Theophylline Disposition in Patients with Hepatic Cirrhosis

Piafsky, Kenneth M.; Sitar, Daniel S.; Rangno, Robert E.; Ogilvie, Richard I.

doi:10.1056/nejm197706302962603

Cited by 189 publications

(40 citation statements)

References 11 publications

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“…Patients with hepatic cirrhosis be avoided. The therapeutic blood levels were have a prolonged plasma half-life; the mean found by Turner-Warwick (133) to be at a value in nine patients was found to be 25.6 h plasma concentration of 10-20 mg/1 and this (100). has been substantially corroborated by all later…”

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confidence: 71%

Untitled

1981

Allergy

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Asthma has proved difficult to define (42, 103, in asthma often comes suddenly and unexpect-116) and physicians do not always agree about edly, and even experienced physicians may when a patient should be called asthmatic, have difficulty in judging the severity of an Status asthmaticus cannot be easier to define, attack. The patient may be a better judge in but it seems much more seldom that physicians this respect (122), but many asthmatics are not disagree about a diagnosis of status asthma-very sensitive to changes in airway obstruction, ticus. The term will be used here to denote a Rubinfeld & Pain (111) found that 15% were sustained attack of severe asthma that has not unable to sense a reduction in FEVj below 50% responded to the treatment administered by of predicted value. An objective assessment the patient and his doctor. It is a serious and ought usually to be the first step taken when potentially lethal phase of the disease and if dealing with a patient in status asthmaticus. It hospital admission is possible it will usually be can be carried out in a few minutes, and it required.provides both a baseline from which the proStatus asthmaticus is an acute aggravation gress of the patient can be assessed and a gradwhich may afflict the allergic as well as the ing of the severity of the attack, non-allergic asthmatic. It may occur at any age.The physical signs of wheezing, the use of but the risk seems to be greatest in the middle-accessory respiratory muscles and the presence aged patient with asthma of late onset. It also of pulsus paradoxus have not been found to be seems to afflict women more often than men. reliable indicators of the severity of asthma (71, In seven recent papers (7,25,58,61,70,118,121). 119) out of a total of 1,540 patients, 1,136 were Counting the heart rate is the simplest of females and 404 males, i.e. a ratio of about 3:1.objective measurements and will provide some We have now fairly good knowledge of the indication of the severity of the attack. An elecliberation of mediator substances from the trocardiogram and a chest radiograph should mast cell in the reaction with specific allergens also be available. Tachycardia is always a feature and about their possible significance in acute, of severe asthma and is related to the degree of asthmatic attacks. Yet we do not understand hypoxaemia (107). The average heart rate is what happens when the patient lapses into about [120][121][122][123][124][125][126][127][128][129][130] found an average status asthmaticus despite the use of the medi-rate of 126; Westerman (137) 139 with a range cation which in other situations has successfully from 110 to 180; Rees (107) 118, range 96-160. brought him relief Cooke et al. (25) found a heart rate above 90 in 87% of their patients and that 75% of the complications occurred in patients with a heart Objective assessment ^ , ,0•^ rate above 130. The treatment of severe asthma must reasonTwo important objective measurements that ably begin with an assessment of severity. Death any emergency ward s...

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confidence: 71%

Untitled

1981

Allergy

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“…While it has been suggested that passive congestion of the liver in patients with heart failure might alter the hepatic capacity to extract and metabolize theophylline (Piafsky et al, 1977b), this possibility has not been experimentally verified. Our observation that cor pulmonale, as well as pulmonary edema, reduces theophylline clearance would be compatible with this mechanism of decreased hepatic cleance, since cardiac output per se and possibly liver perfusion, are normal in cor pulmonale (Parker, Kelkar & West, 1966).…”

Section: Pooled Oral and Intravenous Resultsmentioning

confidence: 99%

Impaired theophylline clearance in patients with cor pulmonale.

Vicuna¹,

McNay²,

Ludden³

et al. 1979

Brit J Clinical Pharma

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I The relationship between serum theophylline concentration and daily dose was studied in 45 patients receiving aminophylline orally and in 36 patients receiving it by constant intravenous infusion. 2 Patients were categorized as uncomplicated chronic obstructive pulmonary disease (COPD) or COPD with cor pulmonale (CP). 3 Serum theophylline concentration relative to daily theophylline dose was significantly higher in patients with COPD plus CP than in patients with COPD alone. 4 Total body clearance of theophylline estimated from data obtained during constant intravenous infusion was significantly lower in COPD plus CP than in patients with COPD alone. 5 We conclude that reduced maintenance doses of theophylline are indicated in patients with COPD when complicated with CP.

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“…High plasma concentrations are associated with gastrointestinal side effects and cardiac arrhythmias (Eaton et al, 1980). Theophylline is metabolized by the liver, and its metabolic rate is very sensitive to changes in hepatic function (Baselt & Albertson, 1982;Mangione et al, 1978;Piafsky et al, 1977a). The dose needs to be adjusted depending on the patient's history of smoking (Hunt et al, 1976;Jusko et al, 1978), heart disease (Piafsky et al, 1977b), liver disease (Baselt & Albertson, 1982;Mangione et al, 1978;Piafsky et al, 1977a), or acute viral illnesses (Chang et al, 1978).…”

Section: Arbaprostil (15(r)-15-methyl Pge2): Lack Of Effect On Theophmentioning

confidence: 99%

“…Theophylline is metabolized by the liver, and its metabolic rate is very sensitive to changes in hepatic function (Baselt & Albertson, 1982;Mangione et al, 1978;Piafsky et al, 1977a). The dose needs to be adjusted depending on the patient's history of smoking (Hunt et al, 1976;Jusko et al, 1978), heart disease (Piafsky et al, 1977b), liver disease (Baselt & Albertson, 1982;Mangione et al, 1978;Piafsky et al, 1977a), or acute viral illnesses (Chang et al, 1978). Theophylline's plasma clearance will be decreased by the concurrent administration of cimetidine or erythromycin (Conlon et al, 1981;Jackson et al, 1981;Landay et al, 1978;Prince et al, 1981;Renton et al, 1981;Roberts et al, 1981).…”

Section: Arbaprostil (15(r)-15-methyl Pge2): Lack Of Effect On Theophmentioning

confidence: 99%