3.1.3 Theophylline

General guidance

• Theophylline may have an additive effect when used in combination with small doses of beta2-adrenoceptor agonists. However, the combination may increase the risk of adverse effects especially hypokalaemia.
• Theophylline is metabolised by the liver. Its half-life shows considerable variation especially in smokers, those with hepatic or cardiac failure and if certain interacting drugs are also taken. These difference are important since the drug has a narrow margin between the therapeutic and toxic dose.
• Modified release theophylline preparations are able to produce adequate plasma concentrations for upto 12 hours. When given as a single dose at night they have a useful role in controlling nocturnal asthma and early morning wheezing and therefore provide an alternative to long acting beta2-agonists in this circumstance.
• The use of rapid release, non-modified release products is to be discouraged due to a higher incidence of adverse effects resulting from rapid theophylline absorption.
• There are a variety of products available with differing drug release profiles. It is very important that once stabilised a patient continues to receive the same brand of theophylline product, this can only be guaranteed by the use of the products proprietary, non-generic name. Generic prescribing of these products is not encouraged.
• Theophylline is associated with several important drug-drug interactions e.g. ciprofloxacin and erythromycin, in such cases the dose of theophylline should be halved.
• Routine blood level monitoring is not required, this should be reserved for instances of suspected toxicity or low efficacy.

Recommended drugs

Theophylline - Uniphyllin Continus

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines      

Purple – Specialist use/initiation

Red – Non Formulary

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low