Theophylline: Brands, Price & Uses in Bangladesh

Theophylline is a methylxanthine bronchodilator used mainly as a second- or third-line option, generally added when preferred inhaled therapies are insufficient. Indications are classified below by evidence strength.

• Established indication: Maintenance (symptomatic and prophylactic) treatment of chronic asthma, including nocturnal asthma and early-morning wheezing, in patients not adequately controlled by preferred inhaled therapies.
• Established indication: Maintenance treatment of reversible airflow obstruction associated with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema.
• Guideline-supported adjunct: Add-on bronchodilator therapy in asthma or COPD inadequately controlled on inhaled corticosteroids and/or long-acting bronchodilators, per current asthma/COPD management guidance, where inhaled options are unavailable, not tolerated, or insufficient — Theophylline is not a preferred first-line agent in current guidelines.
• Requires-combination/adjunct use: Acute exacerbations of asthma or COPD, used together with (not in place of) short-acting bronchodilators and corticosteroids.
• Historical/specialist use (off-label in many settings): Apnea of prematurity, used historically under neonatology specialist supervision; caffeine citrate is generally preferred where available.

Theophylline is not a rescue medicine for acute breathlessness and does not replace fast-acting inhalers.

Because Theophylline has a narrow therapeutic index, dosing must be individualized based on body weight, age, clinical response, and periodic serum Theophylline concentration monitoring. The generally accepted therapeutic serum range is approximately 10–15 mcg/mL; levels above this range substantially increase the risk of toxicity. Therapy is typically started at a lower dose and increased gradually (for example, by no more than about 25% of the previous daily dose at a time), with serum levels checked before further increases. See the Dosage and Administration sections below for indication-specific detail; do not adjust or stop Theophylline dosing without medical supervision.

Side effects are generally dose-related and more likely as serum Theophylline concentrations approach or exceed the therapeutic range. Common side effects include:

• Nausea, vomiting, and epigastric/abdominal discomfort
• Headache
• Nervousness, restlessness, and difficulty sleeping (insomnia)
• Tremor
• Increased heart rate and palpitations
• Increased urination (diuresis), particularly in children

Signs of more serious toxicity — persistent or repeated vomiting, marked tachycardia, irregular heartbeat, or seizures — require immediate medical attention (see Overdose Effects and Precautions and Warnings).