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Theophylline toxicity in Thai children
N Visitsunthorn1, K Udomittipong, L Punnakan
1Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
Theophylline toxicity is prevalent in Thai children with respiratory issues, often linked to elevated blood levels. Monitoring theophylline levels is crucial to prevent adverse effects in pediatric patients.
Area of Science:
- Pediatric Pharmacology
- Clinical Toxicology
- Respiratory Medicine
Background:
- Theophylline is a bronchodilator for respiratory diseases but has a narrow therapeutic index.
- Theophylline toxicity can lead to severe adverse events, necessitating careful monitoring.
Purpose of the Study:
- To determine the association between plasma theophylline levels and the occurrence of toxicity symptoms in Thai children.
- To investigate the prevalence and clinical manifestations of theophylline toxicity in a pediatric population.
Main Methods:
- A study involving 44 admitted Thai children with plasma theophylline levels exceeding 20 microg/ml.
- Correlation analysis between measured theophylline blood levels and observed toxicity symptoms.
Main Results:
- The prevalence of theophylline toxicity (plasma theophylline level > 20 microg/ml) was approximately 11% in Thai children.
- A significant correlation was observed, with 34% of patients below 30 microg/ml and 78% above 30 microg/ml exhibiting toxicity symptoms.
- Common symptoms involved gastrointestinal (34%), cardiovascular (18.2%), neurological (6.8%), and metabolic (54.5%) systems.
Conclusions:
- Theophylline remains a valuable medication for pediatric respiratory conditions but requires cautious use.
- Factors contributing to toxicity include overdosage, drug interactions, impaired liver function, and specific patient conditions like congenital heart disease.
- Regular monitoring of theophylline blood levels is recommended for all pediatric patients receiving this medication.
Abstract:
Theophylline is a useful drug in the treatment of respiratory diseases with bronchospasm but it has very narrow safety margin. The study was carried out in 44 admitted Thai children with plasma theophylline levels > 20 microg/ml to determine the association between blood levels and symptoms of theophylline toxicity. The prevalence of theophylline toxicity (plasma theophylline level > 20 microg/ml) in Thai children is about 11%. Thirty-four percent of the patients who had theophylline levels less than 30 microg/ml and 78% of those who had levels more than 30 microg/ml had symptoms of theophylline toxicity. The symptoms were related to the gastrointestinal tract (34%), cardiovascular system (18.2%), neurological system (6.8%) and metabolism (54.5%). The possible causes of theophylline toxicity were respiratory tract infection, theophylline overdosage, interaction with other drugs, impairment of liver function, congenital heart disease and theophylline usage in neonates. Theophylline is still a useful drug but should be used with caution. Theophylline levels should be checked in every child who receives theophylline.