Reactions 627 - 16 Nov 1996

Theophylline

Adverse effects in an elderly patient: case reportThe following report describes theophylline toxicity that was

initially diagnosed as peptic ulcer disease, in an 82-year-oldman. He had been successfully treated for a duodenal ulcer 8years earlier.

The man was hospitalised with nausea, vomiting anddyspepsia of several weeks duration; he had a history ofbodyweight loss over the past year. His amylase levels wereslightly elevated. One year earlier, he had started treatmentwith sustained release theophylline 600 mg/day for chronicobstructive pulmonary disease.

Initially, the man was treated with cimetidine. However, thenausea and vomiting persisted. His treatment was changed toranitidine, but this did not relieve his symptoms either. Hissymptoms then worsened and treatment with famotidine wasalso unsuccessful.

The man was hospitalised again and, on admission, physicalfindings were normal apart from tachycardia. His serumamylase level had increased further and his creatine kinase-MBlevel was elevated. His theophylline level was 35 µg/ml(therapeutic range 1–20). Theophylline and famotidine werediscontinued. By the fourth hospital day, his symptoms hadresolved. His serum amylase and creatine kinase-MB levelsnormalised. At 2 months’ follow-up, he had not experiencedany further gastrointestinal disorders or tachycardia.

Author comment: This patient was misdiagnosed as havingpeptic ulcer disease because of his past medical history andgastrointestinal disorders. ‘All of the histamine H2-receptorantagonists used in the treatment of this patient could havetheoretically inhibited theophylline metabolism and aggravatedtheophylline toxicity.’ Theophylline should be used verycautiously in elderly patients.Alterman P, et al. Histamine H2-receptor antagonists and chronic theophyllinetoxicity. American Family Physician 54: 1473 & 1477, Oct 1996 -Israel 800476234

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Reactions 16 Nov 1996 No. 6270114-9954/10/0627-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved