Journal Article

Case Report: The risks associated with chronic theophylline therapy and measures designed to improve monitoring and management

Hopkins, Michael E., MacKenzie-Ross, Robert V.

2016

Overview

Background Symptoms of theophylline toxicity and factors that augment the risk of developing it are well documented in the literature. However these appear to be poorly considered in clinical practice. This case underlines the challenges in recognising and managing theophylline toxicity; moreover the requirement for improved application of knowledge of its pharmacokinetics to our practice. Case Presentation In this case we observe how theophylline toxicity can be overlooked due to the presence of non-specific symptoms and lack of a structured system to mitigate error in detection, in both hospital medicine and general practice. Here, the initial theophylline concentration measurement was documented as 59.3 mg/l in a patient taking the medication long-term, with the previous concentration being recorded one year prior. Management consisted of suspension of theophylline along with best supportive care, however in the process other conditions were exacerbated and the patient ultimately died in hospital. Congestive cardiac failure, congestive liver disease and polypharmacy were factors isolated from this case that expedited the patients’ development of theophylline toxicity. This was perpetuated by delay in diagnosis due to presentation with generalised symptoms including tachycardia, vomiting and neurological symptoms. Conclusions Findings from this case necessitate a requirement for more stringent monitoring of theophylline when taken chronically in those who demonstrate risk factors for toxicity. This would aim to prevent accumulation of the drug, toxicity onset and subsequent acute presentation to hospital. Intervention, through charcoal haemoperfusion may provide a means of enhanced recovery to reduce sequelae of toxicity.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Abdomen / Biomedical and Life Sciences / Biomedicine / Bronchodilator Agents - adverse effects / Bronchodilator Agents - blood / Bronchodilator Agents - pharmacokinetics / Case Report / Charcoal / Chronic obstructive pulmonary disease / Combined Modality Therapy / Complications / Congestive heart failure / Consent / Coronary artery disease / Delayed Diagnosis / Drug dosages / Drug Interactions / Drug Monitoring / Drug Therapy, Combination - adverse effects / Electrolytes / Error detection / Ethics / Family medical history / Fatal Outcome / Fatalities / Female / Heart diseases / Heart Failure - complications / Heart Failure - drug therapy / Heart rate / Hospitals / Humans / Information services / Leg / Liver / Liver diseases / Liver Failure - complications / Liver Failure - drug therapy / Medical errors / Medical imaging / Metabolism / Middle Aged / Monitoring / Mortality / Nervous system / Neurotoxicity Syndromes - blood / Neurotoxicity Syndromes - diagnosis / Neurotoxicity Syndromes - physiopathology / Neurotoxicity Syndromes - therapy / NMR / Nuclear magnetic resonance / Patients / Peripheral Nervous System Diseases - etiology / Pharmacokinetics / Pharmacology/Toxicology / Polypharmacy / Pulmonary Disease, Chronic Obstructive - complications / Pulmonary Disease, Chronic Obstructive - drug therapy / Risk analysis / Risk factors / Seizures - etiology / Signs and symptoms / Tachycardia / Tachycardia - etiology / Telemedicine / Theophylline / Theophylline - adverse effects / Theophylline - blood / Theophylline - pharmacokinetics / Tomography / Toxicity / Training / Ultrasonic imaging / Vomiting