Pediatric Theophylline Toxicity Medication
- Author: Tracey H Reilly, MD; Chief Editor: Timothy E Corden, MD more...
These agents may be used to control vomiting. Phenothiazine antiemetics should be avoided to prevent potentiation of theophylline toxicity.
Dopamine antagonist that stimulates acetylcholine release in myenteric plexus. Centrally acts on chemoreceptor triggers in floor of fourth ventricle, which provides important antiemetic activity.
Selective 5-HT3-receptor antagonist that blocks serotonin peripherally and centrally. Prevents nausea and vomiting associated with emetogenic cancer chemotherapy (eg, high-dose cisplatin) and complete-body radiation therapy.
Drug absorption reducers
Activated charcoal is used to decrease drug absorption and may be all that is required in mild-to-moderate toxicity. It is not absorbed and is excreted entirely through the GI tract.
Emergency treatment in poisoning caused by drugs and chemicals. Network of pores present in activated charcoal absorbs 100-1000 mg of drug per gram of charcoal. Does not dissolve in water. For maximum effect, administer within 30 min after poison ingestion.
Whole bowel irrigation agents
Polyethylene glycol is used to increase GI transit time, decreasing absorption of theophylline. It may be used in older children or adults who have ingested significant amounts of products with delayed absorption. It is not absorbed and is entirely excreted through the GI tract.
Laxative with strong electrolyte and osmotic effects that has cathartic actions in GI tract.
These agents may be needed to control agitation and seizures.
Depresses all levels of CNS (eg, limbic system, reticular formation), possibly by increasing activity of GABA. Individualize dose and increase doses cautiously to avoid adverse effects.
Sedative hypnotic with short onset of effects and relatively long half-life. May depress all levels of CNS, including limbic system and reticular formation, by increasing action of GABA, a major inhibitory neurotransmitter in the brain. Excellent when sedation longer than 24 hours is needed.
These agents are used to treat hypotension refractory to fluid challenge.
Strong postsynaptic alpha-receptor stimulant with little beta-adrenergic activity that produces vasoconstriction of arterioles in the body. Increases peripheral venous return.
Beta-adrenergic blocking agents
These agents are used to treat severe tachycardia with ischemia or severe hypertension. Short-acting agents should be used because of the potential for significant hypotension in theophylline toxicity.
Excellent in patients at risk for complications from beta-blockade, particularly those with reactive airway disease, mild-to-moderate LV dysfunction, and/or peripheral vascular disease. Short half-life of 8 min allows for titration to desired effect and quick discontinuation if needed.
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