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KOAH OLGULARINDA TEOFİLİNİN YAN ETKİLERİ İLE HASTA YAŞI VE KAN ELEKTROLİTLERİ ARASINDAKİ İLİŞKİ

Year 2011, Volume: 25 Issue: 2, 81 - 87, 01.10.2011

Abstract

Metilksantin grubu ilaçlar uc uz olması ve inhaler grubu ilaçlar gibi hasta uyum sorunu olmaması nedeniyle KOAH tedavisinde yaygın olarak kullanılmaktadır. Kullanımlarını sınırlayıcı en önemli nedenler; bronkodilatör etkilerinin diğer bronkodilatör grup ilaçlardan daha az olması, terapotik kan düzeylerinin dar olması ve diğer ilaçlarla sık etkileşmeleridir. Bu çalışmada KOAH tanısı ile İV veya oral teofilin kullanan hastalarda, serum teofilin seviyesi ve yaş grupları ile teofiline bağlı oluşan yan etkiler ve kan sodyum (Na), potasyum (K), kalsiyum (Ca), Klor (Cl) ve glukoz seviyeleri arasındaki ilişki araştırıldı. alışmaya, KOAH nedeni ile takip edilen toplam 65 hasta alındı. Birinci gruba (21 hasta) standart tedavi olarak inhale kortikosteroid, kısa ve uzun etkili beta2-agonist verildi. İkinci gruba (44 hasta) ise standart tedaviye ek olarak 600 mg/gün dozunda teofilin eklendi. İkinci gruptaki hastalarda 60 yaş altı ve 60 yaş üstü olarak ikiye ayrıldı; plazma teofilin seviyeleri ve oluşan yan etkiler açısından değerlendirildi. Teofilin alan grubtaki 6 hastada tremor, 4 hastada taşikardi, 3 hastada epigastrik bölgede yanma şikâyetleri mevcuttu ve teofilin almayan gruptan anlamlı artmış olarak bulundu. Teofilin kullanan grupta ortalama teofilin seviyesi 13.2±4.1 µg/L olarak ölçüldü. Altmış yaş altı ve 60 yaş üstü her iki grupta da teofilin seviyeleri benzerdi. Tremor gelişen hastaların serum ortalama teofilin seviyesi 16.1 µg/ml, taşikardi gelişen hastaların 14.5 µg/ml, epigastrik bölgede ağrı şikâyeti olan hastaların 9.25 µg/ml düzeyindeydi. Teofilin kullanan 60 yaş üstü hastalarda yan etkiler daha belirgindi. Uygulanan dozda elde edilen serum teofilin seviyelerinin Na, K, Ca, Cl ve glukoz seviyelerini değiştirmediği ve hayatı tehdit eden yan etkilerin ortaya çıkmadığı görüldü. Sonuç olarak teofilinin önerilen terapotik kan düzeyleri aralığında kullanılsa bile yan etkilerin ortaya çıkabildiği, bu etkilerin özellikle yaşlı hastalarda daha belirgin olduğunu saptadık. Bu nedenle teofilin kullanan hastaların plazma teofilin düzeyleri yanında klinik olarak da dikkatli bir şekilde takibi gerekmektedir.

References

  • Dellen RG. Seizures From Theophylline Use. West J Med 1983; 138: 415.
  • Watson WA, Litovitz TL, Rodgers GC, Jr, et al 2002 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2003; 21: 352-421.
  • Cheng-Yu Chen, MD, Kuang-Yao Yang, MD, Yu-Chin Lee, et al. Effect of Oral Amino- phylline on Pulmonary Function Improvement and Tolerability in Different Age Groups of COPD Patients. Chest 2005; 128: 2088-92.
  • Levine JH, Michael JR, Guarnieri T. Multifocal atrial tachycardia: a toxic effect of theo- phylline. Lancet 1985; 1: 12-4.
  • Bittar G, Friedman HS. The arrhythmogenicity of theophylline. A multivariate analysis of clinical determinants. Chest 1991; 99: 1415-20.
  • Sifton DJ, editor. Physicians Desk Reference. 57th ed. Montvale: Thomson PDR; 2003.
  • Abernethy DR, Arnold GJ, Azarnoff D, editors. Mosby’s Drug Consult. St. Louis: Mosby Inc, 2002.
  • Armijo, JA, Sanchez, BM, Peralta, FG, et al. Pharmacokinetics of an ultralong sustained- release theophylline formulation when given twice daily in elderly patients with chronic obstructive pulmonary disease: monitoring implications. Biopharm Drug Dispos 2003; 24: 165-71.
  • Salem N, Rispal P, Lasseur C, Pellegrin JL, Leng B. [Severe hyponatremia and hypokalemia induced by a moderate overdose of theophylline]. Presse Med 1994; 23(3): 140.
  • Dreiher J, Porath A. Severe hyponatremia induced by theophylline and trimethoprim. Arch Intern Med 2001; 161(2): 291-292.
  • Liberopoulos EN, Alexandridis GH, Christidis DS, Elisaf MS. SIADH and hyponatremia with theophylline. Ann Pharmacother 2002; 36(7- 8): 1180-2.
  • İtoh Y, Tsurumi Y, Kmura T, et al. A case of theophylline induced hypercalcemia. Nippon jinzo Gakkai Shi 2007; 49(4): 446-51.
  • threatening events after chronic theophylline
  • intoxication. Arch Intern Med 1990; 150: 2045-8.
  • Yohannes, AM, Hardy, CC Treatment of chronic obstructive pulmonary disease in older patients: a practical guide. Drugs Aging 2003; 20: 209-28.
  • Cydulka, RK, Rowe, BH, Clark, S, et al. Emer- gency department management of acute exacerbations of chronic obstructive pulmo- nary disease in the elderly: the Multicenter Airway Research Collaboration. J Am Geriatr Soc 2003; 51: 908-91. Yazıflma Adresi: Dr. Hatice YILMAZ
  • Dicle Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları, DİYARBAKIR
  • e-posta: drahmet_007@yahoo.com

THE RELATIONSHIP BETWEEN SIDE EFFECTS OF THEOPHYLLINE IN COPD PATIENTS WITH PATIENT AGE AND BLOOD ELECTROLYTES

Year 2011, Volume: 25 Issue: 2, 81 - 87, 01.10.2011

Abstract

Methylxanthine group drugs are used widely due to become cheap and no patient drug compliance problem such as inhaled medications. The most important limitating reasons their uses are having less branchodilator effects than other bronchodilators, small therapeutic blood levels interval and frequently interacts with other drugs. In this study, we analyzed the kinds and frequency of theophylline-related side effects, due to the many interactions with other drugs in the COPD and asthma patients' recieving intravenous and oral theophylline For this aim, relationship between the serum levels of theophylline and Na, K, Ca, Cl, glucose was investigated Total 44 COPD and asthma patients were subjected to study. The average age of patients was 61±5. Serum theophylline Na, K, Ca, Cl and glucose levels were measured for all patients. ECG's of patients were evaluated. The side effects were recorded during the therapy. Tremor in 6 patients, tachycardia in 4 patients, epigastric burning/pain in the stomach in 3 patients were observed. Serum theophylline values in tremor developed patients was about 16,1µg/ml, in taschicardia developed patients was about 14,5 µg/ml, in epigastric burning/pain developed patients was about 9.25 µg/ml. Theophylline derived side effects was not observed in Cor pulmonale patients. Serum theophylline levels did not affects serum Na, K, Ca, Cl and glucose levels and life-threatening side-effects did not observed in applied dose. As a result, side effects of theophylline can ocur even if used in the recommended therapeutic blood levels. we found that these effects are especially more pronounced in elderly patients. Therefore, theophylline user patients should carefully monitored clinically beside of the monitoring plasma theophylline levels during theophylline administration.

References

  • Dellen RG. Seizures From Theophylline Use. West J Med 1983; 138: 415.
  • Watson WA, Litovitz TL, Rodgers GC, Jr, et al 2002 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2003; 21: 352-421.
  • Cheng-Yu Chen, MD, Kuang-Yao Yang, MD, Yu-Chin Lee, et al. Effect of Oral Amino- phylline on Pulmonary Function Improvement and Tolerability in Different Age Groups of COPD Patients. Chest 2005; 128: 2088-92.
  • Levine JH, Michael JR, Guarnieri T. Multifocal atrial tachycardia: a toxic effect of theo- phylline. Lancet 1985; 1: 12-4.
  • Bittar G, Friedman HS. The arrhythmogenicity of theophylline. A multivariate analysis of clinical determinants. Chest 1991; 99: 1415-20.
  • Sifton DJ, editor. Physicians Desk Reference. 57th ed. Montvale: Thomson PDR; 2003.
  • Abernethy DR, Arnold GJ, Azarnoff D, editors. Mosby’s Drug Consult. St. Louis: Mosby Inc, 2002.
  • Armijo, JA, Sanchez, BM, Peralta, FG, et al. Pharmacokinetics of an ultralong sustained- release theophylline formulation when given twice daily in elderly patients with chronic obstructive pulmonary disease: monitoring implications. Biopharm Drug Dispos 2003; 24: 165-71.
  • Salem N, Rispal P, Lasseur C, Pellegrin JL, Leng B. [Severe hyponatremia and hypokalemia induced by a moderate overdose of theophylline]. Presse Med 1994; 23(3): 140.
  • Dreiher J, Porath A. Severe hyponatremia induced by theophylline and trimethoprim. Arch Intern Med 2001; 161(2): 291-292.
  • Liberopoulos EN, Alexandridis GH, Christidis DS, Elisaf MS. SIADH and hyponatremia with theophylline. Ann Pharmacother 2002; 36(7- 8): 1180-2.
  • İtoh Y, Tsurumi Y, Kmura T, et al. A case of theophylline induced hypercalcemia. Nippon jinzo Gakkai Shi 2007; 49(4): 446-51.
  • threatening events after chronic theophylline
  • intoxication. Arch Intern Med 1990; 150: 2045-8.
  • Yohannes, AM, Hardy, CC Treatment of chronic obstructive pulmonary disease in older patients: a practical guide. Drugs Aging 2003; 20: 209-28.
  • Cydulka, RK, Rowe, BH, Clark, S, et al. Emer- gency department management of acute exacerbations of chronic obstructive pulmo- nary disease in the elderly: the Multicenter Airway Research Collaboration. J Am Geriatr Soc 2003; 51: 908-91. Yazıflma Adresi: Dr. Hatice YILMAZ
  • Dicle Üniversitesi Tıp Fakültesi, Göğüs Hastalıkları, DİYARBAKIR
  • e-posta: drahmet_007@yahoo.com
There are 18 citations in total.

Details

Other ID JA72YJ27RB
Journal Section Research Article
Authors

Ahmet Yılmaz This is me

Cengizhan Sezgi This is me

Hatice Yılmaz This is me

Halis Tanrıverdi This is me

Publication Date October 1, 2011
Published in Issue Year 2011 Volume: 25 Issue: 2

Cite

APA Yılmaz, A., Sezgi, C., Yılmaz, H., Tanrıverdi, H. (2011). KOAH OLGULARINDA TEOFİLİNİN YAN ETKİLERİ İLE HASTA YAŞI VE KAN ELEKTROLİTLERİ ARASINDAKİ İLİŞKİ. İzmir Göğüs Hastanesi Dergisi, 25(2), 81-87.