Theophylline Anxiety *[i]

A 36-year-old woman with kyphoscoliosis and mixed ventilatory changes as a result of childhood poliomyelitis had not received bronchodilator therapy for previous mild respiratory decompensations. She presented with dyspnoea and wheezing, was tachypnoeic with hypoventilation, and HR 75/min and BP 120/70mm Hg were noted.

Theophylline, methylprednisolone and salbutamol [albuterol] therapy was initiated. 24 hours later the patient began to experience panic attacks with sweating, palpitations, distal tremor, thoraCIC oppression, feelings of unreality, sensation of imminent death and loss of control. These occurred at a rate of 10-15/24 hours. Alprazolam 1.5 mg/day produced periods of only 4 to 5 hours free from attacks. The patient was found to be sensitive to caffeine-rtch drinks. ECG recordings showed sinus tachycardia and an axis of 15°

Theophylline was withdrawn. Within about 24 hours the frequency and Intensity of attacks had started to decrease and attacks had disappeared by 48 hours with HR normal by 72 hours. Alprazolam was withdrawn at discharge and 3 months later there had been no recurrence of anxiety symptoms.

The symptoms observed, resolution of symptoms with theophylline withdrawal, positive response to the anti panic drug alprazolam and the patient's history of sensitivity to caffeine-contalntng drtnks suggested that this panic attack was Induced by theophylline. It IS important to distinguish thiS from the nonspecific signs of anxiety associated with respiratory distress. de Pablo J Garcia Pagan JC P,cado C Perez P Medicina Chnlca 88 549·550 11 Apr 1987 [Translated from the original article published in Spanish]

12 REACTIONS'· 5 December 1987 0157-7271/87/1205-0012/0$01.00/0 © ADIS Press