Theophylline

• Theophylline has a modest bronchodilator affect in stable COPD when compared against placebo. It should only be used after a trial of short-acting bronchodilators and long-acting bronchodilators, or in patients who are unable to use inhaled therapy, as there is a need to monitor plasma levels and interactions.
• Particular caution needs to be taken with the use of theophylline in older people because of differences in pharmacokinetics, the increased likelihood of comorbidities and the use of other medications.
• The effectiveness of the treatment with theophylline should be assessed by improvements in symptoms, activities of daily living, exercise capacity and lung function.
• Theophylline should always be prescribed by brand name, the formulary choice being Uniphyllin Continus^®.
• For therapeutic drug monitoring of theophylline see Appendix 3.
• Once stable, theophylline levels should only be checked if dosage adjustment, toxicity is suspected or where there is a potential drug interaction (medicines being started or stopped).
• The dose of theophylline prescribed should be reduced at the time of an exacerbation if macrolide or fluoroquinolone antibiotics (or other
  drugs known to interact) are prescribed.