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Clinicians frequently rely on serum theophylline concentrations (STCs) as an indicator of compliance for asthma medications. Most patients with good compliance do not have excessive fluctuations during routine STC monitoring. However, our experience is that in certain patients, persistently low or erratic STCs may be a sign of abnormal theophylline disposition. With careful analysis of theophylline absorption (STC every 2 hours for 24 hours after oral theophylline doses) and elimination (serial STC for 12 hours after an intravenous dose of aminophylline), we identified several patients with previously unrecognized anomalies of theophylline pharmacokinetics. These include (1) a 16-year-old girl with consistent temporal fluctuation in STCs during administration of a sustained-release formulation every 8 hours because of delayed absorption and enhanced elimination of theophylline at night, (2) a 13-year-old girl with markedly delayed absorption of a once-daily preparation administered in the evening, (3) a 5-year-old boy with erratic absorption of a liquid theophylline preparation with significantly increased STCs during the night, and (4) a 49-year-old man with 60% bioavailability of aminophylline tablets. Based on these observations, we suggest that clinicians carefully consider the possibility of abnormalities in theophylline disposition before assuming unexpected deviations in STCs are solely the result of noncompliance.
A F Kossoy, and
M Hill, and
F L Lin, and
S J Szefler
May 1985,
Israel journal of medical sciences,
A F Kossoy, and
M Hill, and
F L Lin, and
S J Szefler
December 1995,
The Annals of thoracic surgery,
A F Kossoy, and
M Hill, and
F L Lin, and
S J Szefler
July 2004,
Comparative biochemistry and physiology. Part A, Molecular & integrative physiology,
A F Kossoy, and
M Hill, and
F L Lin, and
S J Szefler
July 1999,
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine,
A F Kossoy, and
M Hill, and
F L Lin, and
S J Szefler
December 1989,
The American review of respiratory disease,
A F Kossoy, and
M Hill, and
F L Lin, and
S J Szefler
January 1987,
Annals of clinical and laboratory science,
A F Kossoy, and
M Hill, and
F L Lin, and
S J Szefler
August 1988,
Journal of clinical pharmacy and therapeutics,
A F Kossoy, and
M Hill, and
F L Lin, and
S J Szefler
August 2001,
The Australian and New Zealand journal of psychiatry,
A F Kossoy, and
M Hill, and
F L Lin, and
S J Szefler
August 1979,
Annals of allergy,
A F Kossoy, and
M Hill, and
F L Lin, and
S J Szefler
January 2016,
Nederlands tijdschrift voor geneeskunde,
