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Theophylline-associated status epilepticus in an infant: pharmacokinetics and the risk of suppository use

Zenichiro Kato1, Atsushi Yamagishi, Mitsuhiro Nakamura

  • 1Department of Pediatrics, Graduate School of Medicine, Gifu University, Yanagido 1-1, Gifu, 501-1194, Japan. zen-k@gifu-u.ac.jp

World Journal of Pediatrics : WJP
|November 14, 2009
PubMed

Insights

Theophylline, used for asthma, can cause seizures if dosage guidelines are not followed. Combining oral sustained-release theophylline with aminophylline suppositories led to toxic levels and severe adverse effects in an infant.

Area of Science:

  • Pediatric Pulmonology
  • Clinical Pharmacology

Background:

  • Theophylline is a common asthma medication.
  • Recent concerns highlight the risk of seizures associated with theophylline therapy, prompting guideline revisions.

Observation:

  • An 8-month-old infant experienced a convulsion while on oral sustained-release theophylline and an aminophylline suppository.
  • The infant's seizure required a combination of diazepam, lidocaine, and thiopental for management.

Findings:

  • Pharmacokinetic analysis revealed that theophylline levels exceeded 20 mg/ml due to the combined administration.
  • This elevated concentration, surpassing the recommended 15 mg/ml for sustained-release formulas, resulted in severe adverse effects.

Implications:

  • Physicians and parents require education on the appropriate use of theophylline formulations, especially suppositories.
  • Strict adherence to dosing recommendations is crucial to prevent theophylline-induced toxicity and seizures in pediatric patients.
Abstract

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