Theophylline Toxicity

Around the world, theophylline (1,3-dimethylxanthine) is primarily used as a bronchodilator for patients with asthma and chronic obstructive pulmonary disease (COPD). However, in the United States, asthma and COPD are mainly treated with other agents, and theophylline is largely used to treat bradycardia and apnea in premature newborns. Theophylline causes the endogenous release of catecholamines through indirect stimulation of beta-1 and beta-2 receptors, which at therapeutic levels cause desired bronchodilation. Unfortunately, theophylline has a narrow therapeutic window, and even levels slightly above this therapeutic window can have many adverse effects in the setting of acute and chronic toxicity. The excess circulating catecholamines cause serious clinical effects that are associated with theophylline toxicity. Depending on the dose and route of administration, theophylline can have a wide range of cardiovascular, neurologic, metabolic, musculoskeletal, and gastrointestinal manifestations. Emergency department providers should become familiar with managing patients with theophylline toxicity since arrhythmias, seizures, hyperglycemia, and rhabdomyolysis are several of the complications that can arise.