Mr. Asthma

Question:

>I understand that Theophyllines have an extremely narrow window of >therapeutic effectiveness. Too little has no effect, too much is toxic. >It would seem that the dose you take is below this therapeutic level. >Usually this is checked by blood tests. >Any comments? >Remove the spam from address if replying by email

I’m not sure about this. Trough a better lifestyle and several kinds of alternative medications and food additives I managed to "stabilize" my asthma to the point where the only *chemical* medications I need to take is : 125 to 150 mg two times a day, plus an occasional Ventolin puff (one or two times a day).   I’m 58 and doing a long hours and rather stressfull job. But this seems to work fine with me. Am I in the theophyline "window" you indicate ?   Gus.

Response:

– Hide quoted text — Show quoted text ->I understand that Theophyllines have an extremely narrow window of >therapeutic effectiveness. Too little has no effect, too much is toxic. >It would seem that the dose you take is below this therapeutic level. >Usually this is checked by blood tests. >Any comments? >Remove the spam from address if replying by email >I’m not sure about this. >Trough a better lifestyle and several kinds of alternative medications >and food additives I managed to "stabilize" my asthma to the point >where the only *chemical* medications I need to take is : 125 to 150 >mg two times a day, plus an occasional Ventolin puff (one or two times >a day).   >I’m 58 and doing a long hours and rather stressfull job. But this >seems to work fine with me. Am I in the theophyline "window" you >indicate ?   >Gus.

Best wishes Gus I have honestly no idea, and was relating information from a medic. Presumably the effective level must be determined by blood tests. Regards Remove the spam from address if replying by email

Response:

> I understand that Theophyllines have an extremely narrow window of > therapeutic effectiveness. Too little has no effect, too much is toxic. > It would seem that the dose you take is below this therapeutic level.

That depends on a variety of factors, including one’s body weight, diet, and what other drugs one is taking.  [Theo is famous for synergistic interactions.] > Usually this is checked by blood tests.

Well, yes.  You put the person on the ’standard’ dosage for his/her weight, then mess with the dosage until the blood levels are therapeutic but not toxic.  This can vary widely from person to person. Chris Owens

Response:

– Hide quoted text — Show quoted text -> >> Is Theophylline (Theo-Dur,Slo-Bid,etc.) still being used by many people, > >> or has it been generally replaced by the newer long-acting > >> bronchodilators like Serevent? Jeff. > >I use them both; Serevent 2 pf x2, and Theo Dur 200 mg x 2. > >They are both steroid-sparing drugs, and have been shown to reduce > >the need for steroid inhalers. > >Serevent is a long-acting bronchodilator; so is TheoDur but in addition > >it has been shown to have mild anti-inflammatory properties. > >So I use the TheoDur in Low Dose as an additive drug; at this level the > >side effects are neglible for me; each pill has side effects equivalent > >to a cup of Starbucks coffee. > >I also use Vanceril DS & Intal inhalers. > >Ellis > I understand that Theophyllines have an extremely narrow window of > therapeutic effectiveness. Too little has no effect, too much is toxic. > It would seem that the dose you take is below this therapeutic level. > Usually this is checked by blood tests. > Any comments? > Remove the spam from address if replying by email >Before inhaled steroids became available in 1977, theophylline was the >main drug for treating asthma; and was prescribed in high doses to >attempt to achieve control, often set at 50% of the lethal >value, ie blood levels of 10-30 mcg/mL; many asthmatics suffered from side >effects at these levels; and the levels could rise into the danger zone due >to a drug interaction or case of the flu. >Ellis

Thankyou for posting such a complete reply…I shall make sure that it is safely filed away Regards Remove the spam from address if replying by email

Response:

Is Theophylline (Theo-Dur,Slo-Bid,etc.) still being used by many people, or has it been generally replaced by the newer long-acting bronchodilators like Serevent? Jeff.

Response:

> Is Theophylline (Theo-Dur,Slo-Bid,etc.) still being used by many people, > or has it been generally replaced by the newer long-acting > bronchodilators like Serevent? Jeff.

Don’t you DARE take away my theophylline!  :)  That being said, different things work for different people.  Some of us do best on theo, with fewer side effects than other meds.  Other people do better on something else.  Your doctor just has to work with you to work through the list to find the medication and dosages which best control your symptoms with the least amount of medicantion and the fewest side effects. Chris Owens

Response:

I use them both.  Theophylline has been my salvation for -gosh- thirty years?  Only recently have I used Serevent but my asthma is well controlled. – Hide quoted text — Show quoted text – > Is Theophylline (Theo-Dur,Slo-Bid,etc.) still being used by many people, > or has it been generally replaced by the newer long-acting > bronchodilators like Serevent? Jeff.

Response:

> Is Theophylline (Theo-Dur,Slo-Bid,etc.) still being used by many people, > or has it been generally replaced by the newer long-acting > bronchodilators like Serevent? Jeff.

I use them both; Serevent 2 pf x2, and Theo Dur 200 mg x 2. They are both steroid-sparing drugs, and have been shown to reduce the need for steroid inhalers. Serevent is a long-acting bronchodilator; so is TheoDur but in addition it has been shown to have mild anti-inflammatory properties. So I use the TheoDur in Low Dose as an additive drug; at this level the side effects are neglible for me; each pill has side effects equivalent to a cup of Starbucks coffee. I also use Vanceril DS & Intal inhalers. Ellis

Response:

>Is Theophylline (Theo-Dur,Slo-Bid,etc.) still being used by many people, >or has it been generally replaced by the newer long-acting >bronchodilators like Serevent? Jeff.

Theophylline is still around, but its popularity has decreased with the introduction of the inhaled steroids and the long acting bronchodilators. Doctors typically prefer medications that have fewer side effects and will usually try other medications first.

Response:

As has been posted, people still use it and are helped by it. But, doctor’s (some) are trying to prescribe and treat away from it. The feeling that there is better control with low dose inhaled steroids than an oral steroid sparing medication. But, this seems to be mostly as a result of side effects. From what I’ve read, the effectiveness of theophyline (sp?) therapy is about the same as inhaled steroid therapy.

Response:

> As has been posted, people still use it and are helped by it. But, > doctor’s (some) are trying to prescribe and treat away from it. The > feeling that there is better control with low dose inhaled steroids than > an oral steroid sparing medication. > But, this seems to be mostly as a result of side effects. From what I’ve > read, the effectiveness of theophyline (sp?) therapy is about the same > as inhaled steroid therapy.

Generalities – take ‘em for what they’re worth. ASthma is an airway disease (with an immunologic component). Drugs which can be delivered directly to the airway, or which target receptors expressed primarily in the airway, are likely to have fewer and less serious side effects than systemic drugs. Theophylline acts, among other things, to elevate an intracellular regulatory molecule cyclicAMP which has a number of effects on bronchial sooth muscle AND vascular smooth muscle.  So theophylline has vascular effects that inhaled beta-agonists (which also elevate cAMP) don’t.

Response:

– Hide quoted text — Show quoted text -> Is Theophylline (Theo-Dur,Slo-Bid,etc.) still being used by many people, > or has it been generally replaced by the newer long-acting > bronchodilators like Serevent? Jeff. >I use them both; Serevent 2 pf x2, and Theo Dur 200 mg x 2. >They are both steroid-sparing drugs, and have been shown to reduce >the need for steroid inhalers. >Serevent is a long-acting bronchodilator; so is TheoDur but in addition >it has been shown to have mild anti-inflammatory properties. >So I use the TheoDur in Low Dose as an additive drug; at this level the >side effects are neglible for me; each pill has side effects equivalent >to a cup of Starbucks coffee. >I also use Vanceril DS & Intal inhalers. >Ellis

I understand that Theophyllines have an extremely narrow window of therapeutic effectiveness. Too little has no effect, too much is toxic. It would seem that the dose you take is below this therapeutic level. Usually this is checked by blood tests. Any comments? Remove the spam from address if replying by email

Response:

- Hide quoted text — Show quoted text ->I understand that Theophyllines have an extremely narrow window of >therapeutic effectiveness. Too little has no effect, too much is toxic. >It would seem that the dose you take is below this therapeutic level. >Usually this is checked by blood tests. >Any comments? >Remove the spam from address if replying by email > I’m not sure about this. > Trough a better lifestyle and several kinds of alternative medications > and food additives I managed to "stabilize" my asthma to the point > where the only *chemical* medications I need to take is : 125 to 150 > mg two times a day, plus an occasional Ventolin puff (one or two times > a day). > I’m 58 and doing a long hours and rather stressfull job. But this > seems to work fine with me. Am I in the theophyline "window" you > indicate ? > Gus.

You seem to be under good control as far as asthma symptoms. However, the "window" referred to is determined — not by symptoms — but by the level of theophylline in your blood, which can only be monitored by a blood test. It is possible to be relatively free of asthma symptoms while having too high (potentially toxic) a level of theophylline. Further, the level can fluctuate due to a number of factors even if the dosage you are using has not changed. To be sure of maintaining a safe but therapeutic level you must have regular blood tests, at least monthly. It happened to me once. I had been going along at a steady rate of dosage and blood levels for some time when unexpectedly one monthly test showed a near-toxic level of the medication. I had to adjust my dosage downward. This is one of the reasons I was happy to drop theophylline when Serevent became available.

Response:

- Hide quoted text — Show quoted text ->> Is Theophylline (Theo-Dur,Slo-Bid,etc.) still being used by many people, >> or has it been generally replaced by the newer long-acting >> bronchodilators like Serevent? Jeff. >I use them both; Serevent 2 pf x2, and Theo Dur 200 mg x 2. >They are both steroid-sparing drugs, and have been shown to reduce >the need for steroid inhalers. >Serevent is a long-acting bronchodilator; so is TheoDur but in addition >it has been shown to have mild anti-inflammatory properties. >So I use the TheoDur in Low Dose as an additive drug; at this level the >side effects are neglible for me; each pill has side effects equivalent >to a cup of Starbucks coffee. >I also use Vanceril DS & Intal inhalers. >Ellis > I understand that Theophyllines have an extremely narrow window of > therapeutic effectiveness. Too little has no effect, too much is toxic. > It would seem that the dose you take is below this therapeutic level. > Usually this is checked by blood tests. > Any comments? > Remove the spam from address if replying by email

Before inhaled steroids became available in 1977, theophylline was the main drug for treating asthma; and was prescribed in high doses to attempt to achieve control, often set at 50% of the lethal value, ie blood levels of 10-30 mcg/mL; many asthmatics suffered from side effects at these levels; and the levels could rise into the danger zone due to a drug interaction or case of the flu. Current asthma guidelines, (Expert Panel Report 2) recommend levels of 5-15 mcg/mL. Some studies show that at levels of 5 mcg/mL, theophylline has an additive effect when used with inhaled steroids that can reduce the need for them by a factor of 2. Blood level testing would not generally be needed at low levels; side effects tend to be obvious, ie headaches, diarrhea. I’ve taken theophylline daily for 9 years; only once was my blood level tested to establish the starting dose when I was on medium dose theophylline–this was in the Immunology Dept of a major west coast teaching hospital. (300 mg x 2 Theo Dur) My present dose of TheoDur, 200 ug x2, results in an estimated blood level of 5 mcg/mL. (equivalent to side effects of 2 cups of Starbucks coffee, actually less since TheoDur is sustained release for 12 hr.) I have found TheoDur reduces my need for inhaled beclomethasone (Vanceril DS). Here’s a comprehensive link on theophylline (NEJM): http://www.nejm.org/collections/asthma/RA-1/1.htm Drug Therapy: Theophylline in Asthma Miles Weinberger, Leslie Hendeles Excerpts: "Dosage Because the rate and completeness of absorption vary for different formulations of theophylline, (7,70) only the products known to be completely and consistently absorbed should be prescribed (Table 2). The initial dosing regimen should allow tolerance to develop to the minor caffeine-like sideeffects frequently associated with the initiation of therapy (Table 1). According to an evaluationof the dosing regimen incorporated by the Food and Drug Administration into labeling guidelines from 1978 to 1995, fewer than 3 percent of children and less than 10 percent of adults had minor side effects, and only one or two measurements of the serum concentration were generally needed to determine the appropriate dosage. (64) Other dosing guidelines were subsequently recommended to reduce further the frequency of side effects, (65,66) and the dosage schedule in Table 1 incorporates the findings of a recent assessment of dose requirements for 534 children and adults, in which mean dose requirements were lower than those previously reported (unpublished data). Safety Despite the potential for serious toxicity and the frequency of dosing errors in some institutions, (86) an epidemiologic investigation involving 36,000 ambulatory patients who received 225,000 prescriptions for theophylline identified serious toxic reactions (defined as those requiring hospitalization) only rarely (<1 per 1000 patient-years); the risk was five times greater among elderly patients and those taking cimetidine. (87) Only one child and one adult had theophylline-induced seizures; the serum theophylline concentrations in these two patients were about 60