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Theophylline for chronic symptomatic bradycardia in the elderly
1Department of Pharmacy, Virginia Commonwealth University, Richmond 23298, USA.
The Annals of Pharmacotherapy
|July 29, 1998
Summary
Theophylline offers a viable alternative for managing chronic, symptomatic bradycardia in elderly patients who cannot use pacemakers. Recommended dosages ensure safe serum levels, but individual adjustments are crucial for optimal outcomes.
Area of Science:
- Geriatrics
- Pharmacology
- Cardiology
Background:
- Pacemakers are standard for symptomatic bradycardia, but alternatives are needed for non-candidates.
- Existing pharmacologic options have limitations due to side effects and insufficient long-term data.
- Theophylline presents a potential alternative for bradycardia management.
Purpose of the Study:
- To review the use of theophylline for chronic, symptomatic bradycardia in the elderly.
- To establish appropriate dosing strategies and considerations for this patient population.
Main Methods:
- Literature review focusing on theophylline's efficacy and safety in elderly bradycardia patients.
- Analysis of recommended dosages, serum concentrations, and influencing factors.
- Identification of contraindications and monitoring parameters.
Main Results:
- Theophylline dosages of 400-600 mg/day (approx. 8 mg/kg/day) are supported for elderly patients.
- Target serum concentrations range from 5-15 mg/L.
- Lower initial doses are advised due to reduced theophylline clearance in the elderly, with potential for titration.
Conclusions:
- Theophylline is a reasonable pharmacologic strategy for elderly bradycardia patients unsuitable for pacemakers.
- Dosage individualization is essential, considering age, metabolism, drug interactions, and comorbidities.
- Theophylline should be avoided in sick sinus syndrome with tachyarrhythmias and frequent ventricular ectopy.
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