Theophylline: What It Is, How It Works, and Safe Use

Theophylline is an old‑school drug that many people still use for breathing problems. It belongs to a group called methylxanthines, the same family as caffeine. Doctors mainly give it to folks with asthma or chronic obstructive pulmonary disease (COPD) to help keep the airways open. Unlike inhalers that act fast, theophylline works more slowly but can be useful when other medicines aren’t enough.

When is theophylline prescribed?

Doctors reach for theophylline when inhalers, steroids, or other bronchodilators don’t control symptoms fully. It’s often added to a treatment plan for moderate‑to‑severe asthma that flares up a lot. Some COPD patients also benefit, especially if they have frequent coughing or wheezing that isn’t helped by standard drugs. Because theophylline stays in the blood for a while, doctors usually do a blood test to make sure the level stays in a safe range. If the level is too low, you might not get relief; too high, and you risk side effects.

Key things to watch for: dosage, side effects, and interactions

The dose of theophylline isn’t one‑size‑fits‑all. It’s calculated based on weight, age, and how well your liver processes the drug. Most adults start with a low dose, and the doctor adjusts it after checking blood levels. Keep your dosing schedule consistent – missing a dose or taking extra can push the level into a risky zone.

Common side effects include nausea, stomach upset, headache, and a jittery feeling—much like a strong cup of coffee. Some people notice a fast heartbeat or trouble sleeping. If you get severe nausea, vomiting, tremors, or confusion, call your doctor right away. These could signal a toxic level.

Theophylline loves to mingle with other medicines. Antibiotics like erythromycin, fluoroquinolones, and certain heart drugs can raise its blood level. On the flip side, medications that speed up liver enzymes, such as rifampin or carbamazepine, can lower the level and make the drug less effective. Always tell your pharmacist about every prescription, over‑the‑counter drug, and supplement you take.

Lifestyle habits matter too. Smoking can speed up the breakdown of theophylline, meaning you might need a higher dose. Alcohol can increase side effects, especially nausea. If you’re a smoker, discuss how your habit might affect dosing.

To keep things safe, stick to the same brand or formulation your doctor recommended. Different brands can have slightly different absorption rates, which may confuse blood‑level testing. Store the tablets in a dry place and keep them out of reach of children.

If you’re pregnant or breastfeeding, theophylline crosses the placenta and can appear in breast milk. Talk to your doctor about risks versus benefits before starting. Many clinicians prefer to avoid it in pregnancy unless no other option works.

In short, theophylline can be a useful backup for asthma and COPD, but it needs careful monitoring. By understanding how it works, following the prescribed dose, and watching for side effects, you can use it safely. Always keep an open line with your healthcare team, and don’t hesitate to ask questions about any new symptom or medication you start.