Theophylline anxiety with

Patients with cardiovascular disease (including hypertension), diabetes (risk of hyperglycemia), pregnancy (uterine contractions), prostatism, and anxiety disorders are among those who should not take ma huang at any dose. Drug-herb interactions occur with MAOIs (hypertensive crisis), phenoth-iazines (tachycardia, hypotension), (3-blockers (hypertension) and theophylline (increased CNS effects). Of course, caffeine and other stimulants have an additive effect. 

Theophylline should be used only where methods to measure theophylline blood levels are available because it has a narrow therapeutic window, and its therapeutic and toxic effects are related to its blood level. Improvement in pulmonary function is correlated with plasma concentrations in the range of 5-20 mg/L. Anorexia, nausea, vomiting, abdominal discomfort, headache, and anxiety occur at concentrations of 15 mg/L in some patients and become common at concentrations greater than 20 mg/L. Higher levels (more than 40 mg/L) may cause seizures or arrhythmias these may not be preceded by gastrointestinal or neurologic warning symptoms. 

These cases of interactions of aminophylline with macro-lide antibiotics illustrate that serious, even fatal, adverse effects can occur when possible interactions are not considered. In both cases, experienced physicians prescribed appropriate antimicrobial drugs, but omitted to consider the possibility of interactions with aminophylline, and failed to reduce the dose of aminophyUme or to measure theophylline concentrations. In the first case the development of tachycardia, hypokalemia, acidosis, vomiting, and convulsions can be explained on the basis of theophylline toxicity caused by ciprofloxacin, while in the second the anxiety, tremor, and cardiac arrests could all have resulted from an interaction of aminophylline and erythromycin. These cases add to an extensive literature that emphasizes the potential for interaction between aminophylline and drugs metabolized by CYP1A2. 

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