|Trade names||Theolair, Slo-Bid|
|By mouth, IV, rectal|
|Protein binding||40% (primarily to albumin)|
|Metabolism||Hepatic to 1-methyluric acid|
|Elimination half-life||5–8 hours|
|Chemical and physical data|
|Molar mass||180.164 g/mol|
|3D model (JSmol)|
Theophylline, also known as 1,3-dimethylxanthine, is a methylxanthine drug used in therapy for respiratory diseases such as chronic obstructive pulmonary disease (COPD) and asthma under a variety of brand names. As a member of the xanthine family, it bears structural and pharmacological similarity to theobromine and caffeine, and is readily found in nature, and is present in tea (Camellia sinensis) and cocoa (Theobroma cacao). A small amount of theophylline is one of the products of caffeine metabolic processing in the liver.
- 1 Medical uses
- 2 Adverse effects
- 3 Spectroscopy
- 4 Mechanisms of action
- 5 Natural occurrences
- 6 Pharmacokinetics
- 7 History
- 8 Future Studies
- 9 References
- 10 External links
The main actions of theophylline involve:
- relaxing bronchial smooth muscle
- increasing heart muscle contractility and efficiency; as a positive inotrope
- increasing heart rate: (positive chronotropic)
- increasing blood pressure
- increasing renal blood flow
- anti-inflammatory effects
- central nervous system stimulatory effect mainly on the medullary respiratory center.
The main therapeutic uses of theophylline are aimed at:
- chronic obstructive pulmonary disease (COPD)
- infant apnea
- Blocks the action of adenosine; an inhibitory neurotransmitter that induces sleep, contracts the smooth muscles and relaxes the cardiac muscle.
Uses under investigation
The use of theophylline is complicated by its interaction with various drugs and by the fact that it has a narrow therapeutic window.[quantify] Its use must be monitored by direct measurement of serum theophylline levels to avoid toxicity. It can also cause nausea, diarrhea, increase in heart rate, abnormal heart rhythms, and CNS excitation (headaches, insomnia, irritability, dizziness and lightheadedness). Seizures can also occur in severe cases of toxicity, and are considered to be a neurological emergency. Its toxicity is increased by erythromycin, cimetidine, and fluoroquinolones, such as ciprofloxacin. It can reach toxic levels when taken with fatty meals, an effect called dose dumping. Theophylline toxicity can be treated with beta blockers. In addition to seizures, tachyarrhythmias are a major concern. Theophylline should not be used in combination with SSRI Fluvoxamine.
Proton Nuclear Magnetic Resonance Spectroscopy
The characteristic signals, distinguishing theophylline from related methylxanthines, are approximately 3.23δ and 3.41δ, corresponding to the unique methylation possessed by theophylline. The remaining proton signal, at 8.01δ, corresponds to the proton on the imidazole ring, not transferred between the nitrogen. The transferred proton between the nitrogen is a variable proton and only exhibits a signal under certain conditions.
Carbon Nuclear Magnetic Resonance Spectroscopy
The unique methylation of theophylline corresponds to the following signals: 27.7δ and 29.9δ. The remaining signals correspond to carbons characteristic of the xanthine backbone.
Mechanisms of action
Like other methylated xanthine derivatives, theophylline is both a
- competitive nonselective phosphodiesterase inhibitor, which raises intracellular cAMP, activates PKA, inhibits TNF-alpha and inhibits leukotriene synthesis, and reduces inflammation and innate immunity
- nonselective adenosine receptor antagonist, antagonizing A1, A2, and A3 receptors almost equally, which explains many of its cardiac effects
Theophylline has been shown to inhibit TGF-beta-mediated conversion of pulmonary fibroblasts into myofibroblasts in COPD and asthma via cAMP-PKA pathway and suppresses COL1 mRNA, which codes for the protein collagen.
It has been shown that theophylline may reverse the clinical observations of steroid insensitivity in patients with COPD and asthmatics who are active smokers (a condition resulting in oxidative stress) via a distinctly separate mechanism. Theophylline in vitro can restore the reduced HDAC (histone deacetylase) activity that is induced by oxidative stress (i.e., in smokers), returning steroid responsiveness toward normal. Furthermore, theophylline has been shown to directly activate HDAC2. (Corticosteroids switch off the inflammatory response by blocking the expression of inflammatory mediators through deacetylation of histones, an effect mediated via histone deacetylase-2 (HDAC2). Once deacetylated, DNA is repackaged so that the promoter regions of inflammatory genes are unavailable for binding of transcription factors such as NF-κB that act to turn on inflammatory activity. It has recently been shown that the oxidative stress associated with cigarette smoke can inhibit the activity of HDAC2, thereby blocking the anti-inflammatory effects of corticosteroids.)
Theophylline is distributed in the extracellular fluid, in the placenta, in the mother's milk and in the central nervous system. The volume of distribution is 0.5 L/kg. The protein binding is 40%. The volume of distribution may increase in neonates and those suffering from cirrhosis or malnutrition, whereas the volume of distribution may decrease in those who are obese.
Theophylline is metabolized extensively in the liver (up to 70%). It undergoes N-demethylation via cytochrome P450 1A2. It is metabolized by parallel first order and Michaelis-Menten pathways. Metabolism may become saturated (non-linear), even within the therapeutic range. Small dose increases may result in disproportionately large increases in serum concentration. Methylation to caffeine is also important in the infant population. Smokers and people with hepatic (liver) impairment metabolize it differently. Both THC and nicotine have been shown to increase the rate of theophylline metabolism.
Theophylline is excreted unchanged in the urine (up to 10%). Clearance of the drug is increased in children (age 1 to 12), teenagers (12 to 16), adult smokers, elderly smokers, as well as in cystic fibrosis, and hyperthyroidism. Clearance of the drug is decreased in these conditions: elderly, acute congestive heart failure, cirrhosis, hypothyroidism and febrile viral illness.
The elimination half-life varies: 30 hours for premature neonates, 24 hours for neonates, 3.5 hours for children ages 1 to 9, 8 hours for adult non-smokers, 5 hours for adult smokers, 24 hours for those with hepatic impairment, 12 hours for those with congestive heart failure NYHA class I-II, 24 hours for those with congestive heart failure NYHA class III-IV, 12 hours for the elderly.
Theophylline was first extracted from tea leaves and chemically identified around 1888 by the German biologist Albrecht Kossel. Seven years later, a chemical synthesis starting with 1,3-dimethyluric acid was described by Emil Fischer and Lorenz Ach. The Traube purine synthesis, an alternative method to synthesize theophylline, was introduced in 1900 by another German scientist, Wilhelm Traube. Theophylline's first clinical use came in 1902 as a diuretic. It took an additional 20 years until it was first reported as an asthma treatment. The drug was prescribed in a syrup up to the 1970s as Theostat 20 and Theostat 80, and by the early 1980s in a tablet form called Quibron.
Theophylline, despite its adverse effects and narrow therapeutic range, as discussed above, is still a potent bronchodilator. Current research regarding theophylline-based therapies are oriented towards employing theophylline, as well as other methylxanthines as natural scaffolding for new bronchodilatory pharmaceuticals. In 2017, Mohammed, et al. demonstrated potential derivitization of methylxanthines to produce significant broncodilatory effects in a small mouse study group. However, additional work is oriented towards limiting the interactions of theophylline-based therapies with other drugs and structures, as theophylline has been demonstrated as an effective adjunctive therapy in various diseases. These interactions include maintaining, for example, its activity with HDAC, but eliminating its stimulatory behavior (or rather its adenosine-antagonist behavior).
- Mandal, Ananya. "Caffeine Pharmacology". Website Medical News. Archived from the original on 2016-05-31.
- Alboni et al. Effects of Permanent Pacemaker and Oral Theophylline in Sick Sinus Syndrome The THEOPACE Study: A Randomized Controlled Trial Archived 2013-08-02 at Wikiwix
- For Some Who Have Lost Their Sense Of Smell, A Once Popular Asthma Drug Could Help. Science Daily, American Physiological Society Archived 2016-08-21 at the Wayback Machine.
- MedlinePlus Drug Information: Theophylline Archived 2016-07-05 at the Wayback Machine.
- THEOPHYLLINE - ORAL 24 HOUR TABLET (Uni-Dur) side effects, medical uses, and drug interactions Archived 2008-05-09 at the Wayback Machine.
- Yoshikawa H (Apr 2007). "First-line therapy for theophylline-associated seizures". Acta Neurol Scand. 115 (4 Suppl): 57–61. doi:10.1111/j.1600-0404.2007.00810.x. PMID 17362277.
- Hendeles L, Weinberger M, Milavetz G, Hill M, Vaughan L (1985). "Food-induced "dose-dumping" from a once-a-day theophylline product as a cause of theophylline toxicity". Chest. 87 (6): 758–65. doi:10.1378/chest.87.6.758. PMID 3996063.
- Seneff M, Scott J, Friedman B, Smith M (1990). "Acute theophylline toxicity and the use of esmolol to reverse cardiovascular instability". Annals of Emergency Medicine. 19 (6): 671–3. doi:10.1016/s0196-0644(05)82474-6. PMID 1971502.
- "Fluvoxamine-induced theophylline toxicity". American Journal of Psychiatry. 154 (9): 1317b–1318. September 1997. doi:10.1176/ajp.154.9.1317b. ISSN 0002-953X.
- Sperber, A. D. (November 1991). "Toxic interaction between fluvoxamine and sustained release theophylline in an 11-year-old boy". Drug Safety. 6 (6): 460–462. ISSN 0114-5916. PMID 1793525.
- Brøsen, K. (September 1998). "Differences in interactions of SSRIs". International Clinical Psychopharmacology. 13 Suppl 5: S45–47. ISSN 0268-1315. PMID 9817620.
- Shelke, R. U.; Degani, M. S.; Raju, A.; Ray, M. K.; Rajan, M. G. R. Fragment Discovery for the Design of Nitrogen Heterocycles as Mycobacterium tuberculosis Dihydrofolate Reductase Inhibitors. Archiv der Pharmazie 2016, 349, 602-613.
- Pfleiderer, W. Pteridines. Part CXIX. Helvetica Chimica Acta 2008, 91, 338-353.
- Essayan DM (2001). "Cyclic nucleotide phosphodiesterases". J Allergy Clin Immunol. 108 (5): 671–80. doi:10.1067/mai.2001.119555. PMID 11692087.
- Deree J, Martins JO, Melbostad H, Loomis WH, Coimbra R (2008). "Insights into the Regulation of TNF-α Production in Human Mononuclear Cells: The Effects of Non-Specific Phosphodiesterase Inhibition". Clinics (Sao Paulo). 63 (3): 321–8. doi:10.1590/S1807-59322008000300006. PMC 2664230. PMID 18568240.
- Marques LJ, Zheng L, Poulakis N, Guzman J, Costabel U (February 1999). "Pentoxifylline inhibits TNF-alpha production from human alveolar macrophages". Am. J. Respir. Crit. Care Med. 159 (2): 508–11. doi:10.1164/ajrccm.159.2.9804085. PMID 9927365.
- Peters-Golden M, Canetti C, Mancuso P, Coffey MJ (2005). "Leukotrienes: underappreciated mediators of innate immune responses". J. Immunol. 174 (2): 589–94. doi:10.4049/jimmunol.174.2.589. PMID 15634873. Archived from the original on 2014-01-20.
- Daly JW, Jacobson KA, Ukena D (1987). "Adenosine receptors: development of selective agonists and antagonists". Prog Clin Biol Res. 230 (1): 41–63. PMID 3588607.
- Yano Y, Yoshida M, Hoshino S, Inoue K, Kida H, Yanagita M, Takimoto T, Hirata H, Kijima T (2006). "Anti-fibrotic effects of theophylline on lung fibroblasts". Biochemical and Biophysical Research Communications. 341 (3): 684–90. doi:10.1016/j.bbrc.2006.01.018. PMID 16430859.
- Ito K, Lim S, Caramori G, Cosio B, Chung KF, Adcock IM, Barnes PJ (2002). "A molecular mechanism of action of theophylline: Induction of histone deacetylase activity to decrease inflammatory gene expression". Proceedings of the National Academy of Sciences of the United States of America. 99 (13): 8921–6. doi:10.1073/pnas.132556899. PMC 124399. PMID 12070353.
- Apgar, Joan L; Tarka, Stanly M. Jr. (1998). "Methylxanthine composition and consumption patterns of cocoa and chocolate products and their uses". In Gene A. Spiller. Caffeine. CRC Press. p. 171. ISBN 978-0-8493-2647-9. Retrieved 2013-11-10.
- MAFF Food Surveillance Information Sheet Archived 2006-09-27 at the Wayback Machine.
- Belliardo F, Martelli A, Valle MG. HPLC determination of caffeine and theophylline in Paullinia cupana Kunth (guarana) and Cola spp. samples. Z Lebensm Unters Forsch. 1985 May;180(5):398-401.
- Griffin, J. P. The Textbook of Pharmaceutical Medicine (6th ed.). New Jersey: BMJ Books. ISBN 978-1-4051-8035-1
- "RxList Marinol Interactions". 2008-05-29. Archived from the original on 2013-07-06. Retrieved 2013-06-02. (accessdate may be 2013-02-06)
- Kossel A (1888). "Über eine neue Base aus dem Pflanzenreich". Ber. Dtsch. Chem. Ges. 21: 2164–2167. doi:10.1002/cber.188802101422.
- Kossel A (1889). "Über das Theophyllin, einen neuen Bestandtheil des Thees". Hoppe-Seyler's Z. Physiol. Chem. 13: 298–308.
- Fischer E, Ach L (1895). "Synthese des Caffeins". Ber. Dtsch. Chem. Ges. 28 (3): 3139. doi:10.1002/cber.189502803156.
- Traube W (1900). "Der synthetische Aufbau der Harnsäure, des Xanthins, Theobromins, Theophyllins und Caffeïns aus der Cyanessigsäure]". Chem. Ber. 33 (3): 3035–3056. doi:10.1002/cber.19000330352.
- Minkowski O (1902). "Über Theocin (Theophyllin) als Diureticum". Ther. Gegenwart. 43: 490–493.
- Schultze-Werninghaus G, Meier-Sydow J (1982). "The clinical and pharmacological history of theophylline: first report on the bronchospasmolytic action in man by S. R. Hirsch in Frankfurt (Main) 1922". Clin. Allergy. 12 (2): 211–215. doi:10.1111/j.1365-2222.1982.tb01641.x. PMID 7042115.
- Mohamed, A. R.; Georgey, H. H.; George, R. F.; El-Eraky, W. I.; Saleh, D. O.; Abdel Gawad, N. M. Identification of some novel xanthine-based derivatives with bronchodilator activity. Future Medicinal Chemistry 2017, 9, 1731-1747.
- João Monteiro; Marco G Alves; Pedro F Oliveira; Branca M Silva Pharmacological potential of methylxanthines: Retrospective analysis and future expectations. Critical reviews in food science and nutrition 2018, 58, 1-29.
- Barnes, P. J. Theophylline in Chronic Obstructive Pulmonary Disease: New Horizons. Proceedings of the American Thoracic Society 2005, 2, 1.
|Wikimedia Commons has media related to Theophylline.|