturity of theophylline metabolic pathways in infants under the age of one year, particular attention to dosage selection and frequent monitoring of serum theophylline concentrations are required when theophylline is prescribed to pediatric patients in this age group. P450 isoenzymes 1A2, 2C9 and 3A4 CYP1A2, CYP2C9 and CYP3A4. Bismuth: Bismuth subsalicylate, given concomitantly with enoxacin or 60 minutes following enoxacin administration, decreased enoxacin bioavailability by approximately 25%. Thus, concomitant administration of enoxacin and bismuth subsalicylate should be avoided. Increases in the dose of theophylline should not be made in response to an acute exacerbation of symptoms of chronic lung disease since theophylline provides little added benefit to inhaled beta 2-selective agonists and systemically administered corticosteroids in this circumstance and increases the risk of adverse effects. A peak steady state serum theophylline concentration should be measured before increasing the dose in response to persistent chronic symptoms to ascertain whether an increase in dose is safe. Serum Theophylline Concentration Monitoring. Crush one 300 mg extended release tablet in a mortar and reduce to a fine powder. Vemurafenib: May increase the serum concentration of CYP1A2 Substrates. Management: Consider alternatives to such combinations whenever possible, particularly if the CYP1A2 substrate has a relatively narrow therapeutic index. An inhaled beta-2 selective agonist, alone or in combination with a systemically administered corticosteroid, is the most effective treatment for acute exacerbations of reversible airways obstruction. Theophylline is a relatively weak bronchodilator, is less effective than an inhaled beta-2 selective agonist and provides no added benefit in the treatment of acute bronchospasm. If an inhaled or parenteral beta agonist is not available, a loading dose of an oral immediate release theophylline can be used as a temporary measure. Elevated serum CK-MB levels have been associated with theophylline toxicity in the absence of cardiac disease. CK-MB levels have returned to normal following discontinuation of theophylline therapy. Quinolone Antibiotics: May decrease the metabolism of Theophylline Derivatives. Ciprofloxacin and enoxacin are of greatest concern. Metabolism Following oral dosing, theophylline does not undergo any measurable first-pass elimination. In adults and children beyond one year of age, approximately 90% of the dose is metabolized in the liver. fludrocortisone cheap buy online visa
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Cimetidine: May decrease the metabolism of Theophylline Derivatives. Table IV. Manifestations of theophylline toxicity. Asthma exacerbations: The treatment of asthma exacerbations with theophylline is not supported or recommended by current clinical practice guidelines GINA 2016; NAEPP 2007. Patients are frequently sensitized to ethylenediamine through topical use, as it is used as a preservative in some topical preparations. These patients are generally able to tolerate plain theophylline preparations. Children may be more sensitive to the side effects of this drug. Careful monitoring of side effects and drug blood levels is recommended. bera.info uroxatral
What other drugs will affect theophylline? Lithium dose required to achieve a therapeutic serum concentration increased an average of 60%. Monitor the patient and obtain a serum theophylline concentration in 2 - 4 hours to insure that the concentration is not increasing. There are no adequate and well controlled studies in pregnant women. Gastrointestinal side effects have included anorexia, nausea, vomiting, and abdominal pain. Theophylline may also cause locally-mediated gastrointestinal upset.
If the patient's symptoms are well controlled, there are no apparent adverse effects, and no intervening factors that might alter dosage requirements see and serum theophylline concentrations should be monitored at 6 month intervals for rapidly growing children and at yearly intervals for all others. Theophylline only rarely alters the pharmacokinetics of other drugs. Serum theophylline and phenytoin concentrations decrease about 40%. buy now rabeprazole generic
SDwhere actual range not reported. Uniphyl theophylline anhydrous tablet Tablets on a mg-for-mg basis. The chronicity and pattern of theophylline overdosage significantly influences clinical manifestations of toxicity, management and outcome. Patients with more rapid metabolism, clinically identified by higher than average dose requirements, should receive a smaller dose more frequently every 8 hours to prevent breakthrough symptoms resulting from low trough concentrations before the next dose. phenytoin