What is the difference between theophylline and caffeine

Background: Recurrent apnea is common in preterm infants, particularly at very early gestational ages. These episodes of loss of effective breathing can lead to hypoxemia and bradycardia which may be severe enough to require resuscitation including use of positive pressure ventilation. Two forms of methylxanthine caffeine and theophylline have been used to stimulate breathing and so prevent apnea and its consequences.

Objectives: In preterm infants with recurrent apnea, does caffeine treatment compared to theophylline treatment lead to a clinically important reduction in apnea and use of mechanical ventilation without clinically important side effects?

Search strategy: Standard strategies of the Neonatal Review Group were used. Searches were made of the Oxford Database of Perinatal Trials, MEDLINE see main text for strategy , previous reviews including cross references, abstracts conferences and symposium proceedings, expert informants, journal handsearching mainly in the English language.

Also an expert informant's search in the Japanese language was made by Prof Y. It is usually requested as a trough level — just before the next dose when the blood concentration is expected to be at its lowest level. Random tests may also be requested if a doctor suspects that a patient may be experiencing theophylline toxicity. Serial samples may be used to track theophylline concentrations in a person who has excessive theophylline levels, until therapeutic concentrations are reached.

Caffeine blood levels are not used to monitor therapy as often as theophylline tests. Usually, babies receiving caffeine are monitored clinically for episodes of apnoea and signs of toxicity, and the physiological effects of the drug are closely watched. The majority of those treated respond to standard doses of the drug. The test is usually requested if a baby is not responding to therapy as expected or if the baby is demonstrating signs of toxicity.

Since daily doses and an extended half-life in premature babies generally result in stable drug levels, the sample collected is usually a random level, not a trough level.

When a person is beginning theophylline treatment, the theophylline test may be requested several times as the dose is adjusted as needed, until appropriate levels are attained. Theophylline levels are measured 5 days after starting oral treatment, and at least 3 days after any dose adjustment. The test may be requested whenever someone has symptoms that the doctor suspects are due to theophylline toxicity and whenever someone is not responding as expected to therapy.

A doctor may request a series of theophylline tests when a patient is being treated for theophylline toxicity to make sure that concentrations are falling. Symptoms associated with acute theophylline toxicity may include:. Symptoms associated with excessive caffeine levels may include:.

Blood levels in the target range mean that most people will have their symptoms relieved without experiencing significant side effects. Adverse effects and the risk of seizures increase with higher concentrations of these drugs. Theophylline can affect, and be affected by, a wide variety of drugs and compounds. When your doctor prescribes theophylline, you should discuss all the prescribed and over-the-counter medications that you are taking as well as if taking oral contraceptives, any herbal supplements such as echinacea, chamomile, and gingko, the amount of caffeine and alcohol that you consume, and whether or not you smoke.

Dosage adjustments are likely to be necessary if smoking is stopped or started during treatment. The use of theophylline as a bronchodilator has decreased as other more effective and less toxic asthma treatments have become available. It is still in use in the UK but is not generally the first treatment choice. Theophylline is given by injection as aminophylline, a mixture of theophylline with a compound ethylene diamine that makes it more soluble.

Aminophylline injection is rarely needed for severe acute asthma. It must be given by very slow intravenous injection, over at least 20 minutes. Measurement of theophylline concentrations is essential if aminophylline is given to patients already taking theophylline, to assess potential toxicity.

In infants, a significant amount of the theophylline dose is metabolized to caffeine. This occurs to a much smaller degree in children and adults. In cases where the theophylline concentration is within the therapeutic index but the infant is showing signs of toxicity, caffeine levels should be determined. Likewise, theophylline is one of the metabolites of caffeine.

Yes, this is an important part of your medical history and will have an effect on other treatment plans. In most cases, the caffeine is a short-term treatment, given for a few days or weeks until the baby matures and ceases to have apnoeic episodes. Theophylline and Caffeine. Persistent apnea may be harmful to the developing brain or organs. Methylxanthines such as theophylline and caffeine are drugs that are believed to stimulate breathing efforts and have been used to reduce apnea.

This review of trials found that caffeine has similar effects to theophylline but has a larger gap between levels that are therapeutic and those with toxic effects. Caffeine is more easily absorbed and has a longer half-life that allows for once daily dosing. Theophylline is associated with higher rates of toxicity. The possibility that higher doses of caffeine might be more effective in extremely preterm infants needs further evaluation in randomized clinical trials.

Recurrent apnea is common in preterm infants, particularly at very early gestational ages. These episodes of loss of effective breathing can lead to hypoxemia and bradycardia, which may be severe enough to require resuscitation including use of positive pressure ventilation. Two forms of methylxanthine caffeine and theophylline have been used to stimulate breathing in order to prevent apnea and its consequences.

To evaluate the effect of caffeine compared with theophylline treatment on the risk of apnea and use of mechanical ventilation in preterm infants with recurrent apnea.