Theophylline

Theophylline can help to relieve breathlessness by relaxing muscles in your airways so they open up, and the air can flow through them more easily.

Theophylline in brief

  • Some people with asthma are prescribed theophylline as an 'add on' treatment. It is not a steroid.
  • Theophylline can help to relieve breathlessness by relaxing muscles in your airways so they open up, and the air can flow through them more easily.
  • There are two kinds of theophylline medicines: a tablet or capsule you take at home to help manage your day-to-day asthma symptoms, and an emergency medicine that is only ever given directly into a vein in hospital.
  • To get all the benefits, take theophylline exactly as it's prescribed, usually once or twice a day.
  • When you're taking theophylline, you'll need regular blood tests to make sure the level of theophylline in your blood stays at a safe level. Lots of things (including tobacco and caffeine) can cause the levels of it in your blood to go up potentially to harmful levels. Your GP will talk to you about this.
  • Your theophylline tablets or capsules will not help during an asthma attack. Keep your fast-acting reliever inhaler with you at all times so you can use it if you have any asthma symptoms, such as coughing, wheezing, shortness of breath and tightness in the chest.

How does theophylline help asthma?

There are two kinds of theophylline medicines. One is for you to take at home (usually as a tablet or capsule) to help manage your day-to-day asthma symptoms; the other is an emergency medicine that is only ever given to you in hospital.

  • If you take theophylline at home: Theophylline is available in a long-acting form to help manage asthma every day. As an add-on therapy, it has longer-lasting effects and, if used regularly, can help manage breathlessness.
  • If you're given theophylline in hospital: There are different types of theophylline that can begiven directly into a vein (intravenously) to help relieve your asthma symptoms if an attack of breathlessness or an asthma attack has started. The type most commonly used is called aminophylline.

Theophylline is not a steroid.

Do you still need other asthma medicines?

If you're given theophylline to take at home, it's an 'add-on' to your usual medicine and does not take the place of any other treatment you're taking. If you find that your asthma improves after you start taking it, it's important that you don't stop taking any of your other medicines, as this will cause your symptoms to get worse again.

Who might get benefits from theophylline?

  • Theophylline to take at home is usually prescribed for adults and children over the age of six whose asthma isn't well managed with other medicines.
  • It is not suitable for everyone, including people with certain health conditions or people who are taking some medicines. It is very important that the person prescribing you medicines to help manage your asthma knows your full medical history. They will also need to know details about your lifestyle - for example, whether you smoke or not, whether you take any over-the-counter medicines or recreational drugs, and what you usually eat and drink.

If you take theophylline every day at home, this type of it will not be useful during an asthma attack. Make sure you keep your fast-acting reliever inhaler with you at all times so you can use it if you have an asthma attack.

How does theophylline work?

It is unclear exactly how theophylline works in your body. What we do know is that it relaxes the smooth muscles in your airways so they open up and can let air flow through them more easily.

How often do you need to take theophylline?

If you're given theophylline to help manage your asthma every day, it needs to be taken regularly - usually every 12 or 24 hours. Your GP, asthma nurse or hospital doctor will tell you how often you need to take it - and will write it down on your written asthma action plan. This information is also written on the prescription label on the box of your medicine. If you're unsure, make an appointment to see your GP or asthma nurse as soon as possible so you can ask. You can also ask your pharmacist.

Long-acting bronchodilators like theophylline should never be taken without corticosteroids (your preventer inhaler that you take regularly usually twice daily).

It is very important that you take this medicine exactly as its prescribed. If you don't, you may not be getting all its benefits.

You'll only ever be given theophylline intravenously (usually in the form of aminophylline) if you're in hospital. The doctor or nurse who gives it to you will make sure you get the correct dose and be able to answer any questions you may have.

If you're taking theophylline to help manage your asthma every day, what else do you need to know?

  • You'll need blood tests. When you take theophylline for the first time, your GP or asthma nurse will arrange for you to have a blood test three to five days after you start taking it. You'll also need regular blood tests to check that you're taking the correct dose. It is important you always go for these tests because it means your GP or asthma nurse can make sure that the level of theophylline in your blood stays at a safe level. Depending on the results of the tests, your dose may be adjusted.
  • Sticking to the same brand is important. Make sure you get the same brand of theophylline each time you pick up a new prescription. This is because the amount of theophylline absorbed by your body varies between brands. If you start taking a different brand to the one you normally have, you may be getting too much or too little of the medicine you need.
  • Six weeks is long enough to tell if it works. If theophylline has had no effect after you've been taking it for six weeks, then it is probably not the right medicine for you. You and your GP or asthma nurse will need to discuss other treatment options.
  • It can become unsuitable. Over time, it is possible that theophylline can become unsuitable for some people even if it has been suitable in the past. If you think that taking this medicine is causing you to become unwell, speak to your GP or asthma nurse straight away. You also need to tell your GP or asthma nurse if you are pregnant, planning to get pregnant or breast feeding as theophylline may not be suitable for you.
  • You'll need to tell your GP about your lifestyle. Theophylline can interact with various everyday things that can mean the levels of it in your blood can go up - potentially to harmful levels. If you're taking theophylline, it's really important to be aware that it can interact with:
    • alcohol - ask your GP or asthma nurse if you can drink alcohol
    • tobacco - tell your GP or asthma nurse if you smoke or if you start or give up smoking
    • caffeine - speak to your GP or asthma nurse if you drink lots of caffeinated drinks, such as tea, coffee, hot chocolate or energy drinks
    • a herbal medicine called St. John's Wort - tell your GP or asthma nurse if you're taking any herbal medicines
    • some antibiotics - make sure your GP or asthma nurse is aware that you're taking theophylline if you need a course of antibiotics
    • some anaesthetics - if you're going to have an operation or some dental treatment, tell the doctor or dentist that you're taking theophylline
    • the flu jab - speak to your GP or asthma nurse about whether or not a flu jab is suitable for you. If you do have it, the theophylline levels in your blood may need to be monitored for a while afterwards.

Possible side effects of theophylline

Like all medicines, theophylline can cause side effects. The important thing to remember is that a medicine is only ever available if clinical trials have shown that the benefits of taking it outweigh the risks.

If you're taking theophylline to help manage your asthma every day, there's a list of all potential side effects in the patient information leaflet in the box with your medicine. This can seem worrying when you read through it, but everyone who takes theophylline will respond to it differently. It's difficult to predict who will get side effects and who won't. You may get some. You may get none.

Seek medical attention immediately if you experience any of the following symptoms:

  • vomiting
  • increased or rapid heart rate
  • irregular heartbeat
  • seizures
  • skin rash

Other possible side effects include:

  • headache
  • insomnia
  • nausea
  • irritability
  • stomach upset

If you do get any side effects, or you're worried about anything at all, speak to your GP, asthma nurse or pharmacist as soon as possible. You may find that there are some simple things you can do to help prevent or reduce these side effects. We also have a useful Q&A about the common concerns people have about taking asthma medicine here.

If you suddenly stop taking theophylline, your asthma symptoms may return, which could lead to a potentially fatal asthma attack. If you are having any problems, it's important to speak to your GP or asthma nurse.

As well as all the potential side effects listed above, if you're given theophylline in hospital (usually in the form of aminophylline), another possible short-term side effect is an irregular heartbeat. This is why your healthcare professional may decide to keep an eye on your heart with a cardiac monitor. Electrodes will be taped to your chest which are attached to a screen that displays your heart rate and rhythm. The test is painless, but if the machine makes a bleeping noise that bothers you, you can ask for the sound to be turned down.

Get the best from your theophylline

You need to take theophylline exactly as it's prescribed to get all its benefits. Here's how:

  • Get into a good routine so that you don't forget to take it at the right time(s) every day. You can try linking it to a habit - for example, if you need to take it twice a day you can keep it next to your toothbrush and take it when you clean your teeth in the morning and before bed. Or if you need to take it once a day, take it while you're making your first cup of tea. You might also find it helpful to set a reminder in your phone or make a note in your diary or on your calendar.
  • If you're taking theophylline as tablets, swallow them whole with a drink of water. Crushing or chewing them may mean they can't work as well.
  • If you're taking theophylline as capsules, swallow them whole with a drink of water. Or you (or your child) might find it easier to open the capsule and sprinkle the granules into some soft food, such as yoghurt. The granules should not be chewed as they are swallowed, though.
  • If you've been given the Nuelin SA brand of tablets, it's recommended that you take your doses during a meal or just after a snack. For other brands of theophylline, it doesn't matter whether you take them before, with or after food. Ask your pharmacist if you have any questions about taking your medicines.
  • If you forget to take a dose, take it as soon as you remember (unless it is nearly time for your next dose, in which case leave out the missed dose). Do not take two doses together to make up for a forgotten dose.
  • As well as going for your usual regular blood tests, book an annual asthma review (or every six months for children) with your GP or asthma nurse so they can check how you're doing.

Last updated September 2016

Next review due September 2019