Treatment of theophylline intoxication

The treatment of theophylline intoxication is reviewed. Efforts should be made to decrease the absorption of theophylline from the gastrointestinal tract by the oral administration of activated charcoal and sorbitol; stomach emptying procedures are recommended only in limited circumstances. Patients should receive intensive supportive care and appropriate treatment for complications of intoxication, including metabolic and cardiovascular abnormalities and seizures. Despite these treatments, morbidity (including residual neurological deficits) and mortality may occur. Therefore, efforts to actively remove theophylline from the body before complications occur should be considered in an attempt to reduce morbidity and mortality. The oral administration of multiple doses of activated charcoal (which increases theophylline clearance) is recommended for nearly all patients with theophylline intoxication. Although controversial, hemoperfusion--an efficient but invasive active removal procedure--is recommended in severely intoxicated patients who satisfy specific indications; the prophylactic administration of phenobarbital to prevent seizures should also be considered in these patients. Although these recommendations are rationally based on the extant evidence, controlled clinical trials in patients with theophylline intoxication are needed to prove their utility.