Theophylline diarrhea with

Abdominal examination may reveal ileus, which is typical of poisoning with antimuscarinic, opioid, and sedative drugs. Hyperactive bowel sounds, abdominal cramping, and diarrhea are common in poisoning with organophosphates, iron, arsenic, theophylline, A phalloides, and A muscaria. 

Guarana contains tannins and has been used to treat diarrhea. It also contains a high concentration of caffeine, which, in conjunction with the alkaloids theobromine and theophylline, gives guarana diuretic and stimulant properties. Guarana is used to treat fatigue, mild depression, headache, and migraine. 

Cardiovascular toxicity is also frequently encountered in poisoning. Hypotension may be due to depression of cardiac contractility hypovolemia resulting from vomiting, diarrhea, or fluid sequestration peripheral vascular collapse due to blockade of -adrenoceptor-mediated vascular tone or cardiac arrhythmias. Hypothermia or hyperthermia due to exposure as well as the temperature-dysregulating effects of many drugs can also produce hypotension. Lethal arrhythmias such as ventricular tachycardia and fibrillation can occur with overdoses of many cardioactive drugs such as ephedrine, amphetamines, cocaine, tricyclic antidepressants, digitalis, and theophylline. 

F. Repeat-dose activated charcoal. Repeated doses of activated charcoal (20-30 g or 0.5-1 g/kg every 2-3 hours) are given orally or via gastric tube. The presence of a slurry of activated charcoal throughout several meters of the intestinal lumen reduces blood concentrations by intermpting enterohep-atic or enteroenteric recirculation of the dmg or toxin, a mode of action quite distinct from simple adsorption of ingested but unabsorbed tablets. This technique is easy and noninvasive and has been shown to shorten the half-life of phenobarbital, theophylline, and several other dmgs (Table 1-41). However, it has not been shown in clinical trials to alter patient outcome. Caution Re-peat-dose charcoal may cause serious fluid and electrolyte disturbance secondary to large-volume diarrhea, especially if premixed charcoal-sorbitol suspensions are used. Also, It should not be used in patients with ileus or obstmction. 

In a pooled analysis of two identical multicenter randomized placebo-controlled trials, roflumilast ( = 1537) and placebo ( = 1534) were compared in patients with severe COPD with a chronic bronchitis phenotype and at least one exacerbation requiring glucocorticoids treatment in the previous year [113 ]. Inhaled glucocorticoids, tiotropium, and theophylline were not allowed. Treatment with roflumilast increased the pre-bronchodilator FEVj and reduced the rate of exacerbations. However, adverse events were more common in the intervention group (67% versus 62%), and withdrawal secondary to these effects including headaches, nausea, and diarrhea,... 

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