Lack of influence of an intensive antacid regimen on theophylline bioavailability

Abstract

We examined the influence of a large-volume, therapeutic antacid regimen, administered for three full days, on the steady-state bioavailability of a conventional-release and sustained-release theophylline product, Aminophyllin and Theodur, respectively. Nine stable asthmatics voluntarily completed a four-phase investigation requiring a total stay of 12 days in the Clinical Research Unit. The treatments consisted of administration of the formulations mentioned with and without antacids to each patient in a randomized sequence. Four patients participated in an additional phase where antacids were administered q2h around the clock for three days. After coadministration of theophylline plus antacids for two days, theophylline therapy was discontinued while numerous blood samples were obtained over 22 hr and analyzed for theophylline content via radioimmunoassay. Antacids had no predictable, consistent influence on theophylline absorption rate as determined by the absorption rate constant, the time to maximal theophylline concentration, or the lag time for theophylline absorption. Antacids had no detectable influence on theophylline elimination half-life and had no consistent, statistically significant effect on the extent of theophylline bioavailability, according to measurements of maximal concentration, AUC measured over the appropriate steady-state dosing interval, or elimination-rate adjusted AUC. The substantial intraindividual changes for all parameters of theophylline bioavailability that occurred for control and treatment phases likely represent spontaneous, random between-day variability in theophylline disposition independent of antacid administration, as evidenced by the comparability of the percent coefficient of variation for parameters of bioavailability across all phases. Our data demonstrate that therapeutic antacid administration has no effect on steady-state theophylline bioavailability and does not alter the intrinsic variability in theophylline absorption. Based on the results of our data, it is unlikely that a clinically significant (greater than 20%) decrease in theophylline absorption would occur in any patient treated intensively with antacids concurrently.

Combined administration of controlled release theophylline and ranitidine: a 53‐day controlled survey in patients with chronic obstructive lung disease (COLD) and peptic disease.

“…However, both antacids and H 2 antagonists have been shown to induce, although by different mechanisms, changes in the pharmacodynamics and pharmacokinetics of theophylline 1‐7 . Indeed, theophylline is more soluble in an alkaline medium and the elevation of gastric pH elicited by antacids alters its absorption characteristics 8‐12 . This becomes particularly important when controlled‐release theophyllines are used, due to their sensitivity to gastric pH 8‐10 …”