Version July 2025
Dosage guidance:
Clinical considerations: Individualize dose based on steady state serum theophylline concentrations; use ideal body weight to calculate dose; consider lowering dose or using a slower titration if caffeine-like adverse events occur.
Bradycardia, heart transplantation (off-label use): Note: Based on limited data and clinical experience.
Oral: Initial: 100 to 150 mg twice daily; titrate as needed based on heart rate response and tolerability; daily doses of up to 900 mg/day have been reported (Ref).
Reversible airflow obstruction: Note: Although the manufacturer’s labeling states an oral IR formulation may be used temporarily for acute bronchodilation if an inhaled or parenteral beta agonist is not available, routine use of theophylline is not recommended for the treatment of acute asthma exacerbations or chronic obstructive pulmonary disease exacerbations (Ref). When used for chronic conditions, may use smaller doses more frequently in patients requiring higher than average doses to prevent breakthrough symptoms; in patients at risk for impaired theophylline clearance or if not feasible to monitor serum theophylline concentrations, do not exceed maximum dose of 400 mg/day. Optimal regimen, dose, and therapeutic concentrations are uncertain; refer to institutional protocol.
Acute bronchodilation:
Immediate release (oral solution): Oral: 5 mg/kg once. Note: For patients who have received theophylline or aminophylline in the previous 24 hours, dose adjustments should be based on patient symptoms, response to concomitant bronchodilation therapy and serum theophylline concentrations.
Chronic conditions:
Immediate release (oral solution) (patients without risk factors for impaired clearance): Oral: Initial: 300 mg/day in divided doses every 6 to 8 hours; if tolerated, after 3 days increase to 400 mg/day divided every 6 to 8 hours; if tolerated, after 3 more days increase to 600 mg/day divided every 6 to 8 hours.
Extended release (patients without risk factors for impaired clearance):
12-hour formulation (tablets): Oral: Initial: 300 mg/day in divided doses every 12 hours; if tolerated, after 3 days increase to 400 mg/day in divided doses every 12 hours; if tolerated, after 3 days, increase to 600 mg/day in divided doses every 12 hours.
24-hour formulation (capsules and tablets): Oral: Initial: 300 mg once daily; if tolerated after 3 days increase to 400 to 600 mg once daily; if doses >600 mg are needed, titrate according to serum theophylline concentration.
Dosage adjustment based on serum theophylline concentrations : Note: Recheck serum theophylline concentrations 3 days after dosage adjustment. Patients should be reassessed at 6- to 12-month intervals, when clinically indicated, or if concomitant medication is added that may affect theophylline serum concentration.
Oral: Peak serum theophylline concentration:
<9.9 mcg/mL: If dosage is tolerated, but symptoms are not controlled, increase dose by ~25%; recheck serum theophylline concentration after 3 days for further dosage adjustment.
10 to 14.9 mcg/mL: If symptoms are controlled and current dose tolerated, maintain dose and recheck serum theophylline concentrations at 6- to 12-month intervals; if symptoms are not controlled and current dose is tolerated, consider adding additional medications.
15 to 19.9 mcg/mL: Consider 10% decrease in dose to improve safety margin even if current dose is tolerated.
20 to 24.9 mcg/mL: Decrease dose by 25% even if no adverse effects present; recheck serum theophylline concentrations after 3 days to guide further dosage adjustment.
25 to 30 mcg/mL: Skip next dose; decrease subsequent doses by at least 25% even if no adverse effects present; recheck serum theophylline concentrations after 3 days to guide further dosage adjustments; if symptomatic or signs of toxicity, discontinue therapy and consider if overdose treatment is needed.
>30 mcg/mL: Stop therapy and treat overdose; if theophylline is resumed, decrease dose by at least 50% and recheck serum theophylline concentrations after 3 days to guide further dosage adjustment.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Altered kidney function: Oral:
eGFR ≥15 mL/minute/1.73 m2: No dosage adjustment necessary (Ref).
eGFR <15 mL/minute/1.73 m2: No dosage adjustment necessary (Ref). Although concentrations of theophylline are not significantly altered in kidney impairment, metabolites may accumulate and potentially contribute to adverse effects (Ref); use with caution and monitor for adverse effects.
Hemodialysis, intermittent (thrice weekly): Oral: Dialyzable (~40%) (Ref): Dose as for eGFR <15 mL/minute/1.73 m2 (Ref). Note: When scheduled doses fall on dialysis days, when using immediate release preparations, one of the doses should be administered after hemodialysis, if possible. Sustained-release preparations may be administered regardless of the timing of dialysis (Ref).
Peritoneal dialysis: Oral: Likely to be dialyzable: Dose as for eGFR <15 mL/minute/1.73 m2 (Ref).
CRRT: Oral: No dosage adjustment necessary (Ref).
PIRRT (eg, sustained, low-efficiency diafiltration): Oral: No dosage adjustment necessary (Ref).
There are no specific dosage adjustments provided in manufacturer's labeling. Dose reduction and frequent monitoring of serum theophylline concentration are required; risk of severe and potentially fatal toxicity may occur. Maximum dose: 400 mg/day.
Reversible airflow obstruction, acute bronchodilation: Oral: Refer to adult dosing. Maximum total daily dose: 400 mg/day unless serum theophylline concentrations indicate need for larger dose.
Reversible airflow obstruction, chronic conditions: Oral: Starting doses in older adults should be reduced by 25% compared to younger adult populations (Ref). Maximum total daily dose: 400 mg/day (unless symptomatic and the peak steady-state serum theophylline concentration is <10 mcg/mL).
(For additional information see "Theophylline: Pediatric drug information")
Note: Doses should be individualized based on steady-state serum concentrations; theophylline pharmacokinetics have age-dependent factors which may alter required doses particularly in pediatric patients. For obese patients, ideal body weight should be used for dosage calculation.
Reversible airway obstruction, acute symptoms:
Note: Not recommended for the treatment of asthma exacerbations (Ref). Theophylline is a weak bronchodilator and other agents are more effective for acute bronchospasm. If other agents unavailable, the following doses are recommended (Ref).
Loading dose: Note: Doses presented intended to achieve a serum level of approximately 10 mcg/mL; loading doses should be administered intravenously (aminophylline) or with a rapidly absorbed oral product (not an extended-release product). On the average, for every 1 mg/kg theophylline given, blood concentrations will rise 2 mcg/mL.
Patients not currently receiving methylxanthines:
Oral: Immediate-release product: 5 mg/kg.
Patients currently receiving methylxanthines: A loading dose is not recommended without first obtaining a serum theophylline concentration in patients who have received aminophylline or theophylline within the past 24 hours. The loading dose should be calculated as follows:
Dose = (C desired – C measured) (Vd)
C desired = desired serum theophylline concentration
C measured = measured serum theophylline concentration
Reversible airflow obstruction, chronic conditions:
Note: Increase dose only if tolerated. Consider lowering dose or using a slower titration if caffeine-like adverse events occur. Smaller doses given more frequently may be used in patients with a more rapid metabolism to prevent breakthrough symptoms which could occur due to low trough concentration prior to the next dose.
Immediate-release formulations:
Note: If at risk for impaired clearance or not feasible to monitor serum theophylline concentrations then do not exceed 16 mg/kg/day; maximum daily dose: 400 mg/day.
Infants: Oral:
Total daily dose (mg/day) = [(0.2 × age in weeks) + 5] × (weight in kg); frequency is based on age.
Dosing interval (frequency based on age):
≤26 weeks: Divide in 3 equal doses and administer every 8 hours.
>26 weeks: Divide in 4 equal doses and administer every 6 hours.
Children and Adolescents ≤15 years and ≤45 kg:
Initial:
Days 1 to 3: Oral: 12 to 14 mg/kg/day in divided doses every 4 to 6 hours; maximum daily dose: 300 mg/day.
Days 4 to 6: Oral: 16 mg/kg/day in divided doses every 4 to 6 hours; maximum daily dose: 400 mg/day.
Maintenance: Oral: 20 mg/kg/day in divided doses every 4 to 6 hours; maximum daily dose: 600 mg/day.
Children and Adolescents >45 kg or Adolescents ≥16 years:
Initial:
Days 1 to 3: Oral: 300 mg/day in divided doses every 6 to 8 hours.
Days 4 to 6: Oral: 400 mg/day in divided doses every 6 to 8 hours.
Maintenance: Oral: 600 mg/day in divided doses every 6 to 8 hours.
Note: For maintenance treatment of asthma, experts have recommended lower doses to reduce incidence of adverse events: Initial: ~10 mg/kg/day in infants >6 months, children and adolescents (maximum daily dose: 300 mg/day); if after at least 3 days the initial dose is tolerated, increase to ~13 mg/kg/day (maximum daily dose: 450 mg/day); if after at least 3 days dose increase is tolerated, increase to ~16 mg/kg/day (maximum daily dose: 600 mg/day) (Ref).
Extended-release formulations:
Note: If at risk for impaired clearance or not feasible to monitor serum theophylline concentrations then do not exceed 16 mg/kg/day; maximum daily dose: 400 mg/day.
Children ≥6 years and Adolescents <16 years, weighing ≤45 kg:
Initial:
Days 1 to 3: Oral: 12 to 14 mg/kg/day; maximum daily dose: 300 mg/day.
Days 4 to 6: Oral: 16 mg/kg/day; maximum daily dose: 400 mg/day.
Maintenance: Oral: 20 mg/kg/day; maximum daily dose: 600 mg/day.
Dosing interval (product specific):
12-hour extended-release tablets: Children ≥6 years and Adolescents: Divide in 2 equal doses and administer every 12 hours.
24-hour extended-release tablets: Children ≥12 years and Adolescents: Administer every 24 hours.
Children ≥6 years and Adolescents, weighing >45 kg or Adolescents ≥16 years:
12-hour extended-release tablets: Children ≥6 years and Adolescents, weighing >45 kg or Adolescents ≥16 years:
Initial:
Days 1 to 3: Oral: 300 mg/day in divided doses every 12 hours.
Days 4 to 6: Oral: 400 mg/day in divided doses every 12 hours.
Maintenance: Oral: 600 mg/day in divided doses every 12 hours.
24-hour extended-release tablets: Children ≥12 years and Adolescents, weighing >45 kg or Adolescents ≥16 years:
Initial:
Days 1 to 3: Oral: 300 to 400 mg once daily.
Days 4 to 6: Oral: 400 to 600 mg once daily.
Maintenance: Titrate according to serum concentrations.
Note: For maintenance treatment of asthma, experts have recommended lower doses to reduce incidence of adverse events: Initial: ~10 mg/kg/day in children and adolescents (maximum daily dose: 300 mg/day); if after at least 3 days the dose is tolerated, increase to ~13 mg/kg/day (maximum daily dose: 450 mg/day); if after at least 3 days dose increase is tolerated, increase to ~16 mg/kg/day (maximum daily dose: 600 mg/day) (Ref).
Dosage adjustment based on peak serum theophylline concentrations (Ref):
Infants, Children, and Adolescents:
Note: Recheck serum theophylline concentrations after 3 days. Patients maintained with oral therapy should be reassessed at 6- to 12-month intervals, when clinically indicated, or if concomitant medication is added which may affect theophylline serum concentration.
<10 mcg/mL: If symptoms not controlled and current dose tolerated, increase dose by ~25%. Recheck serum theophylline concentrations.
10 to 15 mcg/mL: If symptoms controlled and current dose tolerated, maintain dosage; recheck serum concentrations at 6- to 12-month intervals. If symptoms are not controlled and current dose is tolerated, consider adding additional medications.
15.1 to 19.9 mcg/mL: Consider 10% dose reduction to improve safety margin even if dose is tolerated.
20 to 24.9 mcg/mL: Withhold next dose, decrease dose by ~25% even if no adverse effect present. Recheck serum concentrations.
25 to 30 mcg/mL: Skip next 1 to 2 doses and decrease subsequent doses by at least 25% even if no adverse effect present. Recheck serum concentrations.
>30 mcg/mL: Stop dosing and treat overdose; if resumed, decrease subsequent doses by at least 50%. Recheck serum concentrations.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Infants 1 to 3 months: Oral: Due to reduced clearance, consider dose reduction and frequent monitoring of serum theophylline concentrations.
Infants >3 months, Children, and Adolescents: Oral: No adjustment necessary.
Infants, Children, and Adolescents: Oral: There are no specific dosage adjustments provided in the manufacturer's labeling. Dose reduction and frequent monitoring of serum theophylline concentration are required in patients with decreased hepatic function (eg, cirrhosis, acute hepatitis, cholestasis).
The following adverse drug reactions are derived from product labeling unless otherwise specified.
Frequency not defined:
Endocrine & metabolic: Hypercholesterolemia (including increased HDL cholesterol), increased cortisol (urinary free cortisol excretion), increased free fatty acids
Gastrointestinal: Nausea, vomiting
Nervous system: Headache, insomnia
Postmarketing:
Cardiovascular: Cardiac arrhythmia, palpitations (Koh 2002), sinus tachycardia (Koh 2002)
Dermatologic: Pruritus, skin rash, urticaria
Endocrine & metabolic: Hypercalcemia (Kuwahara 2022), hyperglycemia (Koh 2002), hyperuricemia (Morita 1984), hypokalemia (Koh 2002), lactic acidosis (Koh 2002)
Gastrointestinal: Abdominal pain, diarrhea, gastric irritation, gastroesophageal reflux disease
Genitourinary: Diuresis, urinary retention
Hypersensitivity: Anaphylaxis, nonimmune anaphylaxis
Nervous system: Agitation, anxiety, irritability, restlessness, seizure, tremor
Hypersensitivity to theophylline or any component of the formulation.
Canadian labeling: Additional contraindications (not in US labeling): Hypersensitivity to xanthine derivatives; coronary artery disease (where cardiac stimulation might prove harmful); peptic ulcers; coadministration with ephedrine in children.
Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Concerns related to adverse effects:
• Theophylline toxicity: Severe and potentially fatal theophylline toxicity may occur if reduced theophylline clearance occurs. Theophylline clearance may be decreased in patients with acute pulmonary edema, heart failure, cor pulmonale, fever (≥102°F for ≥24 hours or lesser temperature elevations for longer periods), hepatic disease, acute hepatitis, cirrhosis, hypothyroidism, sepsis with multiorgan failure, shock, neonates (term and premature), infants <3 months of age with decreased kidney function, infants <1 year of age, patients >60 years of age, and patients following cessation of smoking. Consider benefits versus risks and the need for more intensive monitoring in these patients. If a patient develops signs and symptoms of theophylline toxicity (eg, nausea or persistent, repetitive vomiting), a serum theophylline concentration should be measured immediately and subsequent doses withheld.
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with cardiac arrhythmias (excluding bradyarrhythmias); use may exacerbate arrhythmias.
• Cystic fibrosis: Use with caution in patients with cystic fibrosis; increased theophylline clearance may occur.
• Hepatic impairment: Use with caution in patients with hepatic impairment (eg, cirrhosis, acute hepatitis, cholestasis); risk of severe and potentially fatal theophylline toxicity is increased; theophylline clearance is decreased ≥50% in these patients. Dose reduction and frequent monitoring of serum theophylline concentration are required.
• Hyperthyroidism: Use with caution in patients with hyperthyroidism; increased theophylline clearance may occur.
• Peptic ulcer disease: Use with caution in patients with active peptic ulcer disease; use may exacerbate peptic ulcer.
• Seizure disorder: Use with caution in patients with seizure disorders; use may exacerbate seizure disorder.
Special populations:
• Older adult: Use extreme caution in patients >60 years of age; these patients are at greater risk of serious theophylline toxicity.
• Pediatric: Select dose with caution and with frequent monitoring of concentrations (especially <1 year); rate of clearance is highly variable in these patients.
Dosage form specific issues:
• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Zar 2007).
Other warnings/precautions:
• Appropriate use: Do not increase dose in response to acute exacerbation of symptoms unless steady state serum theophylline concentration is <10 mcg/mL. As the rate of theophylline clearance may be dose-dependent, an increase in dose based upon a subtherapeutic serum theophylline concentration measurement should be limited to ~25% increase of the previous daily dose.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule Extended Release 24 Hour, Oral:
Theo-24: 100 mg [contains fd&c yellow #6 (sunset yellow)]
Theo-24: 200 mg [contains quinoline yellow (d&c yellow #10)]
Theo-24: 300 mg [contains fd&c blue #1 (brilliant blue), fd&c red #40 (allura red ac dye)]
Theo-24: 400 mg [contains fd&c red #40 (allura red ac dye)]
Elixir, Oral:
Elixophyllin: 80 mg/15 mL (473 mL) [contains alcohol, usp, fd&c red #40 (allura red ac dye), saccharin sodium; mixed fruit flavor]
Generic: 80 mg/15 mL (15 mL, 473 mL)
Solution, Oral:
Generic: 80 mg/15 mL (15 mL, 473 mL)
Tablet Extended Release 12 Hour, Oral:
Generic: 100 mg, 200 mg, 300 mg, 450 mg
Tablet Extended Release 24 Hour, Oral:
Generic: 400 mg, 600 mg
May be product dependent
Capsule ER 24 Hour Therapy Pack (Theo-24 Oral)
100 mg (per each): $4.64
200 mg (per each): $6.90
300 mg (per each): $8.48
400 mg (per each): $11.93
Elixir (Elixophyllin Oral)
80 mg/15 mL (per mL): $0.83
Elixir (Theophylline Oral)
80 mg/15 mL (per mL): $0.83
Solution (Theophylline Oral)
80 mg/15 mL (per mL): $0.24 - $1.14
Tablet, 12-hour (Theophylline ER Oral)
100 mg (per each): $3.65
200 mg (per each): $5.43
300 mg (per each): $1.56 - $4.30
450 mg (per each): $3.60 - $6.04
Tablet, 24-hour (Theophylline ER Oral)
400 mg (per each): $1.36 - $1.67
600 mg (per each): $1.96 - $2.42
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Elixir, Oral:
Generic: 80 mg/15 mL (500 mL, 4500 mL)
Solution, Oral:
Theolair: 80 mg/15 mL ([DSC]) [contains methylparaben, propylparaben]
Tablet Extended Release 12 Hour, Oral:
Generic: 100 mg, 200 mg, 300 mg
Tablet Extended Release 24 Hour, Oral:
Generic: 400 mg, 600 mg
Oral:
Immediate-release formulations: Oral solution: Administer with an accurate measuring device (calibrated oral syringe or measuring cup); do not use a household teaspoon or tablespoon to measure dose (overdosage may occur).
Extended release: Administer consistently with or without food (to maintain a consistent drug concentration); do not chew or crush tablets; may split tablet if scored. An intact matrix tablet may pass in stool.
12-hour formulation: May be administered as once daily dosing in non-smokers (with appropriate total body clearance) and patients with low dosage requirements; consider only after titrated to therapeutic serum theophylline concentrations. Base once-daily dosing on the twice-daily dosing and initiate at the end of the last every-12-hour dosing interval. Once-daily dosing should not be administered at night (after the evening meal).
24-hour formulation: Administer each morning at approximately the same time; avoid administration at night (after the evening meal). Patients who require a high dose (ie, ≥900 mg or 13 mg/kg, whichever is less), should take medication less than 1 hour before a high-fat meal (significant increase in peak serum theophylline concentration and absorption may occur). Patients should consistently take theophylline with food or in fasting state. Twice-daily dosing may be considered in patients who metabolize theophylline rapidly (eg, younger patients, smokers, and some nonsmoking adults) and who have symptoms at the end of a dosing interval; administer one dose in the morning and the second dose 10 to 12 hours later (but before the evening meal); avoid administration at night (after the evening meal).
Bariatric surgery: Capsule and tablet, extended release: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate. ER capsule and tablet should be swallowed. Do not crush or chew. IR oral solution, oral elixir, and injectable formulations are available. If safety and efficacy can be effectively monitored, no change in formulation or administration is required after bariatric surgery; however, if swallowing is an issue after surgery, capsule formulations may be opened and sprinkled on soft foods.
Oral:
Immediate-release formulations:
Oral solution: Administer with an accurate measuring device (calibrated oral syringe or measuring cup); do not use a household teaspoon or tablespoon to measure dose (overdosage may occur).
Extended-release formulations:
Capsules: Administer at approximately the same time each morning; avoid administration at night (after the evening meal). Patients who require a high dose (ie, 13 mg/kg or ≥900 mg, whichever is less), should not take medication <1 hour before a high-fat meal (significant increase in peak serum level and absorption may occur). Twice-daily dosing may be considered in patients who metabolize theophylline rapidly (eg, younger patients, smokers, some nonsmoking adults) and who repeatedly have symptoms at the end of a dosing interval; administer 1 dose in the morning and the second dose 10 to 12 hours later (but before the evening meal); avoid administration at night (after the evening meal).
Tablets: Administer consistently with or without food (to maintain a consistent drug level); do not chew or crush tablets; may split tablet if scored. An intact matrix tablet may pass in stool.
Reversible airflow obstruction: Treatment of symptoms and reversible airflow obstruction associated with chronic asthma, or other chronic lung diseases (eg, emphysema, chronic bronchitis).
Bradycardia, heart transplantation
The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs (pediatric liquid medications requiring measurement) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Community/Ambulatory Care Settings).
Substrate of CYP1A2 (Major), CYP2E1 (Minor), CYP3A4 (Minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential;
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Acebrophylline: May increase stimulatory effects of Theophylline Derivatives. Risk X: Avoid
Adalimumab: May decrease serum concentration of Theophylline Derivatives. Risk C: Monitor
Adenosine: Theophylline Derivatives may decrease therapeutic effects of Adenosine. Management: Consider alternatives to this combination if possible. Theophylline may decrease adenosine efficacy and higher adenosine doses may be required. When using adenosine for diagnostic studies, discontinue theophylline derivatives 5 half-lives prior to test. Risk D: Consider Therapy Modification
Alcohol (Ethyl): May increase serum concentration of Theophylline. Risk C: Monitor
Aldesleukin: May increase serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk C: Monitor
Allopurinol: May increase serum concentration of Theophylline Derivatives. Risk C: Monitor
Amifampridine: Agents With Seizure Threshold Lowering Potential may increase neuroexcitatory and/or seizure-potentiating effects of Amifampridine. Risk C: Monitor
Amisulpride (Oral): Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Amisulpride (Oral). Specifically, the risk of seizures may be increased. Risk C: Monitor
Antithyroid Agents: May increase serum concentration of Theophylline Derivatives. Risk C: Monitor
ARIPiprazole Lauroxil: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of ARIPiprazole Lauroxil. Specifically, the risk of seizures may be increased. Risk C: Monitor
ARIPiprazole: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of ARIPiprazole. Specifically, the risk of seizures may be increased. Risk C: Monitor
Asenapine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Asenapine. Specifically, the risk of seizures may be increased. Risk C: Monitor
Atomoxetine: May increase hypertensive effects of Sympathomimetics. Atomoxetine may increase tachycardic effects of Sympathomimetics. Risk C: Monitor
Barbiturates: May decrease serum concentration of Theophylline Derivatives. Risk C: Monitor
Benperidol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Benperidol. Specifically, the risk of seizures may be increased. Risk C: Monitor
Benzodiazepines: Theophylline Derivatives may decrease therapeutic effects of Benzodiazepines. Risk C: Monitor
Beta-Acetyldigoxin: Theophylline Derivatives may increase arrhythmogenic effects of Beta-Acetyldigoxin. Risk C: Monitor
Beta-Blockers (Beta1 Selective): May decrease bronchodilatory effects of Theophylline Derivatives. Risk C: Monitor
Beta-Blockers (Nonselective): May decrease bronchodilatory effects of Theophylline Derivatives. Risk C: Monitor
Beta2-Agonists: Theophylline Derivatives may increase hypokalemic effects of Beta2-Agonists. Beta2-Agonists may increase adverse/toxic effects of Theophylline Derivatives. Specifically, sympathomimetic effects may be increased. Risk C: Monitor
Blonanserin: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Blonanserin. Specifically, the risk of seizures may be increased. Risk C: Monitor
Bornaprine: Sympathomimetics may increase anticholinergic effects of Bornaprine. Risk C: Monitor
Brexpiprazole: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Brexpiprazole. Specifically, the risk of seizures may be increased. Risk C: Monitor
Broccoli: May decrease serum concentration of CYP1A2 Substrates (High risk with Inducers). Risk C: Monitor
Bromperidol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Bromperidol. Specifically, the risk of seizures may be increased. Risk C: Monitor
BuPROPion: May increase neuroexcitatory and/or seizure-potentiating effects of Agents With Seizure Threshold Lowering Potential. Risk C: Monitor
Cannabinoid-Containing Products: May increase tachycardic effects of Sympathomimetics. Risk C: Monitor
Cannabis: May decrease serum concentration of CYP1A2 Substrates (High risk with Inducers). Risk C: Monitor
CarBAMazepine: May decrease serum concentration of Theophylline Derivatives. Theophylline Derivatives may decrease serum concentration of CarBAMazepine. Management: Seek alternatives to this combination when possible. If these agents are used together, monitor closely for decreased serum concentrations/therapeutic effects of both medications. Risk D: Consider Therapy Modification
Cariprazine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Cariprazine. Specifically, the risk of seizures may be increased. Risk C: Monitor
ChlorproMAZINE: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of ChlorproMAZINE. Specifically, the risk of seizures may be increased. Risk C: Monitor
Clarithromycin: May increase serum concentration of Theophylline Derivatives. Risk C: Monitor
Clothiapine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Clothiapine. Specifically, the risk of seizures may be increased. Risk C: Monitor
CloZAPine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of CloZAPine. Specifically, the risk of seizures may be increased. Risk C: Monitor
Cocaine (Topical): May increase hypertensive effects of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Risk D: Consider Therapy Modification
CYP1A2 Inducers (Moderate): May decrease serum concentration of Theophylline Derivatives. Risk C: Monitor
CYP1A2 Inhibitors (Moderate): May increase serum concentration of Theophylline Derivatives. Management: Consider avoidance of this combination. If coadministration is necessary, monitor for increased theophylline serum concentrations and toxicities when combined. Theophylline dose reductions will likely be required. Risk D: Consider Therapy Modification
CYP1A2 Inhibitors (Strong): May increase serum concentration of Theophylline Derivatives. Management: Consider avoidance of this combination. If coadministration is necessary, consider an empiric theophylline dose reduction to one-third of the original theophylline dose. Monitor for increased theophylline serum concentrations and toxicities when combined. Risk D: Consider Therapy Modification
CYP1A2 Inhibitors (Weak): May increase serum concentration of Theophylline Derivatives. Risk C: Monitor
Diazoxide Choline: May increase serum concentration of CYP1A2 Substrates (High risk with Inhibitors). Risk X: Avoid
Dichlorphenamide: Theophylline may increase hypokalemic effects of Dichlorphenamide. Risk C: Monitor
Digitoxin: Theophylline Derivatives may increase adverse/toxic effects of Digitoxin. Risk C: Monitor
Dihydralazine: Sympathomimetics may decrease therapeutic effects of Dihydralazine. Risk C: Monitor
Dinutuximab Beta: May increase serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk C: Monitor
Disulfiram: May increase serum concentration of Theophylline. Risk C: Monitor
Doxofylline: Theophylline Derivatives may increase adverse/toxic effects of Doxofylline. Risk X: Avoid
DroPERidol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of DroPERidol. Specifically, the risk of seizures may be increased. Risk C: Monitor
Elranatamab: May increase serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk C: Monitor
Epcoritamab: May increase serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk C: Monitor
EPHEDrine (Systemic): Theophylline may increase stimulatory effects of EPHEDrine (Systemic). Risk C: Monitor
Erythromycin (Systemic): May increase serum concentration of Theophylline Derivatives. Theophylline Derivatives may decrease serum concentration of Erythromycin (Systemic). Management: Consider alternatives to this combination. If combined, monitor for increased serum concentrations/toxic effects of theophylline derivatives.Theophylline derivative dose reductions may be needed. Also monitor for reduced erythromycin efficacy. Risk D: Consider Therapy Modification
Esketamine (Injection): May increase adverse/toxic effects of Theophylline Derivatives. Specifically, the risk for seizures may be increased. Risk X: Avoid
Febuxostat: May increase active metabolite exposure of Theophylline Derivatives. Specifically, concentrations of 1-methylxanthine, a metabolite of unknown clinical importance, may become elevated. Risk C: Monitor
Filgotinib: May increase serum concentration of CYP1A2 Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk C: Monitor
Fluconazole: May increase serum concentration of Theophylline Derivatives. Risk C: Monitor
Flupentixol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Flupentixol. Specifically, the risk of seizures may be increased. Risk C: Monitor
FluPHENAZine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of FluPHENAZine. Specifically, the risk of seizures may be increased. Risk C: Monitor
Fosphenytoin-Phenytoin: May decrease serum concentration of Theophylline Derivatives. Risk C: Monitor
Glofitamab: May increase serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk C: Monitor
Guanethidine: May increase hypertensive effects of Sympathomimetics. Guanethidine may increase arrhythmogenic effects of Sympathomimetics. Risk C: Monitor
Haloperidol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Haloperidol. Specifically, the risk of seizures may be increased. Risk C: Monitor
Iloperidone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Iloperidone. Specifically, the risk of seizures may be increased. Risk C: Monitor
Interleukin-6 (IL-6) Inhibiting Therapies: May decrease serum concentration of Theophylline. Risk C: Monitor
Iohexol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Iohexol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iohexol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic antiseizure drugs. Risk D: Consider Therapy Modification
Iomeprol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Iomeprol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iomeprol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic antiseizure drugs. Risk D: Consider Therapy Modification
Iopamidol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Iopamidol. Specifically, the risk for seizures may be increased. Management: Discontinue agents that may lower the seizure threshold 48 hours prior to intrathecal use of iopamidol. Wait at least 24 hours after the procedure to resume such agents. In nonelective procedures, consider use of prophylactic antiseizure drugs. Risk D: Consider Therapy Modification
Isoniazid: May increase serum concentration of Theophylline Derivatives. Risk C: Monitor
Isoproterenol: May decrease serum concentration of Theophylline Derivatives. Risk C: Monitor
Ketamine: May increase adverse/toxic effects of Theophylline Derivatives. Specifically, the risk for seizures may be increased. Risk C: Monitor
Kratom: May increase adverse/toxic effects of Sympathomimetics. Risk X: Avoid
Leniolisib: May increase serum concentration of CYP1A2 Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk X: Avoid
Levothyroxine: May increase therapeutic effects of Sympathomimetics. Sympathomimetics may increase therapeutic effects of Levothyroxine. Levothyroxine may increase adverse/toxic effects of Sympathomimetics. Specifically, the risk of coronary insufficiency may be increased in patients with coronary artery disease. Risk C: Monitor
Linezolid: May increase hypertensive effects of Sympathomimetics. Management: Consider initial dose reductions of sympathomimetic agents, and closely monitor for enhanced blood pressure elevations, in patients receiving linezolid. Risk D: Consider Therapy Modification
Lithium: Theophylline Derivatives may decrease serum concentration of Lithium. Risk C: Monitor
Loxapine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Loxapine. Specifically, the risk of seizures may be increased. Risk C: Monitor
Lumateperone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Lumateperone. Specifically, the risk of seizures may be increased. Risk C: Monitor
Lurasidone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Lurasidone. Specifically, the risk of seizures may be increased. Risk C: Monitor
Methacholine: Theophylline may decrease therapeutic effects of Methacholine. Management: Hold theophylline for 12 to 48 hours before methacholine use. Risk D: Consider Therapy Modification
Methotrexate: May increase serum concentration of Theophylline Derivatives. Risk C: Monitor
Methotrimeprazine: May increase CNS depressant effects of Products Containing Ethanol. Management: Avoid products containing alcohol in patients treated with methotrimeprazine. Risk X: Avoid
MetroNIDAZOLE (Systemic): May increase adverse/toxic effects of Products Containing Ethanol. A disulfiram-like reaction may occur. Risk X: Avoid
MetroNIDAZOLE (Topical): May increase adverse/toxic effects of Products Containing Ethanol. A disulfiram-like reaction may occur. Risk C: Monitor
Molindone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Molindone. Specifically, the risk of seizures may be increased. Risk C: Monitor
Mosunetuzumab: May increase serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk C: Monitor
NIFEdipine (Topical): May decrease serum concentration of Theophylline Derivatives. NIFEdipine (Topical) may increase serum concentration of Theophylline Derivatives. Risk C: Monitor
Nirmatrelvir and Ritonavir: May decrease serum concentration of Theophylline Derivatives. Risk C: Monitor
Norfloxacin: May increase serum concentration of Theophylline Derivatives. Risk C: Monitor
OLANZapine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of OLANZapine. Specifically, the risk of seizures may be increased. Risk C: Monitor
Pacritinib: May increase serum concentration of CYP1A2 Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk C: Monitor
Paliperidone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Paliperidone. Specifically, the risk of seizures may be increased. Risk C: Monitor
Pancuronium: Theophylline Derivatives may decrease neuromuscular-blocking effects of Pancuronium. Theophylline Derivatives may increase adverse/toxic effects of Pancuronium. Risk C: Monitor
Pentoxifylline: May increase serum concentration of Theophylline Derivatives. Risk C: Monitor
Periciazine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Periciazine. Specifically, the risk of seizures may be increased. Risk C: Monitor
Perphenazine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Perphenazine. Specifically, the risk of seizures may be increased. Risk C: Monitor
Pimozide: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Pimozide. Specifically, the risk of seizures may be increased. Risk C: Monitor
Pipamperone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Pipamperone. Specifically, the risk of seizures may be increased. Risk X: Avoid
Polyethylene Glycol-Electrolyte Solution: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Polyethylene Glycol-Electrolyte Solution. Specifically, the risk of seizure may be increased. Risk C: Monitor
Primaquine: May increase serum concentration of CYP1A2 Substrates (High risk with Inhibitors). Risk C: Monitor
Prochlorperazine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Prochlorperazine. Specifically, the risk of seizures may be increased. Risk C: Monitor
Promazine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Promazine. Specifically, the risk of seizures may be increased. Risk C: Monitor
QUEtiapine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of QUEtiapine. Specifically, the risk of seizures may be increased. Risk C: Monitor
QuiNINE: May decrease serum concentration of Theophylline Derivatives. Theophylline Derivatives may increase serum concentration of QuiNINE. Risk C: Monitor
Regadenoson: Theophylline may decrease vasodilatory effects of Regadenoson. Theophylline may increase neuroexcitatory and/or seizure-potentiating effects of Regadenoson. Management: Avoid using theophylline or other methylxanthines (eg, caffeine) for at least 12 hours prior to the administration of regadenoson. Methylxanthines may be administered after regadenoson to diminish adverse events. Monitor for seizures. Risk D: Consider Therapy Modification
RifAMPin: May decrease serum concentration of Theophylline Derivatives. Risk C: Monitor
Riociguat: Theophylline Derivatives may increase hypotensive effects of Riociguat. Risk X: Avoid
RisperiDONE: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of RisperiDONE. Specifically, the risk of seizures may be increased. Risk C: Monitor
Ritlecitinib: May increase serum concentration of CYP1A2 Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk C: Monitor
Ritonavir: May decrease serum concentration of Theophylline Derivatives. Risk C: Monitor
Secnidazole: Products Containing Ethanol may increase adverse/toxic effects of Secnidazole. Risk X: Avoid
Sertindole: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Sertindole. Specifically, the risk of seizures may be increased. Risk C: Monitor
Sodium Phosphates: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Sodium Phosphates. Specifically, the risk of seizure or loss of consciousness may be increased in patients with significant sodium phosphate-induced fluid or electrolyte abnormalities. Risk C: Monitor
Solriamfetol: Sympathomimetics may increase hypertensive effects of Solriamfetol. Sympathomimetics may increase tachycardic effects of Solriamfetol. Risk C: Monitor
St John's Wort: May decrease serum concentration of Theophylline. Risk C: Monitor
Sulfinpyrazone: May decrease serum concentration of Theophylline Derivatives. Risk C: Monitor
Sulpiride: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Sulpiride. Specifically, the risk of seizures may be increased. Risk C: Monitor
Sympathomimetics: May increase adverse/toxic effects of Sympathomimetics. Risk C: Monitor
Talquetamab: May increase serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk C: Monitor
Tarlatamab: May increase serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk C: Monitor
Teclistamab: May increase serum concentration of CYP Substrates (Narrow Therapeutic Index/Sensitive with Inhibitors). Risk C: Monitor
Tedizolid: May increase adverse/toxic effects of Sympathomimetics. Specifically, the risk for increased blood pressure and heart rate may be increased. Risk C: Monitor
Thioridazine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Thioridazine. Specifically, the risk of seizures may be increased. Risk C: Monitor
Thiothixene: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Thiothixene. Specifically, the risk of seizures may be increased. Risk C: Monitor
Thyroid Products: May increase metabolism of Theophylline Derivatives. Risk C: Monitor
Tobacco (Smoked): May decrease serum concentration of Theophylline Derivatives. Risk C: Monitor
Trifluoperazine: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Trifluoperazine. Specifically, the risk of seizures may be increased. Risk C: Monitor
Verapamil: May increase serum concentration of Theophylline Derivatives. Risk C: Monitor
Viloxazine: May increase serum concentration of Theophylline Derivatives. Risk X: Avoid
Zafirlukast: Theophylline Derivatives may decrease serum concentration of Zafirlukast. Zafirlukast may increase serum concentration of Theophylline Derivatives. Risk C: Monitor
Ziprasidone: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Ziprasidone. Specifically, the risk of seizures may be increased. Risk C: Monitor
Zuclopenthixol: Agents With Seizure Threshold Lowering Potential may increase adverse/toxic effects of Zuclopenthixol. Specifically, the risk of seizures may be increased. Risk C: Monitor
Ethanol: Ethanol may decrease theophylline clearance. Management: Monitor theophylline concentrations, particularly when alcohol consumption patterns change.
Food: Theophylline clearance is increased and half-life decreased by low carbohydrate/high protein diets, parenteral nutrition, and daily consumption of charcoal-broiled beef; a high carbohydrate/low protein diet can decrease the clearance and prolong the half-life of theophylline. Management: Avoid extremes of dietary protein and carbohydrate intake.
Theophylline crosses the placenta.
Maternal use of theophylline is not associated with an increased risk of fetal malformations (ERS/TSANZ [Middleton 2020]; GINA 2024). Infants exposed to theophylline during the third trimester should be monitored for adverse events (irritability, tachycardia, vomiting) (ERS/TSANZ [Middleton 2020]).
Uncontrolled asthma is associated with adverse events in pregnancy (increased risk of perinatal mortality, preeclampsia, preterm birth, low birth weight infants, cesarean delivery, and the development of gestational diabetes). Poorly controlled asthma or asthma exacerbations may have a greater fetal/maternal risk than what is associated with appropriately used asthma medications. Maternal treatment improves pregnancy outcomes by reducing the risk of some adverse events (eg, preterm birth, gestational diabetes) (ERS/TSANZ [Middleton 2020]; GINA 2024).
Theophylline is considered compatible for use during pregnancy (ERS/TSANZ [Middleton 2020]). Due to pregnancy-induced physiologic changes, some pharmacokinetic properties of theophylline are altered. The half-life is similar to that observed in otherwise healthy, nonsmoking adults with asthma during the first and second trimesters (~8.7 hours) but may increase to 13 hours (range: 8 to 18 hours) during the third trimester. The volume of distribution is also increased during the third trimester. Monitor serum theophylline concentrations. In addition, maternal asthma symptoms should be monitored every 4 to 6 weeks during pregnancy. Use at term may inhibit uterine contractions (ERS/TSANZ [Middleton 2020]; GINA 2024).
Theophylline is present in breast milk.
The concentration of theophylline in breast milk is similar to the maternal serum theophylline concentration. Irritability may be observed in the breastfeeding infant. Serious adverse events in the infant are unlikely unless toxic serum theophylline concentrations are present in the mother. Maternal use of theophylline is considered compatible with breastfeeding (ERS/TSANZ [Middleton 2020]; WHO 2002). Infants exposed to theophylline via breast milk should be monitored for adverse events (irritability, tachycardia, vomiting). Mothers may consider breastfeeding their infant just prior to taking their regular dose of theophylline (ERS/TSANZ [Middleton 2020]).
Heart rate, CNS effects (insomnia, irritability); respiratory rate; arterial or capillary blood gases (if applicable).
Theophylline serum concentrations: Serum theophylline concentrations should be monitored after initiation of therapy, prior to making dose increases; in the presence of signs or symptoms of toxicity; or when a new illness, worsening of a present illness, or change in patient's treatment regimen occur that may alter theophylline clearance (eg, fever >102°F or sustained for 24 hours or more, hepatitis, or drugs that are added or discontinued). For patients on chronic therapy (ie, drug concentrations at steady state) with well controlled symptoms, monitor serum theophylline concentrations at 6-month intervals for rapidly growing children and at yearly intervals for all others.
Therapeutic serum trough concentration:
Note: Therapeutic goal may vary depending on acuity and severity of the patient as well as disease state (Barnes 2013).
Children: 5 to 15 mcg/mL (SI: 27.8 to 83.3 micromole/L)
Adults: 5 to 15 mcg/mL (SI: 27.8 to 83.3 micromole/L) (Barnes 2013)
Toxic concentration: >20 mcg/mL (SI: >111 micromole/L)
Theophylline has two distinct actions; smooth muscle relaxation (ie, bronchodilation) and suppression of the response of the airways to stimuli (ie, non-bronchodilator prophylactic effects). Bronchodilation is mediated by inhibition of two isoenzymes, phosphodiesterase (PDE III and, to a lesser extent, PDE IV) while non-bronchodilation effects are mediated through other molecular mechanisms. Theophylline increases the force of contraction of diaphragmatic muscles through enhancement of calcium uptake through adenosine-mediated channels.
Absorption: Oral (solution and immediate release): Rapid and complete.
Distribution: ~0.45 L/kg based on ideal body weight; distributes poorly into body fat; Vd may increase in premature neonates, hepatic cirrhosis, acidemia (uncorrected), patients >60 years of age, and third trimester of pregnancy.
Metabolism: Hepatic via demethylation (CYP 1A2) and hydroxylation (CYP 2E1 and 3A4); forms active metabolites (caffeine and 3-methylxanthine).
Protein binding: ~40%, primarily to albumin; decreased in neonates (due to a greater percentage of fetal albumin), hepatic cirrhosis, acidemia (uncorrected), third trimester of pregnancy, and patients >60 years of age.
Half-life elimination (Hendeles 1995): Highly variable and dependent upon age, hepatic function, cardiac function, lung disease, and smoking history.
Premature infants, postnatal age 3 to 15 days: 30 hours (range: 17 to 43 hours); Premature infants, postnatal age 25 to 57 days: 20 hours (range: 9.4 to 30.6 hours); Term infants, postnatal age 1 to 2 days: 25.7 hours (range: 25 to 26.5 hours); Term infants, postnatal age 3 to 30 weeks: 11 hours (range: 6 to 29 hours); Children 1 to 4 years: 3.4 hours (range: 1.2 to 5.6 hours); Children and Adolescents 6 to 17 years: 3.7 hours (range: 1.5 to 5.9 hours); Adults ≥18 years to ≤60 years of age (nonsmoking, asthmatic, otherwise healthy): 8.7 hours (range: 6.1 to 12.8 hours); patients >60 years of age (nonsmoking, healthy): 9.8 hours (range: 1.6 to 18 hours).
Time to peak, serum: Oral (solution and immediate release): 1 to 2 hours.
Excretion: Urine (~50% as unchanged drug [Neonates]; ~10% as unchanged drug [Infants >3 months, Adolescents, and Adults]).
Clearance: Certain conditions may significantly alter theophylline clearance; severe and potentially fatal theophylline toxicity may occur if reduced theophylline clearance occurs.
Decreased theophylline clearance: Neonates; infants <3 months with decreased kidney function; infants <1 year; patients >60 years of age; acute pulmonary edema, cor pulmonale; fever (≥102°F for ≥24 hours or lesser temperature elevations for longer periods); heart failure; hepatic impairment (eg, cirrhosis, acute hepatitis, cholestasis); hypothyroidism; patients following cessation of smoking; sepsis with multiple organ failure; shock; third trimester of pregnancy.
Increased theophylline clearance: Hyperthyroidism; cystic fibrosis; smoking (ie, marijuana or tobacco).
