Leukotriene antagonists Theophylline

Patients receiving these agents may notice improvement in 1 to 2 weeks, but maximal benefit may not be seen for 4 to 6 weeks. Cromolyn and nedocromil appear to be similar in efficacy to the leukotriene antagonists and theophylline for persistent asthma.18 Both agents are well tolerated with adverse effects limited to cough and wheezing. Bad taste and headache have also been reported with nedocromil. One dose of cromolyn or nedocromil prior to exercise or allergen exposure will provide effective prophylaxis for 1 to 2 hours. Cromolyn and nedocromil are not as effective as albuterol for prophylaxis of exercise-induced asthma. 

Sustained-release theophylline is less effective than inhaled corticosteroids and no more effective than oral sustained-release /J2-agonists, cromolyn, or leukotriene antagonists. 

Treatment with a leukotriene-receptor antagonist, particularly montelukast, is widely prescribed, especially by primary care providers. Taken orally, leukotriene-receptor antagonists are easy to use and appear to be used more regularly than inhaled corticosteroids. They are rarely associated with troublesome side effects. Maintenance therapy with a leukotriene antagonist or with cromolyn or nedocromil appears to be roughly as effective as maintenance therapy with theophylline. Because of concerns over the possible long-term toxicity of systemic absorption of inhaled corticosteroids, this maintenance therapy is widely used for treating children in the USA. 

Sustained-release theophylline is less effective than ICSs and no more effective than oral sustained-release 82-agonists, cromolyn or leukotriene antagonists. The addition of theophylline to ICSs is similar to doubling the dose of the ICS and is overall less effective than the long-acting inhaled 82-agonists as adjunctive therapy. ... 

Cromolyn and nedocromil are no more or less effective than theophylline or the leukotriene antagonists for persistent asthma. ... 

Figure 20-3. Possible mechanisms of beta agonists, muscarinic antagonists, theophylline, and leukotriene antagonists in altering bronchial tone in asthma. AC, adenylyl cyclase PDE, phosphodiesterase.

Yurdakul, AS, Taci, N, Eren, A and Sipit, T (2003) Comparative efficacy of once-daily therapy with inhaled corticosteroid, leukotriene antagonist or sustained-release theophylline in patients with mild persistent asthma. Respir Med, 97, 1313-1319. 

Cromolyn, leukotriene receptor antagonists, and theophylline are considered alternative agents, but they are not preferred. 

Zafirlukast and montelukast are well tolerated. Zafirlukast increases plasma concentrations of warfarin and decreases the concentrations of theophylline and erythromycin. In rare cases, treatment of patients with CysLT receptor antagonists is associated with the development of Churg-Strauss syndrome, a condition marked by acute vasculitis, eosinophilia, and a worsening of pulmonary symptoms. Because these symptoms often appear when patients are given the leukotriene receptor antagonists when they are being weaned from oral corticosteroid therapy, it is not clear whether they are related to the action of the antagonists or are due to a sudden reduction in corticosteroid therapy. 

THEOPHYLLINE LEUKOTRIENE RECEPTOR ANTAGONISTS -ZAFIRLUKAST Possibly t theophylline levels. Also possibly 4 zafirlukast levels Mutual alteration of metabolism Be aware watch for features of theophylline toxicity and measure levels... 

Effective agents may include glucocorticoids, anticholineigic agents, leukotriene-receptor antagonists, and P2-adrenergic receptor agonists. Methylxanthines, such as theophylline, are also useful. 

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