Nausea aminophylline

Gl Nausea vomiting epigastric pain hematemesis diarrhea rectal irritation or bleeding (aminophylline suppositories). Therapeutic doses of theophylline may induce gastroesophageal reflux during sleep or while recumbent, increasing the potential for aspiration, which can aggravate bronchospasm. 

A 20-year-old man is hospitalized after an asthmatic attack precipitated by an upper respiratory infection and fails to respond in the emergency room to two subcutaneously injected doses of epinephrine. The patient has not been taking theophylline-containing medications for the past 6 weeks. He weighs 60 kg and you estimate that his apparent volume of theophylline distribution is 0.45 L/kg. Bronchodilator therapy includes a 5.6-mg/kg loading dose of aminophylline, infused intravenously over 20 min, followed by a maintenance infusion of 0.63 mg/kg per hour (0.50 mg/kg per hour of theophylline). Forty-eight hours later, the patient s respiratory status has improved. However, he has nausea and tachycardia, and his plasma theophylline level is 24 xg/mL. 

The commonest gastrointestinal adverse effects of aminophylline in adults are nausea and gastrointestinal irritation, which are primarily a function of serum theophylline concentrations, although some additional local irritation may be produced by oral administration. Nausea was reported in six of 20 asthmatic patients with serum theophylline concentrations of 20 pg/ml (SED-9, 4). In a survey of 2766 theophylline-treated patients with cardiac or pulmonary diseases, 11% had adverse effects, most of which were gastrointestinal disturbances (7.8%) (SED-9, 4). 

The emergency department use of aminophylline, a moderate bron-chodUator, for acute asthma has not been recommended for a number of years. Clinical trials of aminophylline in adults and children hospitalized with acute asthma have not reported sufficient evidence of efficacy (improvement in lung function and reduced hospital stay) but have reported an increased risk of adverse effects. However, two smdies of aminophylline in children with severe disease suggested a possible small benefit in reducing intensive care unit admissions. Adverse effects of theophylline include nausea and vomiting and potentiation of the cardiac effects of the inhaled /32-agonists. 

The apparent elearanee of theophylline (given as oral aminophylline, eholine theophyllinate or theophylline) was reduced by 19% in 8 patients with severe, steroid-dependent asthma after 6 weeks of treatment with in-tramuseular methotrexate 15 mg weekly. Three patients complained of nausea and the theophylline dosage was reduced in one of them as the theophylline level was more than 20 mierograms/mL. ... 

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