Saturday, September 22, 2012

Why the hang up on theophylline?

Perhaps I'm a stubborn old asthmatic (although I'm only 42), or perhaps I have a viable argument, but I contend it's time physicians got over their fear of theophylline and start prescribing it again for asthmatics who need it.  

Between 1972 and 2007 I was chronically addicted to the substance.  That sounds bad in and of itself, but the theophylline worked.  It worked to keep my lungs opened up.  It helped me and thousands of other asthmatics before Long Acting Beta Adrenergics were combined with improved inhaled corticosteroids.  

Before I started taking Advair in 2003, and when I forgot a dose of theophylline (which was most often Theo-dur), my airways twitched and an asthmatic attack often ensued.  These attacks were the worse ever, and a sure sign of my addiction.  Getting off the substance was something I yearned, yet never hoped for.  

After starting Advair I observed I didn't have such attacks when I missed a dose of theophylline.  It was at this point I started talking to my doctor about weaning myself off the theophylline.  It took a year, and I succeeded.

Now fast forward five years.  Thanks to allergies the Advair is sometimes not enough to prevent an asthma attack.  When I had one last year at hunting camp, I suffered all night and the entire weekend before my breath came all the way back.  

The next time that happened, and I felt panicked, I reached into my medicine cabinet and grabbed the bottle of theophylline I kept in their as a momento of my long-time addiction to the product.  I downed one.  Thirty minutes later my breath came back.  

A month later the same happened, and the theophylline pulled me from the grips of an asthma attack once again.  So I talked to my doctor about this hoping he'd at least give me one bottle of theophylline so I didn't have to dip into the five year old bottle.  He said no.  

Why?  If something works so well, why not let me have it.  It makes me kind of almost upset I told him I was able to wean myself off it.  

To his defense, he gave me a prednisone pack.  That's great, but why would I take prednisone for two weeks when one theophyllline would pull me out of an attack?  It is my view that one theophylline pill would be much safer than two weeks of prednisone.   He disagreed.

I suppose I should add the fear of theophylline to my growing list of myths of respiratory therapy.  It's not like you can get high off theophylline, and it's not like I want to take it regularly.  I tolerated it without side effects for more than 30 years.  So why the hang up?  

I don't want to waste valuable time at a doctor/patient visit to discuss this.  However, one of these days I'm going to run into him on a slow day at work, and I'm going to embellish him with compliments and suck him into a discussion about theophylline.

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1 comment:

  1. First -- I'm not a doctor, and this isn't medical advice, it is just my observations over a couple of decades, ok?

    Theophylline is a very good asthma medicine. (I can remember when the ever-slow FDA finally approved it). It controls asthma very well. I have a close relative with asthma that theophylline probably saved.

    The biggest concern when prescribing/taking theophylline is it conflicts with a really large number of common prescrips -- for example, a *vast* number of antibiotics, even *entire classes* of antibiotics. Theophylline has by far the most conflicts I have *ever* seen in any med.

    Mostly, the conflicts are about "theophylline clearance", e.g., how fast the body can get rid of theophylline. Theophylline only works in a narrow band of blood level, and if another med slows (or speeds) the clearance, the theophylline may not work as well (or at all).

    If that explanation isn't clear, think of the speed limit signs that give both Minimum and Maximum speeds. Theophylline only works between the min and max speed, so to speak.

    If you look up its drug interactions, you'll see about 3 pages of meds that it doesn't get along with, and I would encourage you to do this -- knowledge is a good thing.

    There are other conflicts listed as well; other interactions are listed. As a for-example, I see in the writeups that grapefruit juice is a no-no with theophylline (WebMD has a good writeup of this.)

    I believe it's a good idea to look up the prescribing info for this, and see the list of conflicts. Become an expert on the meds you take. It's worth the time and effort!

    I'm not saying doctors are inept or don't check this. I'm saying they're human beings.
    Doctors get **deluged** with information. They have company reps calling on them to try out new meds, giving them samples, and so forth. The new med writeups tend to run very long in MedicalEse.

    In my experience doctors do not have the *time* to read all this stuff. I don't think any human being does!

    So imagine what the doctors probably know about a med that isn't used much anymore. Doctors forget about its interaction warnings. They're increasingly unaware of just how touchy this med is. If *you* know, then you can help the doc avoid meds that will cause conflicts.

    ALSO: Over-the-counter meds can really trip you up. If I remember correctly, theophylline does not get along with St. John's Wort.

    There are good writeups of theophylline at websites like drugs.com, webmd.com, and many others.

    I hope this is helpful for you. I encourage you to look this up for yourself!

    Thanks,
    David

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