Role of dialysis in the management and prevention of theophylline toxicity. Commentary.

Various methods have been described for the extracoporeal removal of theophylline from the body. Charcoal hemoperfusion appears to be the most efficient means while peritoneal dialysis does not even match normal metabolic clearance. None have been unequivocally associated with clinical benefit in the presence of severe theophylline toxicity, although the use of efficient means that increases theophylline elimination may be of value prior to the onset of seizures if serum concentrations are over 60 micrograms/ml. While the treatment of life-threatening symptoms from theophylline overdose remains poorly defined, toxicity during clinical use is avoidable. Mean pharmacokinetic indices and dose requirements can be used to asses risk, and measurement of serum levels further allows appropriate individualized dosage.