Treatment of theophylline overdose

American Journal of Emergency Medicine

Volumn 14, Issue 6, 1996, Pages 606-612

  Minton, Neil A ^a,b   Henry, John A ^a  

^a GUY S HOSPITAL   (United Kingdom)

^b NONE   (United Kingdom)

Author keywords

overdose; Theophylline; treatment

Indexed keywords

ACTIVATED CARBON; ADENOSINE; ANTICONVULSIVE AGENT; ANTIEMETIC AGENT; ESMOLOL; HISTAMINE H2 RECEPTOR ANTAGONIST; IPECAC; LAXATIVE; METOPROLOL; PROPRANOLOL; THEOPHYLLINE;

CONVULSION; DRUG ABSORPTION; DRUG OVERDOSE; HEMODIALYSIS; HEMOPERFUSION; HUMAN; PATIENT CARE; PERITONEAL DIALYSIS; PRIORITY JOURNAL; REVIEW; STOMACH LAVAGE; STOMACH PH; SUPRAVENTRICULAR TACHYCARDIA; THEOPHYLLINE BLOOD LEVEL; VOMITING;

EID: 0029795664     PISSN: 07356757     EISSN: None     Source Type: Journal    
DOI: 10.1016/S0735-6757(96)90111-4     Document Type: Article

References (143)

1. Gaudreault P, Guay J: Theophylline poisoning. Pharmacological considerations and management. Med Toxicol 1986;1:169-191
2. Minton NA, Henry JA: Acute and chronic human toxicity of theophylline. Hum Exp Toxicol 1996;15:471-481
3. D'Angio R, Sabatelli F: Management considerations in treating metabolic abnormalities associated with theophylline overdose. Arch Intern Med 1987;147:1837-1838
4. Buckley BM, Braithwaite RA, Vale JA: Theophylline poisoning. Lancet 1983;2:618
5. Weinberger MC: Theophylline. In Poisindex, vol 86. Denver, CO, Micromedex Inc, 1995
6. Spyker DA: Activated charcoal reborn: Progress in poison management. Arch Intern Med 1985;145:43-44
7. Minton NA, Henry JA, Glucksman E: Prevention of drug absorption in simulated theophylline overdose. Hum Exp Toxicol 1995;14:170-174
8. Boldy DAR, Buckley BM, Vale JA: Advances in the treatment of poisoning. J Clin Hosp Pharm 1984;9:147-160
9. Laggner AN, Kajk G, Lenz K, et al: Treatment of severe poisoning with slow release theophylline. BMJ 1984;288:1497
10. Whyte KF, Addis GJ: Treatment of theophylline poisoning. BMJ 1984;288:1835
11. Cereda J-M, Scott J, Quigley EMM: Endoscopic removal of pharmacobezoar of slow-release theophylline. BMJ 1986;293:1143
12. Goldberg MJ, Park GD, Berlinger WG: Treatment of theophylline intoxication. J Allergy Clin Immunol 1986;78:811-817
13. Blake DR, Bramble DR, Evans JG: Is there excessive use of gastric lavage in the treatment of self-poisoning? Lancet 1978;2:1362-1364
14. Matthew H, MackintoshTF, TompsettTL, Cameron JC: Gastric aspiration and lavage in acute poisoning. BMJ 1966;1:1333-1337
15. Wheeler-Usher DH, Wanke LA, Bayer MJ: Gastric emptying. Risk versus benefit in the treatment of acute poisoning. Med Toxicol 1986;1:142-153
16. Thompson AM, Robins JB, Prescott LF: Changes in cardiorespiratory function during gastric lavage for drug overdose. Hum Toxicol 1987;6:215-218
17. Amitai Y, Mitchell AA, McGuigan MA, Lovejoy FH Jr: Ipecac-induced emesis and reduction of plasma concentrations of drugs following accidental overdose in children. Pediatrics 1987;80:364-367
18. Krenzelok EP, Dean BS: Syrup of ipecac in children less than one year of age. Clin Toxicol 1985;23:171-176
19. Litovitz TL, Klein-Schwartz W, Oderda GM, et al: Ipecac administration in children younger than 1 year of age. Pediatrics 1985;76:761-764
20. Mofenson HC, Caraccio TR: Benefits/risks of syrup of ipecac. Pediatrics 1986;77:551-552
21. Anon: Mallory-Weiss syndrome. Reactions 1984;101:7
22. Timberlake GA: Ipecac as a cause of the Mallory-Weiss syndrome. South Med J 1984;77:804-805
23. Biberstein MP, Fiegler MG, Ward DM: Use of β-blockade and hemoperfusion for acute theophylline poisoning. West J Med 1984; 141:485-490
24. Dean LS, Brown JW: Massive theophylline overdose. Survival without hemoperfusion. JAMA 1982;248:1742
25. Greenberg A, Piraino BH, Kroboth PD, Weiss J: Severe theophylline toxicity. Role of conservative measures, antiarrhythmic agents and charcoal hemoperfusion. Am J Med 1984;76:854-860
26. Jefferys DB, Raper SM, Helliwell M, et al: Haemoperfusion for theophylline overdose. BMJ 1980;80:1167
27. Gaudreault P, Wason S, Lovejoy Jr FH. Acute pediatric theophylline overdose: A summary of 28 cases. J Pediatr 1983;102: 474-476
28. Heath A, Knudsen K: Role of extracorporeal drug removal in acute theophylline poisoning. Med Toxicol 1987;2:294-308
29. Corby DG, Decker WJ, Moran MJ, Payne CE: Clinical comparison of pharmacologic emetics in children. Pediatrics 1968;4:361-364
30. Rumack BH, Rosen P: Emesis: Safe and effective? Ann Emerg Med 1981;10:551
31. Tenenbein M: Inefficacy of gastric emptying procedures. J Emerg Med 1985;3:133-136
32. Vale JA, Meredith TJ, Proudfoot AT: Syrup of ipecacuanha: Is it really useful? BMJ 1986;293:1321-1322
33. Minton N, Swift R, Lawlor C, et al: Ipecacuanha-induced emesis: A human model for testing anti-emetic drug activity. Clin Pharmacol Ther 1993;54:53-57
34. Freedman GE, Pasternak S, Krenzelok EP: A clinical trial using syrup of ipecac and activated charcoal concurrently. Ann Emerg Med 1987;16:164-166
35. Olkkola KT: Effect of charcoal-drug ratio on the antidotal efficacy of oral activated charcoal in man. Br J Clin Pharmacol 1985;19:767-773
36. Neuvonen PJ: Clinical pharmacokinetics of oral activated charcoal in acute intoxications. Clin Pharmacokinet 1982;7:465-489
37. Neuvonen PJ, Olkkola KT: Oral activated charcoal in the treatment of intoxication. Role of single and repeat doses. Med Toxicol 1988;3:33-58
38. Harsch HH: Aspiration of activated charcoal. New Engl J Med 1986;314:318
39. Pollack MM, Dunbar BS, Holbrook PR, Fields Al: Aspiration of activated charcoal and gastric contents. Ann Emerg Med 1981;10:528-529
40. Watson WA, Cremer K, Chapman GA: Gastrointestinal obstruction associated with multiple dose of activated charcoal. J Emerg Med 1986;4:401-407
41. Longdon P, Henderson A: Intestinal pseudo-obstruction following the use of enterai charcoal and sorbitol and mechanical ventilation with papaveretum sedation for theophylline poisoning. Drug Safety 1992;7:74-77
42. Shannon M, Fish SS, Lovejoy FH Jr: Cathartics and laxatives. Do they still have a place in management of the poisoned patient. Med Toxicol 1986;1:247-252
43. Vale JA, Proudfoot AT: How useful is activated charcoal? BMJ 1993;306:78-79
44. Gal P, Miller A, McCue JD: Oral activated charcoal to enhance theophylline elimination in an acute overdose. JAMA 1984;251:3130-3131
45. Mahutte CK, True RJ, Michiels TM, et al: Increased serum theophylline clearance with orally administered activated charcoal. Am Rev Respir Dis 1983;128:820-822
46. Radomski L, Park GD, Goldberg MJ, et al: Model for theophylline overdose treatment with oral activated charcoal. Clin Pharmacol Ther 1984;35:402-408
47. True RJ, Berman JM, Mahutte CK: Treatment of theophylline overdose with oral activated charcoal. Crit Care Med 1984;12:113-114
48. Helliwell M, Berry D: Theophylline absorption by effervescent activated charcoal (Medicoal). J Int Med Res 1981;9:222-225
49. Lim DT, Singh P, Nourtsis S, Cruz RD: Absorption inhibition and enhancement of elimination of sustained-release theophylline tablets by oral activated charcoal. Ann Emerg Med 1986;15:1303-1307
50. Ilkhanipour K, Yealy DM, Krenzelok EP: The comparative efficacy of various multiple-dose activated charcoal regimens. Am J Emerg Med 1992;10:298-300
51. Minton NA, Henry JA: Prevention of drug absorption in simulated theophylline overdose. Clin Toxicol 1995;33:43-49
52. Pond SM: Role of repeated oral doses of activated charcoal in clinical toxicology. Med Toxicol 1986;1:3-11
53. Kulig KW, Bar-Orr D, Rumack BH: Intravenous theophylline poisoning and multiple dose charcoal in an animal model. Ann Emerg Med 1987;16:842-846
54. McKinnon RS, Desmond PV, Harman PJ, et al: Studies on the mechanisms of action of activated charcoal on theophylline pharmacokinetics. J Pharm Pharmacol 1987;39:522-525
55. Levy G: Gastrointestinal clearance of drugs with activated charcoal. N Engl J Med 1982;307:676-678
56. Al-Shareef AH, Buss D, Allen EM, Routledge PA: The effects of charcoal and sorbitol (alone and in combination) on plasma theophylline concentrations after a sustained-release theophylline formulation. Hum Toxicol 1990;9:179-182
57. Goldberg MJ, Spector R, Park GD, et al: The effect of sorbitol and activated charcoal on serum theophylline concentrations after slow-release theophylline. Clin Pharmacol Ther 1987;41:108-111
58. Krenzelok EP, Keller R, Stewart RD: Gastrointestinal transit times of cathartics combined with charcoal. Ann Emerg Med 1985;14: 1152-1155
59. Easom JM, Caraccio TR, Lovejoy Jr FH: Evaluation of activated charcoal and magnesium citrate in the prevention of aspirin absorption in humans. Clin Pharm 1982;1:154-156
60. Galinsky RE, Levy G: Evaluation of activated charcoal-sodium sulfate combination for inhibition of acetaminophen absorption and repletion of inorganic sulfate. Clin Toxicol 1984;22:21-30
61. Mayersohn M, Perrier D, Picchioni AL: Evaluation of a charcoalsorbitol mixture as an antidote for oral aspirin overdose. Clin Toxicol 1977;11:561-567
62. McNamara RM, Aaron CK, Gemborys M, Davidheiser S: Sorbitol catharsis does not enhance efficacy of charcoal in a simulated acetaminophen overdose. Ann Emerg Med 1988;17:243-246
63. Neuvonen PJ, Olkkola KT: Effect of purgatives on antidotal efficacy of oral activated charcoal. Hum Toxicol 1986;5:255-263
64. Sketris IS, Mowry JB, Czajka PA, et al: Saline catharsis: Effect on aspirin bioavailability in combination with activated charcoal. J Clin Pharmacol 1982;22:59-64
65. Garrelts JC, Watson WA, Holloway KD, Sweet DE: Magnesium toxicity secondary to catharsis during management of theophylline poisoning. Am J Emerg Med 1989;7:34-37
66. Weber CA, Santiago RM: Hypermagnesemia. A potential complication during treatment of theophylline intoxication with oral activated charcoal and magnesium-containing cathartics. Chest 1989; 95:56-59
67. Farley TA: Severe hypematremic dehydration after use of an activated charcoal-sorbitol suspension. J Pediatr 1986;109:719-722
68. Gazda-Smith E, Synhavsky A: Hypernatraemia following treatment of theophylline toxicity with activated charcoal and sorbitol. Arch Intern Med 1990;150:689-690
69. Sullivan JB, Krenzelok EP: Repetitive doses of the activated charcoal-sorbitol combination: A word of caution. Am J Emerg Med 1988;6:201-202
70. Tenenbein M: Whole bowel irrigation as a gastrointestinal decontamination procedure after acute poisoning. Med Toxicol 1988; 3:77-84
71. Janss GJ: Acute theophylline overdose treated with whole bowel irrigation. D J Med 1990;43:7-8
72. Huffman RS, Chiang WK, Howland MA, et al: Theophylline desorption from activated charcoal caused by whole bowel irrigation solution. Clin Toxicol 1991;29:191-201
73. Berlinger WG, Spector R, Goldberg MJ, et al: Enhancement of theophylline clearance by oral activated charcoal. Clin Pharmacol Ther 1983;33:351-354
74. Rygnestadt T, Walstad RA, Dahl K: Self-poisoning with theophylline. Acta Med Scand 1986;219:425-427
75. Shannon M, Amitai Y, Lovejoy FH Jr: Multiple dose activated charcoal for theophylline poisoning in young infants. Pediatrics 1987;80:368-370
76. Park GD, Radomski L, Goldberg MJ, et al: Effect of the size and frequency of oral doses of charcoal on theophylline clearance. Clin Pharmacol Ther 1983;34:663-666
77. Higgins RM, Hearing S, Goldsmith DJA, et al: Severe theophylline poisoning: Charcoal hemoperfusion or hemodialysis? Postgrad Med J 1995;71:224-226
78. Hootkins R Sr, Lerman MJ, Thompson JR: Sequential and simultaneous "in series" hemodialysis and hemoperfusion in the management of theophylline intoxication. J Am Soc Nephrol 1990;1: 923-926
79. Rongved G, Westlie L: Hemoperfusion/hemodialysis in the treatment of acute theophylline poisoning. Description of a fatal case. Int J Clin Pharmacol Ther Toxicol 1986;24:85-87
80. Benowitz NL, Toffelmire EB: The use of hemodialysis and haemoperfusion in the treatment of theophylline intoxication. Semin Dialysis 1993;6:243-252
81. Brown GS, Lohr TO, Mayor GH, et al: Peritoneal clearance of theophylline. Am J Kidney Dis 1981;1:24-26
82. Lawyer C, Aitchison J, Sutton J, et al: Treatment of theophylline neurotoxicity with resin hemoperfusion. Ann Intern Med 1978;88: 516-517
83. Ehlers SM, Zaske DE, Sawchuk RJ: Massive theophylline overdose - Rapid elimination by charcoal hemoperfusion. JAMA 1978;240:474-475
84. De Broe ME, Bismuth C, De Groot G, et al: Hemoperfusion: A useful therapy for a severely poisoned patient? Hum Toxicol 1986;5: 11-14
85. Connell JMC, McGeachie JF, Knepil J, et al: Self-poisoning with sustained-release aminophylline: Secondary rise in serum theophylline concentration after charcoal hemoperfusion. BMJ 1982;284: 943
86. Kelly WJ, Parkin WG: Charcoal hemoperfusion treatment of severe theophylline toxicity. Aust N Z J Med 1985;15:75-77
87. Lynn KL, Buttimore AL, Begg EJ, Gordon GS: Treatment of theophylline poisoning with haemoperfusion. N Z Med J 1988;101: 4-5
88. Park GD, Spector R, Roberts RJ, et al: Use of hemoperfusion for treatment of theophyliine intoxication. Am J Med 1983;74:961-966
89. Russo M: Management of theophylline intoxication with charcoal column hemoperfusion. N Engl J Med 1979;300:24-26
90. Stegeman CA, Jordans JGM: Theophylline intoxication. Clinical features, treatment and outcome: A case report and a review of the literature. Neth J Med 1991;39:115-125
91. Woo OF, Pond SM, Benowitz NL, Olson KR: Benefit of hemoperfusion in acute theophylline intoxication. Clin Toxicol 1984; 22:411-424
92. Ahlmen J, Heath A, Herlitz H, et al: Treatment of oral theophylline poisoning. Acta Med Scand 1984;216:423-426
93. Helliwell M, Berry D: Theophylline poisoning in adults. BMJ 1979;2:1114
94. Hall KW, Dobson KE, Dalton JG, et al: Metabolic abnormalities associated with intentional theophylline overdose. Ann Intern Med 1984;101:457-462
95. Olson KR, Pond SM, Benowitz NL, Becker CE: Treatment of theophylline overdose. JAMA 1983;249:3176
96. Coupe M: Self-poisoning with sustained-release aminophylline: A mechanism for observed secondary rise in serum theophylline. Hum Toxicol 1986;5:341-342
97. Struthers AD, Elliot HL, Addis GJ: Self poisoning with sustained release aminophylline: Secondary rise in serum theophylline concentration after charcoal haemoperfusion. BMJ 1982;284:1709
98. Sahney S, Abarzna J, Sessum L: Hemoperfusion in theophylline neurotoxicity. Pediatrics 1983;71:615-619
99. Sessler CN: Theophylline toxicity: Clinical features of 116 consecutive cases. Am J Med 1990;88:567-576
100. Gallagher EJ, Howland M, Greenblatt H: Hemolysis following treatment of theophylline overdose with coated charcoal hemoperfusion. J Emerg Med 1987;5:19-22
101. Shannon M: Predictors of major toxicity after theophylline. Ann Intern Med 1993;119:1161-1167
102. Shannon MW, Woolf A: Does extracorporeal removal alter the course of major toxicity after theophylline intoxication. Vet Hum Toxicol 1992;34:325
103. Amitai Y, Yeung AC, Moye J, Lovejoy FH Jr. Repetitive oral activated charcoal and control of emesis in severe theophylline toxicity. Ann Intern Med 1986;105:386-387
104. Henderson A, Wright DM, Pond SM: Management of theophylline overdose patients in the Intensive Care Unit. Anaesth Intens Care Unit. Anaesth Intens Care 1992;20:56-62
105. Amitai Y, Lovejoy FH Jr: Characteristics of vomiting associated with sustained release theophylline poisoning: implications for management with oral activated charcoal. Clin Toxicol 1987;25:539-554
106. Simpson GM, Pi EH, Sramek Jr JJ: Neuroleptics and antipsychotics. In Dukes MNG (ed): Meyler's side effects of drugs (ed 12). Amsterdam, London, New York, Tokyo, Elsevier, 1992, pp 105-121
107. Andrews PLR, Rapeport WG, Sanger GJ: Neuropharmacology of emesis. Trends Pharmacol Sci 1988;9:334-341
108. Brown SGA, Prentice DA: Ondansetron in the treatment of theophylline overdose. Med J Austr 1992;156:512
109. Sage TA, Jones WN, Clark RF: Ondansetron in the treatment of intractable nausea associated with theophylline toxicity. Ann Pharmacother 1993;27:584-585
110. Cano R, Isenberg JI, Grossman MI: Cimetidine inhibits caffeine-stimulated gastric acid secretion in man. Gastroenterology 1976;70:1055-1057
111. Foster LJ, Trudeau WL, Goldman AL: Bronchodilator effects on gastric acid secretion. JAMA 1979;241:2613-2615
112. Powell JR, Rogers JF, Wargin WA, et al: Inhibition of theophylline clearance by Cimetidine but not ranitidine. Arch Intern Med 1984;144:484-486
113. Vestal RE. Thumel KE, Musser B: Cimetidine inhibits theophylline clearance in patients with chronic obstructive pulmonary disease: A study using stable isotope methodology during multiple oral dose administration. Br J Clin Pharmacol 1983;15:411-418
114. Fernandes E, Melewicz FM: Ranitidine and theophylline. Ann Intern Med 1984;100:459
115. Gardner ME, Sikorski GW: Ranitidine and theophylline. Ann Intern Med 1985;102:559
116. Hegman GW, Gilbert RP: Ranitidine-theophylline interaction - Fact or fiction? Drug Intell Clin Pharm 1991;25:21-25
117. Upton RA: Pharmacokinetic interactions between theophylline and other medication (Part II). Clin Pharmacokinet 1991;20:135-150
118. Amin DA, Henry JA: Propranolol administration in theophylline overdose. Lancet 1985;1:520-521
119. Kearney TE, Manoguerra AS, Curtis GP, Ziegler MG: Theophylline toxicity and the beta-adrenergic system. Ann Intern Med 1985;102:766-769
120. Angaran DM, Schultz NJ, Tischida YH: Esmoiol hydrochloride: An ultra-short acting beta-adrenergic blocking agent. Clin Pharmacol Ther 1986;5:288-303
121. Seneff M, Scott J, Friedman B, Smith M: Acute theophylline toxicity and the use of esmolol to reverse cardiovascular instability. Ann Emerg Med 1990;19:671-673
122. Vanden Hoek T, Murphy C, Aks S, Paloucek F: The use of esmolol to reverse unstable supraventricular tachycardia in a theophylline toxic patient. Vet Hum Toxicol 1991;33:390
123. Whyte KF, Addis GJ: Toxicity of salbutamol and theophylline together. Lancet 1983;2:618-619
124. Minton NA, Baird AR, Henry JA: Modulation of the effects of salbutamol by propranolol and atenolol. Eur J Clin Pharmacol 1989;36:449-453
125. Skinner MH: Adverse reactions and interactions with theophylline. Drug Safety 1990;5:275-285
126. Levine JH, Michael JR, Guarnieri T: Treatment of multifocal atrial tachycardia with verapamil. N Engl J Med 1985;312:21-25
127. Burnakis TG, Seldon M, Czaplicki AD: Increased serum theophylline concentrations secondary to oral verapamil. Clin Pharm 1983;2:458-461
128. Kesler KM, Interian A Jr, Cox M, et al: Proarrhythmia related to a kinetic and dynamic interaction of mexiletine and theophylline. Am Heart J 1989;117:964-966
129. Stoysich AM, Mohiuddin SM, Destache CJ, et al: Influence of mexiletine on the pharmacokinetics of theophylline in healthy volunteers. J Clin Pharmacol 1991;31:354-357
130. Fredholm BB: On the mechanism of action of theophylline and caffeine. Acta Med Scand 1985;217:149-153
131. Biaggioni I, Paul S, Puckett A, Arzubiaga C: Caffeine and theophylline as adenosine receptor antagonists in humans. J Pharm Exp Ther 1991;258:588-593
132. Minton NA, Henry JA: Pharmacodynamic interactions between infused adenosine and oral theophylline. Hum Exp Toxicol 1991;10:411-418
133. Ujhelyi MR, Hulula GE, Skau KA: Role of exogenous adenosine as a modulator of theophylline toxicity. Crit Care Med 1994;22: 1639-1646
134. Drake I, Routledge PA, Richards R: Bronchospasm induced by intravenous adenosine. Hum Exp Toxicol 1994;13:263-265
135. Anon: Adenosine for acute cardiac arrythmias. Drug Ther Bull 1993;31:49-50
136. Richards W, Church JA, Brent DK: Theophylline-associated seizures in children. Ann Allergy 1985;54:276-279
137. Mountain RD, Neff TA: Oral theophylline intoxication: A serious error of patient and physician understanding. Arch Intern Med 1984;144:724-727
138. Robertson NJ: Fatal overdose from a sustained-release theophylline preparation. Ann Emerg Med 1985;14:154-158
139. Yarnell PR, Chu NS: Focal seizures and aminophylline. Neurology 1975;25:819-822
140. Haddad ZH, Sakai R: Massive accidental theophylline ingestion. Linear first order elimination kinetics in an infant. Ann Allergy 1982;48:178-179
141. Hornfeldt CS, Larson AA: Adenosine receptors are not involved in theophylline-induced seizures. Clin Toxicol 1994;32:257-265
142. Shannon MW, Maher T: Anticonvulsant efficacy of adenocard in experimental theophylline-induced seizures. Vet Hum Toxicol 1993;35:338
143. Blake KV, Massey KL, Hendeles L, et al: Relative efficacy of phenytoin and phenobarbital for the prevention of theophylline-induced seizures in mice. Ann Emerg Med 1988;17:1024-102