Reactions 621 - 5 Oct 1996

STheophylline

Death in an elderly patient after smoking cessation:case report

A 65-year-old woman receiving oral sustained-releasetheophylline 200mg twice daily for emphysema [duration oftherapy not stated] was hospitalised with toxic theophyllinelevels after she stopped smoking.

The woman had a history of mild congestive heart failureand stroke and smoking > 90 packs of cigarettes per year.Nine months after she stopped smoking, the woman washospitalised with a 3-week history of weakness, nausea andvomiting. During hospitalisation she developed atrialfibrillation unresponsive to electrical cardioversion, andseizures, and required ventilatory support for respiratoryinsufficiency. She then developed fever and leucocytosis. Herserum theophylline concentration was found to be elevated to45.2 µg/ml (therapeutic range 10–20).

The woman was treated with anticonvulsants, antibacterials,activated charcoal and magnesium citrate. By hospital day 4,her serum theophylline concentration had decreased to 7.1 µg/ml and, 2 days later, she was extubated. That evening shedeveloped a high fever, hypotension and hypoxia. She wasreintubated and treated with dopamine, but died the followingday.

Author comment: When theophylline recipients stopcigarette smoking, their theophylline dosage needs to bereduced by a third or fourth, with careful monitoring of serumconcentrations.Rao JK, et al. Smoking cessation and theophylline toxicity in an elderly patientwith emphysema. P and T 21: 432-434 & 448, Aug 1996 - USA 800469301

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Reactions 5 Oct 1996 No. 6210114-9954/10/0621-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved