Theophylline misadventures: Part I

Theophylline intoxication has become an important clinical problem in the NICU, in large part because of its increased and extensive use for treatment of neonatal respiratory diseases. This article reviews the mechanisms of action involved in current methylxanthine uses, outlines the range of dosage recommendations and target plasma levels in the neonate, describes reported toxicities as extensions of the pharmacologic effects, summarizes some recent litigation reports addressing theophylline toxicity, and shares recommendations from practitioners who have written about the clinical use of this class over the past 50 years. By using suitable initial dosing guidelines and aggressive early serum concentration monitoring, practitioners can use theophylline safely and effectively in neonates.