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พญ.มุกดา หวังวีรวงศ์ หัวหน้าหน่วยโรคภูมิแพ้ สถาบันสุขภาพเด็กแห่งชาติมหาราชินี

ชมรมโรคระบบหายใจและเวชบำบัดวิกฤตในเด็กแห่งประเทศไทย ร่วมกับ ยูโรดรัก ลาบอราทอรีส์. พญ.มุกดา หวังวีรวงศ์ หัวหน้าหน่วยโรคภูมิแพ้ สถาบันสุขภาพเด็กแห่งชาติมหาราชินี. Factors altering theophylline metabolism. Hendeles,et al. J Pediatr 1992; 120(2):177-83.

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พญ.มุกดา หวังวีรวงศ์ หัวหน้าหน่วยโรคภูมิแพ้ สถาบันสุขภาพเด็กแห่งชาติมหาราชินี

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  1. ชมรมโรคระบบหายใจและเวชบำบัดวิกฤตในเด็กแห่งประเทศไทยชมรมโรคระบบหายใจและเวชบำบัดวิกฤตในเด็กแห่งประเทศไทย ร่วมกับ ยูโรดรัก ลาบอราทอรีส์ พญ.มุกดา หวังวีรวงศ์ หัวหน้าหน่วยโรคภูมิแพ้ สถาบันสุขภาพเด็กแห่งชาติมหาราชินี

  2. Factors altering theophylline metabolism Hendeles,et al. J Pediatr 1992; 120(2):177-83.

  3. Factors altering theophylline metabolism Hendeles,et al. J Pediatr 1992; 120(2):177-83.

  4. Factors altering theophylline metabolism Hendeles,et al. J Pediatr 1992; 120(2):177-83.

  5. Factors altering theophylline metabolism Hendeles,et al. J Pediatr 1992; 120(2):177-83.

  6. Factors altering theophylline metabolism Hendeles,et al. J Pediatr 1992; 120(2):177-83.

  7. Factors altering theophylline metabolism Hendeles,et al. J Pediatr 1992; 120(2):177-83.

  8. Clinician’s concern“Non-effect to high toxicity” *Sessier CN, Am j med.1988 Allegra L,Giom It Mal Tor 2006

  9. Initial dosageAdults and children >1 yr or age:12-14 mg/kg/day up to a maximum of 300 mg/day After 3 days, if tolerated, ,increase dose to Incremental increaseAdults and children > 45 kg : 400 mg/dayChildren <45 kg : 16 mg/kg/day up to maximum of 400 mg/day After 3 days, if tolerated, increase dose to: i Final dosage before serum concentration measurementAdults and children > 45 kg : 600 mg/dayChildren <45 kg : 20 mg/kg/day up to maximum of 600 mg/day Check serum concentration ~4 hours after a morning dose of most slow-release products or 8 hours after a dose of a very slowly absorbed productgiven once every 24 hours, when no doses have been missed, added, or taken at unequal intervals for 3 days

  10. Hendeles,et al. J Pediatr 1992; 120(2):177-83.

  11. Hendeles,et al. J Pediatr 1992; 120(2):177-83.

  12. Side-effects • Most common - anorexia - nausea/vomiting - headache

  13. Side-effects • May occur -CNS stimulation, seizures - palpitations -tachycardia - arrhythmia - abdominal pain, diarrhea - GERD - rarely gastric bleeding

  14. Side-effects • Changes in mood and personality, impaired school performance has been reported. (Furukawa CT,et al. Lancet 1984;1:621,J allergy Clin Immunol 1988;81:83-8) • Children with asthma receiving theophylline attain scores on standardized achievement tests that, on average, match those of their non-asthmatics siblings (Lokshin,et al.Ann Allergy 1991; 66:65.) (Lindgren S,et al. New Engl J Med 1992;327:926-3)

  15. Theophylline toxicity in children • 65 cases of theophylline toxicity,aged <17 yo. were reviewed at Johns Hopkins U. 1974-1985 • Mean age 7.4 yo. (3 mo.-16 yo.) • Most common manifestations :- vomiting, tachycardia, CNS excitation • Seizures – 4 cases with serum conc. < 70 mcg/ml • Hallucinations – 2 cases associated with high serum conc. Baker MD.J Pediatr 1986; 109:538-42

  16. Dosage • > 1 yr. = 12-14 mg/d max 300 mg/d GINA 2006:- start 5 mg/d – 10mg/d • < 1 yr. dose = (0.2)×(age in weeks) + 5.0 (mg/d)

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