Citation

Magdalan J. Advances in Clinical and Experimental Medicine 2005; 14(6): 1319-1326.

Copyright

(Copyright © 2005)

DOI

unavailable

PMID

unavailable

Abstract

This paper presents a review of current opinion on toxicity of theophylline, the clinical picture, diagnosis and treatment of acute and chronic theophylline poisoning. Theophylline, a methylxanthine, has been used for the management of pulmonary disorders such as chronic obstructive pulmonary disease and asthma but it has a very narrow therapeutic index, which makes toxicity a common problem. The acute theophylline overdose is usually a result of attempted suicide. Patient develop chronic theophylline toxicity as a result of accumulation secondary to inappropriate dosing over several days, liver disease, drug interactions, or other processes that inhibit the elimination of theophylline. The patient with theophylline overdose commonly presents: nausea, vomiting, sinus tachycardia, muscle tremor, tachypnoe and respiratory alkalosis. Severe theophylline intoxication can lead to severe cardiac arrhythmias, convulsions, cardiovascular collapse and metabolic acidosis. In cases of severe theophylline intoxications prompt diagnosis and symptomatic treatment in an intensive care unit are of primary importance. Activated charcoal for gastrointestinal decontamination is the mainstay for acute and chronic theophylline poisoning. Whole bowel irrigation may be considered under some circumstances. In patients with severe theophylline poisoning hemoperfusion is the recommended method for rapid reduction of serum theophylline levels. Hemodialysis removes significant amounts of theophylline and should be performed when hemoperfusion is not available. Preliminary study suggests that "high-flux" synthetic membrane hemodialysis with large-surface-area dialyzers or continous venovenous hemofiltration are an effective alternative to charcoal hemoperfusion. It is still need of a safe and effective antidote of theophylline for routine medical use.

Language: pl

Keywords

Intoxication; human; shock; Treatment; hemodialysis; suicide attempt; drug overdose; review; vomiting; drug intoxication; clinical feature; fluvoxamine; intensive care unit; gastrointestinal symptom; isoniazid; convulsion; drug potentiation; nausea; tremor; hypotension; asthma; antidote; theophylline; lung disease; cimetidine; heart arrhythmia; chronic obstructive lung disease; cytochrome P450; drug elimination; metabolic acidosis; intestine lavage; charcoal; respiratory alkalosis; continuous hemofiltration; sinus tachycardia; ciprofloxacin; ticlopidine; verapamil; liver disease; erythromycin; tachypnea; allopurinol; Theophylline; clarithromycin; hemoperfusion; marbofloxacin; methylxanthine; norfloxacin