Cardiac arrhythmias (not including bradyarrhythmias), Fever; ≥102°F for 24 hours or more; or lesser temperature elevations for longer periods, Liver disease; cirrhosis, acute hepatitis, Reduced renal function in infants <3 months of age. Sincalide: (Moderate) Sincalide-induced gallbladder ejection fraction may be affected by concurrent aminophylline. Lansoprazole; Naproxen: (Minor) Concomitant use of theophylline, a CYP1A2 and CYP3A substrate, and lansoprazole has led to a small increase in theophylline clearance. Since this non-linearity results in more than proportional changes in serum theophylline concentrations with changes in dose, it is advisable to make increases or decreases in dose in small increments in order to achieve desired changes in serum theophylline concentrations (see DOSAGE AND ADMINISTRATION, Table VI). (Minor) Oral terbinafine is reported to decrease theophylline clearance by 14%. In contrast, the large fraction of the theophylline dose excreted in the urine as unchanged theophylline and caffeine in neonates requires careful attention to dose reduction and frequent monitoring of serum theophylline concentrations in neonates with reduced renal function (See WARNINGS). In general, limiting dose increases to about 25% of the previous total daily dose will reduce the risk of unintended excessive increases in serum theophylline concentration (see DOSAGE AND ADMINISTRATION, Table VI). Patients should be closely monitored for toxicity. If the patient's symptoms are well controlled, there are no apparent adverse effects, and no intervening factors that might alter dosage requirements (see WARNINGS and PRECAUTIONS), serum theophylline concentrations should be monitored at 6 month intervals for rapidly growing children and at yearly intervals for all others. (Moderate) Concurrent administration of theophylline or aminophylline with some sympathomimetics can produce excessive stimulation and effects such as nervousness, irritability, or insomnia. Chlorpheniramine; Dihydrocodeine; Phenylephrine: (Moderate) Concurrent administration of theophylline or aminophylline with some sympathomimetics can produce excessive stimulation and effects such as nervousness, irritability, or insomnia. In a study conducted in healthy adults, coadministration of febuxostat (80 mg PO daily) resulted in increased theophylline Cmax (6%) and AUC (6.5%). A proposed mechanism is competitive binding of aminophylline to adenosine receptors in the brain. Brompheniramine; Carbetapentane; Phenylephrine: (Moderate) Concurrent administration of theophylline or aminophylline with some sympathomimetics can produce excessive stimulation and effects such as nervousness, irritability, or insomnia. The transient caffeine-like adverse reactions occur in about 50% of patients when theophylline therapy is initiated at doses higher than recommended initial doses (e.g., >300 mg/day in adults and >12 mg/kg/day in children beyond >1 year of age). Since the long-term safety of exposure to 1-methylxanthine in humans is unknown, use with caution when coadministering febuxostat with aminophylline. If these drugs are used together, therapeutic drug monitoring should be considered. More serious effects are rare, but may result in additive cardiovascular effects such as increased blood pressure and heart rate. Seizures or cardiac arrhythmias are also possible. Seizures or cardiac arrhythmias are also possible. Adverse effects such as tremors, insomnia, seizures, or cardiac arrhythmias are also possible when excessive dosages of caffeine are taken concurrently. Store at 20° to 25°C (68° to 77°F). Protein binding is approximately 40% for healthy adults and is lower in neonates and patients with hepatic impairment. Concomitant use can cause additive CNS stimulation; some patients may experience tremor or nervousness with combined use. Further dose adjustments may be needed due to concurrent medical conditions that reduce clearance or concomitant drug therapy; review drug interactions. Aprepitant, Fosaprepitant: (Major) Use caution if theophylline, aminophylline and aprepitant, fosaprepitant are used concurrently and monitor for an increase in theophylline- or aminophylline-related adverse effects and altered serum levels for several days after administration of a multi-day aprepitant regimen. Patients taking theophylline should avoid medications containing caffeine when possible. Prilocaine; Epinephrine: (Moderate) Concurrent administration of theophylline or aminophylline with some sympathomimetics can produce excessive stimulation and effects such as nervousness, irritability, or insomnia. Do not exceed 400 mg/day IV, 400 mg/day PO in patients >= 16 years, or 16 mg/kg/day up to 400 mg/day PO in patients < 16 years unless serum theophylline concentration and patient condition warrant higher dose; careful attention to dose reduction and frequent monitoring of serum theophylline concentrations are required. Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: (Moderate) Caution is warranted when cobicistat is administered with theophylline; aminophylline as there is a potential for elevated theophylline concentrations. The manufacturer of vemurafenib suggests that concomitant use with agents with narrow therapeutic windows that are metabolized by CYP1A2 is not recommended. In patients with chronic asthma, including patients with severe asthma requiring inhaled corticosteroids or alternate-day oral corticosteroids, many clinical studies have shown that theophylline decreases the frequency and severity of symptoms, including nocturnal exacerbations, and decreases the "as needed" use of inhaled beta-2 agonists. Precise data are lacking, but a temperature of 39°C (102°F) for at least 24 hours is probably required to produce a clinically significant increase in serum theophylline concentrations. Tiotropium; Olodaterol: (Moderate) Beta-agonists are commonly used in conjunction with aminophylline or theophylline therapy. Propafenone: (Moderate) Although limited data are available, it appears that propafenone may affect theophylline clearance. Adverse effects such as tremors, insomnia, seizures, or cardiac arrhythmias are also possible when excessive dosages of caffeine are taken concurrently with theophylline. Patients should avoid medications containing caffeine when possible. The interaction risk with CYP450 substrates is likely the highest during the first 9 days of the first cycle and the first 2 days of the second cycle. Calculate initial mg/kg dose based on ideal body weight as theophylline distributes poorly into body fat. Therefore, CYP450 substrates with a narrow therapeutic index may have fluctuations in drug levels and therapeutic effect when tocilizumab therapy is started or discontinued. Renal excretion of unchanged theophylline in neonates amounts to about 50% of the dose, compared to about 10% in children older than three months and in adults. Acetaminophen; Dichloralphenazone; Isometheptene: (Moderate) Concurrent administration of theophylline or aminophylline with some sympathomimetics can produce excessive stimulation and effects such as nervousness, irritability, or insomnia. Capmatinib: (Moderate) Monitor theophylline concentrations and watch for an increase in aminophylline-related adverse reactions if coadministration with capmatinib is necessary; an aminophylline dose reduction may be necessary. Theophylline/aminophylline concentrations should be monitored closely after the addition or discontinuation of armodafinil until a new steady-state level is achieved. Concomitant use can cause additive CNS stimulation; some patients may experience tremor or nervousness with combined use. (Minor) Mycophenolic acid is highly protein bound. (Moderate) Concurrent administration of theophylline or aminophylline with some sympathomimetics can produce excessive stimulation and effects such as nervousness, irritability, or insomnia. Begin with 0.2 mg/kg/hour IV (Max: 400 mg/day) to patients with CHF, cor pulmonale, liver dysfunction, sepsis with multiorgan failure, shock, or other factors for reduced theophylline clearance. Concurrent use of theophylline with caffeine in neonates is not recommended due to the potential for additive toxicity. Phenylephrine: (Moderate) Concurrent administration of theophylline or aminophylline with some sympathomimetics can produce excessive stimulation and effects such as nervousness, irritability, or insomnia. Seizures or cardiac arrhythmias are also possible. Givosiran may moderately reduce hepatic CYP1A2 enzyme activity because of its pharmacological effects on the hepatic heme biosynthesis pathway. Extended-release products should NOT be used to treat acute symptoms. May be administered once daily, in the AM or in the PM and without regard to meals. For example, hypothyroidism causes decreased clearance of theophylline, which returns to normal in the euthyroid state. (Moderate) Concurrent administration of theophylline or aminophylline with some sympathomimetics can produce excessive stimulation and effects such as nervousness, irritability, or insomnia. Do not exceed 16 mg/kg/day (up to 400 mg/day) in patients with risk factors for decreased theophylline clearance or who cannot receive recommended serum concentration monitoring. In neonates, theophylline is metabolized to caffeine; initiating caffeine after theophylline therapy is halted may result in caffeine toxicity in neonates if serum caffeine levels are not monitored prior to the initiation of caffeine therapy. Usual dose: 450 +/- 100 mg/day.[63867]. Whenever a patient receiving theophylline develops nausea or vomiting, particularly repetitive vomiting, or other signs or symptoms consistent with theophylline toxicity (even if another cause may be suspected), additional doses of theophylline should be withheld and a serum theophylline concentration measured immediately. Carbamazepine can stimulate the hepatic metabolism of theophylline if used concurrently. A peak steady state serum theophylline concentration should be measured before increasing the dose in response to persistent chronic symptoms to ascertain whether an increase in dose is safe. Further dose adjustments may be needed due to concurrent medical conditions that reduce clearance or concomitant drug therapy; review drug interactions. More frequently, however, the interaction is pharmacokinetic, i.e., the rate of theophylline clearance is altered by another drug resulting in increased or decreased serum theophylline concentrations. (Major) Caffeine is a CNS stimulant. If theophylline dose adjustments are made, re-adjust the dose upon completion of boceprevir treatment. Patients may also need to limit their intake of caffeine-containing beverages or foods (e.g., coffee, green tea, other teas, colas, or chocolate) to avoid caffeine-like side effects. Careful attention to dose reduction and frequent monitoring of serum theophylline concentrations are required in elderly patients (see WARNINGS). Theophylline has two distinct actions in the airways of patients with reversible obstruction; smooth muscle relaxation (i.e., bronchodilation) and suppression of the response of the airways to stimuli (i.e., non-bronchodilator prophylactic effects). Halothane sensitizes the myocardial conduction system to catecholamines, and theophylline increases the release of endogenous catecholamines. Patients should be monitored for loss of therapeutic effect if a barbiturate is added is added to aminophylline therapy. Administer oral semaglutide separately from other oral medications. More serious effects are rare, but may result in additive cardiovascular effects such as increased blood pressure and heart rate. 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