Guide to oral theophylline therapy for the treatment of chronic asthma

Theophylline, when used appropriately, seems to be the most effective noncorticosteroid prophylactic medication for chronic asthma. Dosage, however, requires consideration of the relationship between serum concentration, efficacy, and toxicity, in addition to the variability in rates of elimination. Therapy is initiated with 16 mg/kg/day or 400 mg/day (whichever is less) in divided doses at appropriate intervals depending on the rate of absorption of the product used. If side effects are absent, the dosage is increased at three-day intervals until the age-related mean dosage necessary to produce a therapeutic level, is reached. Final dosage adjustment is generally based on a single determination of serum concentration; dosage requirements generally then remain constant for six to 12 months depending upon the child's growth rate. Dosage adjustment in this manner optimizes benefit, minimizes risk of toxic effect, and avoids excessive numbers of serum theophylline measurements.