BESTOPHYLINE 2ML INJ

• Relaxes bronchial smooth muscle through phosphodiesterase inhibition and adenosine antagonism, relieving acute bronchospasm.
• The injectable route works where a patient is too breathless to use an inhaler effectively or is not responding to nebulised therapy.
• Xanthines also improve diaphragmatic contractility, which helps in the fatigued patient with severe airflow obstruction.
• Etofylline is better tolerated in the stomach than theophylline alone, and the combination allows a lower theophylline load.
• Useful as an adjunct in acute severe asthma when first-line beta-agonist and corticosteroid treatment is insufficient.

Not everyone gets these. Most are mild and settle as the course finishes.

• Theophylline has a narrow therapeutic index. Nausea, vomiting, palpitations, agitation and seizures are the sequence of toxicity, and seizures can occur without warning symptoms.
• Intravenous administration must be slow — rapid injection can cause arrhythmia, hypotension and sudden death.
• Do not give to a patient already taking oral theophylline or aminophylline without knowing the current level; the doses are additive.
• Clearance is reduced by heart failure, liver disease, fever, and by drugs including ciprofloxacin, erythromycin, cimetidine and allopurinol; clearance is increased by smoking and by rifampicin, phenytoin and carbamazepine.
• Use with caution in ischaemic heart disease, arrhythmia, hyperthyroidism, epilepsy and peptic ulcer disease.
• Monitor serum potassium, particularly alongside beta-agonists, corticosteroids and diuretics.
• For administration by a qualified healthcare professional only, with cardiac monitoring where the intravenous route is used.
• Use in pregnancy and breastfeeding only where clearly indicated.