Meriphyllin Uses

How do you administer this medicine?
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Consists of Etophylline, Theophylline

Etophylline (Meriphyllin) side effects

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Vomiting, Nausea, Restlessness, Nervousness, Frequent urge to urinate, Allergic reaction, Flushing, Diarrhoea, Abdominal pain, Headache, Insomnia, Irritation, Loss of appetite, Tremor

What is Theophylline (Meriphyllin)?

Theophylline (Meriphyllin) injection is used together with other medicines to treat the acute symptoms of asthma, bronchitis, emphysema, and other lung diseases in a hospital setting.

Theophylline (Meriphyllin) belongs to a group of medicines known as bronchodilators. Bronchodilators are medicines that relax the muscles in the bronchial tubes (air passages) of the lungs. They relieve cough, wheezing, shortness of breath, and troubled breathing by increasing the flow of air through the bronchial tubes.

Theophylline (Meriphyllin) is available only with your doctor's prescription.

Theophylline (Meriphyllin) indications

An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.

Oral

Acute bronchospasm

Adult: Patients not taking Theophylline (Meriphyllin) or other xanthine medication: Loading dose: 5 mg/kg.

Child: ≥1 yr Same as adult dose.

Elderly: Lower doses should be used.

Hepatic impairment: Reduce dose.

Oral

Chronic bronchospasm

Adult: 300-1,000 mg in divided doses 6-8 hrly. As modified-release preparation: 175-500 mg 12 hrly.

Child: <6 yr Not recommended; 6-12 yr 20-35 kg: 120-250 mg bid; >12 yr 250-500 mg bid.

Elderly: Lower doses should be used.

Hepatic impairment: Reduce dose.

Intravenous

Acute severe bronchospasm

Adult: Patients not taking Theophylline (Meriphyllin) or other xanthine medication: Loading dose: 4-5 mg/kg by infusion over 20-30 min. Maintenance dose: 0.4-0.6 mg/kg/hr.

Child: Patients not taking Theophylline (Meriphyllin) or other xanthine medication: Loading dose: 4-5 mg/kg by infusion over 20-30 min. Maintenance dose: 1-9 yr Initially, 0.8-1 mg/kg/hr; >9-12 yr Initially, 0.7-0.77 mg/kg/hr.

Elderly: Lower doses should be used.

Hepatic impairment: Reduce dose.

Incompatibility: Y-site: Cefepime, hetastarch in normal saline, phenytoin, ceftazidime. Syringe: Ceftriaxone.

Special Populations: Reduce dose in patients w/ cor pulmonale, heart failure, liver disease and fever. Smokers and those who consume alcohol may require higher maintenance dose.

How should I use Theophylline (Meriphyllin)?

Use Theophylline (Meriphyllin) as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Ask your health care provider any questions you may have about how to use Theophylline (Meriphyllin).

Uses of Theophylline (Meriphyllin) in details

There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
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Use: Labeled Indications

Reversible airflow obstruction:

Oral: Treatment of symptoms and reversible airflow obstruction associated with chronic asthma, or other chronic lung diseases (eg, emphysema, chronic bronchitis).

Injection: Treatment of acute exacerbations of the symptoms and reversible airflow obstruction associated with asthma and other chronic lung diseases (eg, chronic bronchitis, emphysema) as an adjunct to inhaled beta-2 selective agonists and systemically administered corticosteroids. Guideline recommendations:

Guideline recommendations:

Asthma: The 2019 Global Initiative for Asthma Guidelines (GINA) and the 2007 National Heart, Lung and Blood Institute Asthma Guidelines recommends against Theophylline (Meriphyllin) as a long-term control medication for asthma in children ≤5 years of age. Additionally, GINA guidelines do not recommend Theophylline (Meriphyllin) for asthma in children 6 to 11 years of age.

Oral Theophylline (Meriphyllin) is a potential alternative option (not preferred) in adolescents and adults as a long-term control medication in mild asthma or as an add-on long-term control medication in moderate to severe asthma; however, a stepwise approach using inhaled corticosteroids (+/- inhaled long-acting beta agonists depending on asthma severity) is preferred to Theophylline (Meriphyllin) due to efficacy concerns and potential for adverse events (GINA 2019). Both guidelines recommend against Theophylline (Meriphyllin) for the treatment of asthma exacerbations due to poor efficacy and safety concerns (GINA 2019; NAEPP 2007).

COPD: Based on the Global Initiative for Chronic Obstructive Lung Disease Guidelines (2019), use of Theophylline (Meriphyllin) in patients with COPD is controversial and lacks data. Theophylline (Meriphyllin) may favorably impact functional impairment in COPD patients, but exact effects are unclear. Studies that demonstrated improvement were done with slow-release preparations. Theophylline (Meriphyllin) is not a preferred agent for COPD exacerbations due to its potential for toxicity.

Off Label Uses

Bradycardia, heart transplantation

Data from small observational studies suggest that Theophylline (Meriphyllin) may be beneficial for the treatment of bradycardia following heart transplantation.

Theophylline (Meriphyllin) description

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Theophylline (Meriphyllin) is a chiral compound. The racemic mixture can be divided into its optical antipodes: levo- and dextro-amphetamine. Theophylline (Meriphyllin) is the parent compound of its own structural class, comprising a broad range of psychoactive derivatives, e.g., MDMA (Ecstasy) and the N-methylated form, methamphetamine. Theophylline (Meriphyllin) is a homologue of phenethylamine.

Theophylline (Meriphyllin) dosage

General Considerations

Theophylline (Meriphyllin) (Theophylline (Meriphyllin) anhydrous capsule) ®, like other extended-release Theophylline (Meriphyllin) products, is intended for patients with relatively continuous or recurring symptoms who have a need to maintain therapeutic serum levels of Theophylline (Meriphyllin). It is not intended for patients experiencing an acute episode of bronchospasm (associated with asthma, chronic bronchitis, or emphysema). Such patients require rapid relief of symptoms and should be treated with an immediate-release or intravenous Theophylline (Meriphyllin) preparation (or other bronchodilators) and not with extended-release products.

Patients who metabolize Theophylline (Meriphyllin) at a normal or slow rate are reasonable candidates for once-daily dosing with Theophylline (Meriphyllin) (Theophylline (Meriphyllin) anhydrous capsule) ®. Patients who metabolize Theophylline (Meriphyllin) rapidly (e.g., the young, smokers, and some nonsmoking adults) and who have symptoms repeatedly at the end of a dosing interval, will require either increased doses given once a day or preferably, are likely to be better controlled by a schedule of twice-daily dosing. Those patients who require increased daily doses are more likely to experience relatively wide peak-trough differences and may be candidates for twice-a-day dosing with Theophylline (Meriphyllin) (Theophylline (Meriphyllin) anhydrous capsule) ®.

Patients should be instructed to take this medication each morning at approximately the same time and not to exceed the prescribed dose.

Recent studies suggest that dosing of extended-release Theophylline (Meriphyllin) products at night (after the evening meal) results in serum concentrations of Theophylline (Meriphyllin) which are not identical to those recorded during waking hours and may be characterized by early trough and delayed peak levels. This appears to occur whether the drug is given as an immediate-release, extended-release, or intravenous product. To avoid this phenomenon when two doses per day are prescribed, it is recommended that the second dose be given 10 to 12 hours after the morning dose and before the evening meal.

Food and posture, along with changes associated with circadian rhythm, may influence the rate of absorption and/or clearance rates of Theophylline (Meriphyllin) from extended-release dosage forms administered at night. The exact relationship of these and other factors to nighttime serum concentrations and the clinical significance of such findings require additional study. Therefore, it is not recommended that

Theophylline (Meriphyllin) (Theophylline (Meriphyllin) anhydrous capsule) ® (when used as a once-a-day product) be administered at night.

Patients who require a relatively high dose of Theophylline (Meriphyllin) (i.e., a dose equal to or greater than 900 mg or 13 mg/kg, whichever is less) should not take Theophylline (Meriphyllin) (Theophylline (Meriphyllin) anhydrous capsule) ® less than 1 hour before a high-fat-content meal since this may result in a significant increase in peak serum level and in the extent of absorption of Theophylline (Meriphyllin) as compared to administration in the fasted state.

The steady-state peak serum Theophylline (Meriphyllin) concentration is a function of the dose, the dosing interval, and the rate of Theophylline (Meriphyllin) absorption and clearance in the individual patient. Because of marked individual differences in the rate of Theophylline (Meriphyllin) clearance, the dose required to achieve a peak serum Theophylline (Meriphyllin) concentration in the 10-20 mcg/mL range varies fourfold among otherwise similar patients in the absence of factors known to alter Theophylline (Meriphyllin) clearance (e.g., 400-1600 mg/day in adults < 60 years old and 10-36 mg/kg/day in children 1-9 years old). For a given population there is no single Theophylline (Meriphyllin) dose that will provide both safe and effective serum concentrations for all patients. Administration of the median Theophylline (Meriphyllin) dose required to achieve a therapeutic serum Theophylline (Meriphyllin) concentration in a given population may result in either sub-therapeutic or potentially toxic serum Theophylline (Meriphyllin) concentrations in individual patients. For example, at a dose of 900 mg/day in adults < 60 years or 22 mg/kg/day in children 1-9 years, the steady-state peak serum Theophylline (Meriphyllin) concentration will be < 10 mcg/mL in about 30% of patients, 10-20 mcg/mL in about 50% and 20-30 mcg/mL in about 20% of patients. The dose of Theophylline (Meriphyllin) must be individualized on the basis of peak serum Theophylline (Meriphyllin) concentration measurements in order to achieve a dose that will provide maximum potential benefit with minimal risk of adverse effects.

Transient caffeine-like adverse effects and excessive serum concentrations in slow metabolizers can be avoided in most patients by starting with a sufficiently low dose and slowly increasing the dose, if judged to be clinically indicated, in small increments. Dose increases should only be made if the previous dosage is well tolerated and at intervals of no less than 3 days to allow serum Theophylline (Meriphyllin) concentrations to reach the new steady state. Dosage adjustment should be guided by serum Theophylline (Meriphyllin) concentration measurement. Health care providers should instruct patients and care givers to discontinue any dosage that causes adverse effects, to withhold the medication until these symptoms are gone and to then resume therapy at a lower, previously tolerated dosage.

If the patient's symptoms are well controlled, there are no apparent adverse effects, and no intervening factors that might alter dosage requirements, serum Theophylline (Meriphyllin) concentrations should be monitored at 6 month intervals for rapidly growing children and at yearly intervals for all others. In acutely ill patients, serum Theophylline (Meriphyllin) concentrations should be monitored at frequent intervals, e.g., every 24 hours.

Theophylline (Meriphyllin) distributes poorly into body fat, therefore, mg/kg dose should be calculated on the basis of ideal body weight. Table V contains Theophylline (Meriphyllin) dosing titration schema recommended for patients in various age groups and clinical circumstances. Table VI contains recommendations for Theophylline (Meriphyllin) dosage adjustment based upon serum Theophylline (Meriphyllin) concentrations. Application of these general dosing recommendations to individual patients must take into account the unique clinical characteristics of each patient. In general, these recommendations should serve as the upper limit for dosage adjustments in order to decrease the risk of potentially serious adverse events associated with unexpected large increases in serum Theophylline (Meriphyllin) concentration.

Table V. Dosing initiation and titration (as anhydrous Theophylline (Meriphyllin)).*

A. Children (12-15 years) and adults (16-60 years) without risk factors for impaired clearance.
Titration Step Children < 45 kg Children > 45 kg and adults
1. Starting Dosage 12-14 mg/kg/day up to a maximum of 300 mg/day divided Q 24 hrs* 300-400 mg/day Dose reduction and/or serum Theophylline (Meriphyllin) concentration measurement is indicated whenever adverse effects are present, physiologic abnormalities that can reduce Theophylline (Meriphyllin) clearance occur (e.g., sustained fever), or a drug that interacts with Theophylline (Meriphyllin) is added or discontinued.

How supplied

Theophylline (Meriphyllin) (Theophylline (Meriphyllin) anhydrous capsule) ® (Theophylline (Meriphyllin) anhydrous) is supplied in extended-release capsules containing 100, 200, 300 or 400 mg of anhydrous Theophylline (Meriphyllin).

Theophylline (Meriphyllin) (Theophylline (Meriphyllin) anhydrous capsule) ® 100 mg capsules are yellow-orange and clear, with markings Theophylline (Meriphyllin) (Theophylline (Meriphyllin) anhydrous capsule), 100 mg, ucb, and 2832, supplied as:

NDC Number Size
50474-100-01 bottle of 100
Theophylline (Meriphyllin)® 200 mg capsules are red-orange and clear, with markings Theophylline (Meriphyllin), 200 mg, ucb, and 2842, supplied as:
NDC Number Size
50474-200-01 bottle of 100
50474-200-50 bottle of 500
Theophylline (Meriphyllin)® 300 mg capsules are red and clear, with markings Theophylline (Meriphyllin), 300 mg, ucb, and 2852, supplied as:
NDC Number Size
50474-300-01 50474-300-50 bottle of 100 bottle of 500
Theophylline (Meriphyllin)® 400 mg capsules are pink and clear, with markings Theophylline (Meriphyllin), 400 mg, ucb, and 2902, supplied as:
NDC Number Size
50474-400-01 bottle of 100

Storage

Store below 77 °F (25 °C).

FOR MEDICAL INFORMATION Contact: Medical Affairs Department Phone: (800) 477-7877, Fax: (770) 970-8859. Manufactured for: UCB Pharma, Inc. Smyrna, GA 30080. by Pfizer Pharmaceuticals LLC Caguas, PR 00725. 04/2005.

Theophylline (Meriphyllin) interactions

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What other drugs will affect Theophylline (Meriphyllin)?

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Drug/Drug Interactions

Theophylline (Meriphyllin) interacts with a wide variety of drugs. The interaction may be pharmacodynamic, i.e., alterations in the therapeutic response to Theophylline (Meriphyllin) or another drug or occurrence of adverse effects without a change in serum Theophylline (Meriphyllin) concentration. More frequently, however, the interaction is pharmacokinetic, i.e., the rate of Theophylline (Meriphyllin) clearance is altered by another drug resulting in increased or decreased serum Theophylline (Meriphyllin) concentrations. Theophylline (Meriphyllin) only rarely alters the pharmacokinetics of other drugs.

The drugs listed in Table II have the potential to produce clinically significant pharmacodynamic or pharmacokinetic interactions with Theophylline (Meriphyllin). The information in the “Effect ” column of Table II assumes that the interacting drug is being added to a steady-state Theophylline (Meriphyllin) regimen. If Theophylline (Meriphyllin) is being initiated in a patient who is already taking a drug that inhibits Theophylline (Meriphyllin) clearance (e.g., cimetidine, erythromycin), the dose of Theophylline (Meriphyllin) required to achieve a therapeutic serum Theophylline (Meriphyllin) concentration will be smaller. Conversely, if Theophylline (Meriphyllin) is being initiated in a patient who is already taking a drug that enhances Theophylline (Meriphyllin) clearance (e.g., rifampin), the dose of Theophylline (Meriphyllin) required to achieve a therapeutic serum Theophylline (Meriphyllin) concentration will be larger. Discontinuation of a concomitant drug that increases Theophylline (Meriphyllin) clearance will result in accumulation of Theophylline (Meriphyllin) to potentially toxic levels, unless the Theophylline (Meriphyllin) dose is appropriately reduced. Discontinuation of a concomitant drug that inhibits Theophylline (Meriphyllin) clearance will result in decreased serum Theophylline (Meriphyllin) concentrations, unless the Theophylline (Meriphyllin) dose is appropriately increased.

The drugs listed in Table III have either been documented not to interact with Theophylline (Meriphyllin) or do not produce a clinically significant interaction (i.e., < 15% change in Theophylline (Meriphyllin) clearance).

The listing of drugs in Table II is current as of June 2004. The listing of drugs in Table III is current as of January 2, 1996. New interactions are continuously being reported for Theophylline (Meriphyllin), especially with new chemical entities. The healthcare professional should not assume that a drug does not interact with Theophylline (Meriphyllin) if it is not listed in Table II. Before addition of a newly available drug in a patient receiving Theophylline (Meriphyllin), the package insert of the new drug and/or the medical literature should be consulted to determine if an interaction between the new drug and Theophylline (Meriphyllin) has been reported.

Table II. Clinically significant drug interactions with Theophylline (Meriphyllin)*.

Drug Type of Interaction Effect**
Adenosine Theophylline (Meriphyllin) blocks adenosine receptors. Higher doses of adenosine may be required to achieve desired effect.
Alcohol A single large dose of alcohol (3 mL/kg of whiskey) decreases Theophylline (Meriphyllin) clearance for up to 24 hours. 30% increase
Allopurinol Decreases Theophylline (Meriphyllin) clearance at allopurinol doses ≥ 600 mg/day. 25% increase
Aminoglutethimide Increases Theophylline (Meriphyllin) clearance by induction of microsomal enzyme activity. 25% decrease
Carbamazepine Similar to aminoglutethimide. 30% decrease
Cimetidine Decreases Theophylline (Meriphyllin) clearance by inhibiting cytochrome P450 1A2. 70% increase
Ciprofloxacin Similar to cimetidine. 40% increase
Clarithromycin Similar to erythromycin. 25% increase
Diazepam Benzodiazepines increase CNS concentrations of adenosine, a potent CNS depressant, while Theophylline (Meriphyllin) blocks adenosine receptors. Larger diazepam doses may be required to produce desired level of sedation. Discontinuation of Theophylline (Meriphyllin) without reduction of diazepam dose may result in respiratory depression.
Disulfiram Decreases Theophylline (Meriphyllin) clearance by inhibiting hydroxylation and demethylation. 50% increase
Enoxacin Similar to cimetidine. 300% increase
Ephedrine Synergistic CNS effects. Increased frequency of nausea, nervousness, and insomnia.
Erythromycin Erythromycin metabolite decreases Theophylline (Meriphyllin) clearance by inhibiting cytochrome P450 3A3. 35% increase. Erythromycin steady-state serum concentrations decrease by a similar amount.
Estrogen Estrogen containing oral contraceptives decrease Theophylline (Meriphyllin) clearance in a dose-dependent fashion. The effect of progesterone on Theophylline (Meriphyllin) clearance is unknown. 30% increase
Flurazepam Similar to diazepam. Similar to diazepam.
Fluvoxamine Similar to cimetidine. Similar to cimetidine
Halothane Halothane sensitizes the myocardium to catecholamines, Theophylline (Meriphyllin) increases release of endogenous catecholamines. Increased risk of ventricular arrhythmias.
Interferon, human recombinant alpha-A Decreases Theophylline (Meriphyllin) clearance. 100% increase
Isoproterenol (IV) Increases Theophylline (Meriphyllin) clearance. 20% decrease
Ketamine Pharmacologic. May lower Theophylline (Meriphyllin) seizure threshold.
Lithium Theophylline (Meriphyllin) increases renal lithium clearance. Lithium dose required to achieve a therapeutic serum concentration increased an average of 60%.
Lorazepam Similar to diazepam. Similar to diazepam.
Methotrexate (MTX) Decreases Theophylline (Meriphyllin) clearance. 20% increase after low dose MTX, higher dose MTX may have a greater effect.
Mexiletine Similar to disulfiram. 80% increase
Midazolam Similar to diazepam. Similar to diazepam.
Moricizine Increases Theophylline (Meriphyllin) clearance. 25% decrease
Pancuronium Theophylline (Meriphyllin) may antagonize non-depolarizing neuromuscular blocking effects, possibly due to phosphodiesterase inhibition. Larger dose of pancuronium may be required to achieve neuromuscular blockade
Pentoxifylline Decreases Theophylline (Meriphyllin) clearance. 30% increase
Phenobarbital (PB) Similar to aminoglutethimide. 25% decrease after two weeks of concurrent PB.
Phenytoin Phenytoin increases Theophylline (Meriphyllin) clearance by increasing microsomal enzyme activity. Theophylline (Meriphyllin) decreases phenytoin absorption. Serum Theophylline (Meriphyllin) and phenytoin concentrations decrease about 40%.
Propafenone Decreases Theophylline (Meriphyllin) clearance and pharmacologic interaction. 40% increase. Beta blockingeffect may decrease efficacy oftheophylline
Rifampin Increases Theophylline (Meriphyllin) clearance by increasing cytochrome P450 1A2 and 3A3 activity. 20-40% decrease
St. John's Wort (Hypericum Perforatum) Decrease in Theophylline (Meriphyllin) plasma concentrations. Higher doses of Theophylline (Meriphyllin) may be required to achieve desired effect. Stopping St. John's Wort may result in Theophylline (Meriphyllin) toxicity.
Sulfinpyrazone Increases Theophylline (Meriphyllin) clearance by increasing demethylation and hydroxylation. Decreases renal clearance of Theophylline (Meriphyllin). 20% decrease
Tacrine Similar to cimetidine, also increases renal clearance of Theophylline (Meriphyllin). 90% increase
Thiabendazole Decreases Theophylline (Meriphyllin) clearance. 190% increase
Ticlopidine Decreases Theophylline (Meriphyllin) clearance. 60% increase
Troleandomycin Similar to erythromycin. 33-100% increase depending on troleandomycin dose.
Verapamil Similar to disulfiram. 20% increase
* Refer to PRECAUTIONS, Drug Interactions for further information regarding table.

** Average effect on steady state Theophylline (Meriphyllin) concentration or other clinical effect for pharmacologic interactions. Individual patients may experience larger changes in serum Theophylline (Meriphyllin) concentration than the value listed.

Table III. Drugs that have been documented not to interact with Theophylline (Meriphyllin) or drugs that produce no clinically significant interaction with Theophylline (Meriphyllin).*

albuterol, systemic and inhaled finasteride norfloxacin
hydrocortisone ofloxacin
amoxicillin isoflurane omeprazole
ampicillin, with or without sulbactam isoniazid prednisone, prednisolone
isradipine ranitidine
atenolol influenza vaccine rifabutin
azithromycin ketoconazole roxithromycin
caffeine, dietary ingestion lomefloxacin sorbitol
cefaclor mebendazole (purgative doses do not inhibit Theophylline (Meriphyllin) absorption)
co-trimoxazole (trimethoprim and sulfamethoxazole) medroxyprogesterone
methylprednisolone
metronidazole sucralfate
diltiazem metoprolol terbutaline,systemic
dirithromycin nadolol terfenadine
enflurane nifedipine tetracycline
famotidine nizatidine tocainide
felodipine
* Refer to PRECAUTIONS: DRUG INTERACTIONS for information regarding table.

Drug/Food Interactions

Taking Theophylline (Meriphyllin) (Theophylline (Meriphyllin) anhydrous capsule) ® less than one hour before a high-fat-content meal, such as 8 oz whole milk, 2 fried eggs, 2 bacon strips, 2 oz hashed brown potatoes, and 2 slices of buttered toast (about 985 calories, including approximately 71 g of fat) may result in a significant increase in peak serum level and in the extent of absorption of Theophylline (Meriphyllin) as compared to administration in the fasted state. In some cases (especially with doses of 900 mg or more taken less than one hour before a high-fat-content meal) serum Theophylline (Meriphyllin) levels may exceed the 20 mcg/mL level, above which Theophylline (Meriphyllin) toxicity is more likely to occur.

The Effect of Other Drugs on Theophylline (Meriphyllin) Serum Concentration Measurements

Most serum Theophylline (Meriphyllin) assays in clinical use are immunoassays which are specific for Theophylline (Meriphyllin). Other xanthines such as caffeine, dyphylline, and pentoxifylline are not detected by these assays. Some drugs (e.g., cefazolin, cephalothin), however, may interfere with certain HPLC techniques. Caffeine and xanthine metabolites in neonates or patients with renal dysfunction may cause the reading from some dry reagent office methods to be higher than the actual serum Theophylline (Meriphyllin) concentration.

Theophylline (Meriphyllin) side effects

See also:
What are the possible side effects of Theophylline (Meriphyllin)?

Adverse reactions associated with Theophylline (Meriphyllin) are generally mild when peak serum Theophylline (Meriphyllin) concentrations are < 20 mcg/ mL and mainly consist of transient caffeine-like adverse effects such as nausea, vomiting, headache, and insomnia. When peak serum Theophylline (Meriphyllin) concentrations exceed 20 mcg/mL, however, Theophylline (Meriphyllin) produces a wide range of adverse reactions including persistent vomiting, cardiac arrhythmias, and intractable seizures which can be lethal. The transient caffeine-like adverse reactions occur in about 50%of patients when Theophylline (Meriphyllin) therapy is initiated at doses higher than recommended initial doses (e.g., > 300 mg/day in adults and > 12 mg/kg/day in children beyond 1 year of age). During the initiation of Theophylline (Meriphyllin) therapy, caffeine-like adverse effects may transiently alter patient behavior, especially in school age children, but this response rarely persists. Initiation of Theophylline (Meriphyllin) therapy at a low dose with subsequent slow titration to a predetermined age-related maximum dose will significantly reduce the frequency of these transient adverse effects. In a small percentage of patients ( < 3%of children and < 10%of adults)the caffeine-like adverse effects persist during maintenance therapy, even at peak serum Theophylline (Meriphyllin) concentrations within the therapeutic range (i.e., 10-20 mcg/mL). Dosage reduction may alleviate the caffeine-like adverse effects in these patients, however, persistent adverse effects should result in a reevaluation of the need for continued Theophylline (Meriphyllin) therapy and the potential therapeutic benefit of alternative treatment.

Other adverse reactions that have been reported at serum Theophylline (Meriphyllin) concentrations < 20 mcg/mL include diarrhea, irritability, restlessness, fine skeletal muscle tremors, and transient diuresis. In patients with hypoxia secondary to COPD, multifocal atrial tachycardia and flutter have been reported at serum Theophylline (Meriphyllin) concentrations ≥ 15 mcg/mL. There have been a few isolated reports of seizures at serum Theophylline (Meriphyllin) concentrations < 20 mcg/mL in patients with an underlying neurological disease or in elderly patients. The occurrence of seizures in elderly patients with serum Theophylline (Meriphyllin) concentrations < 20 mcg/mL may be secondary to decreased protein binding resulting in a larger proportion of the total serum Theophylline (Meriphyllin) concentration in the pharmacologically active unbound form. The clinical characteristics of the seizures reported in patients with serum Theophylline (Meriphyllin) concentrations < 20 mcg/mL have generally been milder than seizures associated with excessive serum Theophylline (Meriphyllin) concentrations resulting from an overdose (i.e., they have generally been transient, often stopped without anticonvulsant therapy, and did not result in neurological residua).

Table IV. Manifestations of Theophylline (Meriphyllin) toxicity.*

Percentage of Patients Reported With Sign or Symptom
Acute Overdose

(Large Single Ingestion)

Chronic Overdosage

(Multiple Excessive Doses)

Sign/Symptom Study 1

(n=157)

Study 2

(n=14)

Study 1

(n=92)

Study 2

(n=102)

Asymptomatic NR** 0 NR** 6
Gastrointestinal
Vomiting 73 93 30 61
Abdominal Pain NR** 21 NR** 12
Diarrhea NR** 0 NR** 14
Hematemesis NR** 0 NR** 2
Metabolic/Other
Hypokalemia 85 79 44 43
Hyperglycemia 98 NR** 18 NR**
Acid/base disturbance 34 21 9 5
Rhabdomyolysis NR** 7 NR** 0
Cardiovascular
Sinus tachycardia 100 86 100 62
Other supraventricular tachycardias 2 21 12 14
Ventricular premature beats 3 21 10 19
Atrial fibrillation or flutter 1 NR** 12 NR**
Multifocal atrial tachycardia 0 NR** 2 NR**
Ventricular arrhythmias with hemodynamic instability 7 14 40 0
Hypotension/shock NR** 21 NR** 8
Neurologic
Nervousness NR** 64 NR** 21
Tremors 38 29 16 14
Disorientation NR** 7 NR** 11
Seizures 5 14 14 5
Death 3 21 10 4
* These data are derived from two studies in patients with serum Theophylline (Meriphyllin) concentrations > 30 mcg/mL. In the first study (Study #1 –Shanon, Ann Intern Med 1993; 119: 1161-67), data were prospectively collected from 249 consecutive cases of Theophylline (Meriphyllin) toxicity referred to a regional poison center for consultation. In the second study (Study #2 –Sessler, Am J Med 1990; 88: 567-76), data were retrospectively collected from 116 cases with serum Theophylline (Meriphyllin) concentrations > 30 mcg/mL among 6000 blood samples obtained for measurement of serum Theophylline (Meriphyllin) concentrations in three emergency departments. Differences in the incidence of manifestations of Theophylline (Meriphyllin) toxicity between the two studies may reflect sample selection as a result of study design (e.g., in Study #1, 48%of the patients had acute intoxications versus only 10% in Study #2) and different methods of reporting results.

** NR =Not reported in a comparable manner.

Theophylline (Meriphyllin) contraindications

See also:
What is the most important information I should know about Theophylline (Meriphyllin)?

Do not take Theophylline (Meriphyllin) in larger or smaller amounts or for longer than recommended. Theophylline (Meriphyllin) overdose can occur if you accidentally take too much at one time, or if your daily doses are too high. To be sure you are using the correct dose, your blood will need to be tested often.

Do not start or stop smoking without first talking to your doctor. Smoking changes the way your body uses Theophylline (Meriphyllin), and you may need to use a different dose.

Sometimes it is not safe to use certain drugs at the same time. Many drugs can interact with Theophylline (Meriphyllin). Tell your doctor about all other medicines you use. Also tell your doctor if you start or stop using any of your other medications.

Stop using Theophylline (Meriphyllin) and call your doctor at once if you have severe or continued vomiting, rapid heartbeats, confusion, tremors, or seizure.

Active ingredient matches for Meriphyllin:

Etophylline/Theophylline


Unit description / dosage (Manufacturer)Price, USD
MERIPHYLLIN INJECTION 1 vial / 2 ML injection each (Wockhardt Ltd)$ 0.05

List of Meriphyllin substitutes (brand and generic names):

10's (Agron Rem. (Agrogem))$ 0.04
Tablets; Oral; Etofylline 23 mg; Theophylline 77 mg (Agron Rem. (Agrogem))
Agrophyllin Theophylline 77 mg, etofylline23 mg. TAB / 10 (Agron Rem. (Agrogem))$ 0.04
AGROPHYLLIN 23MG/77MG TABLET 1 strip / 10 tablets each (Agron Rem. (Agrogem))$ 0.04
AGROPHYLLIN inj 2ml (Agron Rem. (Agrogem))$ 0.05
AGROPHYLLIN tab 10's (Agron Rem. (Agrogem))$ 0.04
Agrophyllin Theophylline 77 mg, etofylline23 mg. TAB / 10 (Agron Rem. (Agrogem))$ 0.04
Agrophyllin 23 mg/77 mg Tablet (Agron Rem. (Agrogem))$ 0.00
DERICIP RETARD 150 TABLET 1 strip / 10 tablets each (Cipla)$ 0.09
DERICIP RETARD 69 MG/231 MG TABLET 1 strip / 10 tablets each (Cipla)$ 0.12
DERICIP RETARD modified-release tab 10's (Cipla)$ 0.12
Dericip Retard 150 Tablet SR (Cipla)$ 0.01
DERITARD INJECTION 1 vial / 2 ML injection each (Lupin Ltd)$ 0.06
ETOBROSMIN 25.3MG/84.7MG INJECTION 1 vial / 2 ml injection each (Synthiko Formulations & Pharma Pvt Ltd)$ 0.06
Etobrosmin 25.3 mg/84.7 mg Injection (Synthiko Formulations & Pharma Pvt Ltd)$ 0.03
ETOPHYLLINE 84.7MG + THEOPHYLLINE 25.3MG INJECTION 1 vial / 2 ML injection each (Jan Aushadhi)$ 0.11
ETOSAL 231MG/69MG TABLET 1 strip / 10 tablets each (Indica Laboratories Pvt Ltd)$ 0.08
Etosal Tablet (Indica Laboratories Pvt Ltd)$ 0.01
THEOPHYLLINE 23MG+ ETOPHYLLIN 77MG TABLET 1 strip / 10 tablets each (Jan Aushadhi)$ 0.06

References

  1. DailyMed. "THEOPHYLLINE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
  2. PubChem. "theophylline". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  3. DrugBank. "theophylline". http://www.drugbank.ca/drugs/DB00277 (accessed September 17, 2018).

Reviews

The results of a survey conducted on ndrugs.com for Meriphyllin are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Meriphyllin. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.

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Information checked by Dr. Sachin Kumar, MD Pharmacology

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