Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed. Take this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day. Keep taking this medication even if you feel well. Do not increase your dose, take this drug more often, or stop taking it without first consulting your doctor. Your pharmacist can provide more information about guaifenesin and theophylline. Stenius-aarniala B, Riikonen S, Teramo K "Slow-release theophylline in pregnant asthmatics. pharmacy chloroquine royal
In selected patients at high risk for theophylline-induced seizures, consideration should be given to the administration of prophylactic anticonvulsant therapy. Theophylline is rapidly and completely absorbed after oral administration in solution or immediate-release solid oral dosage form. The initial dose was administered within 30 minutes of birth. Repeat doses were administered at 12 and 24 hours if the patient remained intubated. Each dose was administered divided in 2 equal aliquots, and given through a side port adapter into the proximal end of the endotra cheal tube. Each aliquot was given in small bursts over 20-30 inspiratory cycles. After each aliquot was instilled, the infant was positioned with either the right or the left side dependent.
In patients with chronic obstructive pulmonary disease COPD clinical studies have shown that theophylline decreases dyspnea, air trapping, the work of breathing, and improves contractility of diaphragmatic muscles with little or no improvement in pulmonary function measurements. If symptoms are controlled and current dosage is tolerated, maintain dose and recheck serum concentration at 6-12 month intervals. Treatment of cardiac arrhythmias. What are the possible side effects of theophylline Theo-24?
Refer to for information regarding table. The listing of drugs in Tables II and III are current as of October 8, 1996. New interactions are continuously being reported for theophylline, especially with new chemical entities. All medicines may cause side effects, but many people have no, or minor, side effects. This may not be a complete list of all interactions that may occur. Ask your health care provider if Quibron may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.
Serum theophylline concentration monitoring. If you have more than one doctor, be sure to tell each of your doctors that you are taking Quibron-T. Many drugs can interact with theophylline and not all possible interactions are listed in this medication guide. Dose is based on body weight and must be determined by your doctor. At first, the dose is 12 to 14 milligrams mg per kg of body weight per day, divided and given every 4 to 6 hours. Your doctor may adjust your dose as needed. However, the total dose is usually not more than 20 mg per kg of body weight per day or 600 mg per day. Metabolism Following oral dosing, theophylline does not undergo any measurable first-pass elimination. In adults and children beyond one year of age, approximately 90% of the dose is metabolized in the liver. Do not stop or change the dose of this medicine without checking first with your doctor. Infasurf as measured on a pulsating bubble surfactometer. Ex vivo, Infasurf restores the pressure volume mechanics and compliance of surfactant-deficient rat lungs. In vivo, Infasurf improves lung compliance, respiratory gas exchange, and survival in preterm lambs with profound surfactant deficiency. Theophylline can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Follow your doctor's instructions about whether to take your medication with food or on an empty stomach. Take the medication the same way every time. What should I discuss with my healthcare provider before taking Quibron guaifenesin and theophylline? Get medical help right away if your asthma symptoms worsen or if you are using your quick-relief inhaler more than usual or more often than prescribed. During the initiation of theophylline therapy, caffeine-like adverse effects may transiently alter patient behavior, especially in school age children, but this response rarely persists. Administer multiple dose oral activated charcoal and measures to control emesis.
Other medications can affect the removal of theophylline from your body, which may affect how theophylline works. Examples include cimetidine, disulfiram, fluvoxamine, interferon, mexiletine, propranolol, rifampin, drugs used to treat seizures such as carbamazepine, phenytoin St. John's wort, ticlopidine, among others. HPLC techniques. Caffeine and xanthine metabolites in neonates or patients with renal dysfunction may cause the reading from some dry reagent office methods to be higher than the actual serum theophylline concentration. It is possible that some side effects of Quibron may not have been reported. Dosage reduction may alleviate the caffeine-like adverse effects in these patients, however, persistent adverse effects should result in a reevaluation of the need for continued theophylline therapy and the potential therapeutic benefit of alternative treatment. Treatment Duration: Safety and efficacy of this drug for treatment of apnea of prematurity have not been established beyond 12 days. In contrast, approximately 50% of the administered theophylline dose is excreted unchanged in the urine in neonates. tecta
Phenytoin increases theophylline clearance by increasing microsomal enzyme activity. Theophylline decreases phenytoin absorption. The listing of drugs in Tables II and III are current as of January 2, 1996. New interactions are continuously being reported for theophylline, especially with new chemical entities. Dose tapering on treatment cessation is unnecessary due to the slow drug elimination in this patient population. Each bead is an individual extended-release delivery system. While simultaneously instituting treatment, contact a regional poison center to obtain updated information and advice on individualizing the recommendations that follow. Caffeine Citrate: Use with caution in infants with impaired renal function; monitor serum drug concentrations and adjust dose accordingly to avoid toxicity. Halothane sensitizes the myocardium to catecholamines, theophylline increases release of endogenous catecholamines. Distribution Once theophylline enters the systemic circulation, about 40% is bound to plasma protein, primarily albumin. Unbound theophylline distributes throughout body water, but distributes poorly into body fat. Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully. osor.info symbicort
Ask your healthcare professional how you should dispose of any medicine you do not use. If symptoms are not controlled and current dosage is tolerated consider adding additional medications to treatment regimen. Take this medicine exactly as directed by your doctor. Do not take more of it and do not take it more often than your doctor ordered. This medicine works best if there is a constant amount in the blood. To keep the blood level constant, take this medicine at the same time each day and do not miss any doses. During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor. Changes in your body during the last 3 months of pregnancy may affect the amount of this drug in your blood. Your doctor should carefully monitor the amount of drug in your blood, as well as any side effects, so that your dose may be changed if needed. This may not be a complete list of all interactions that may occur. Ask your health care provider if Quibron-T may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine. Take the missed dose as soon as you remember. Arwood LL, Dasta JF, Friedman C "Placental transfer of theophylline: two case reports. Additionally, TRUVEN HEALTH MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON REUTERS HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Truven Health does not assume any responsibility or risk for your use of the Truven Health products. Older adults may be more likely to have side effects from this medication. Table IV. Manifestations of theophylline toxicity. This medication can affect the results of certain medical tests. Tell any doctor who treats you that you are using theophylline. Prophylaxis and treatment study results for each surfactant are combined. Follow the directions on your prescription label. Do not take theophylline in larger or smaller amounts or for longer than recommended. Your doctor may occasionally change your dose to make sure you get the best results. Dose is based on body weight and must be determined by your doctor. At first, the dose is 12 to 14 milligrams mg per kg of body weight per day as a single dose, usually in the morning, or divided and given two times per day. Your doctor may adjust your dose as needed. However, the total dose is usually not more than 20 mg per kg of body weight per day or 600 mg per day. buying xeloda without insurance
Take this medication by mouth as directed by your doctor, usually once or twice daily. Since different manufacturers have different ways to take this medication, ask your doctor or pharmacist about the best times to take your brand of theophylline and if you should take the drug with or without food. Pediatrics The clearance of theophylline is very low in neonates see . Theophylline clearance reaches maximal values by one year of age, remains relatively constant until about 9 years of age and then slowly decreases by approximately 50% to adult values at about age 16. Renal excretion of unchanged theophylline in neonates amounts to about 50% of the dose, compared to about 10% in children older than three months and in adults. In neonates, approximately 50% of the theophylline dose is excreted unchanged in the urine. Beyond the first three months of life, approximately 10% of the theophylline dose is excreted unchanged in the urine. Monitor the patient and obtain serial theophylline concentrations every 2-4 hours to gauge the effectiveness of therapy and to guide further treatment decisions. Fluid and electrolyte abnormalities should be promptly corrected. Preventing and treating symptoms and blockage of airway due to asthma or other lung diseases such as emphysema or bronchitis. It may also be used for other conditions as determined by your doctor. Type 2. Compte Tenu des rsultats des tudes et de Cliniques DISPONIBLES ltude observationnelle ralise Qui a confirmer Lapport de LANTUS en conditions Relles dutilisation, LANTUS Apporte juin amlioration du Service mdical rendu mineure de niveau IV en Termes de tolrance. Avis au favorable du Maintien Remboursement en ville. Le Service mdical rendu par mdicament non SMR correspond fils intrt en fonction including de Ses performances Cliniques et de la gravit de la traite maladie. La Commission de la Transparence de la HAS valeur le SMR, qui-peut tre importante, MODR, faible, Ou insuffisant Pour Que le mdicament Soit pris en charger par la solidarit nationale. Lamlioration du Service mdical rendu ASMR correspondent progrs Au thrapeutique APPORT by a mdicament nominale rapport aux Traitements existants. La Commission de la transparence de la HAS valeur le niveau dASMR, cote de I, majeure, IV, mineure. Une ASMR de niveau V quivalent de pas dASMR signifié absence de progrs thrapeutique. Progrs thrapeutique mineur nominale comparaison aux Autres insulines LANTUS insuline glargine is a insulino daction lente Indique, partir de 6 ans, DANS LE treatment du diabte sucr ncessitant non treatment par insuline. Dans le diabte de type 1, les analogues et Rapides carêmes de linsuline, ne pas linsuline glargine, Ont contribu faire du Schma basal-bolus le Schma dadministration de rfrence. Dans le diabte de type 2, lorsquune insulinothrapie is Indique, il ny a pas dargument clinic verser privilgier analogique non prêté de linsuline par rapport aux insulines NPH, Qué this Soit en Termes de Contrle glycmique ous de tolrance. LANTUS un permis juin: réduction modeste des hypoglycmies nocturnes Mais la qualit de vie des patients pas de napparat amliore. LANTUS les exposerait patients Moins dhypoglycmies nocturnes quune insulino daction intermdiaire NPH la taille de CET effet impor-, au mieux, modeste. Pour en savoir plus, tlchargez la ous en synthèse ci-lavis complet dessous. PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Quibron-T while you are pregnant. Quibron-T is found in breast milk. If you are or will be breast-feeding while you use Quibron-T, check with your doctor. Discuss any possible risks to your baby. Store at room temperature away from moisture, heat, and light. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company. Your dose and the number of times you take theophylline daily will depend on the reason you are taking this medication. How should I take Quibron guaifenesin and theophylline? Take Quibron-T at evenly spaced times throughout the day. Taking Quibron-T at the same time each day will help you remember to take it. Contact your doctor with any questions or concerns about the best way to take Quibron-T. There are several readily identifiable causes of reduced theophylline clearance. If the total daily dose is not appropriately reduced in the presence of these risk factors, severe and potentially fatal theophylline toxicity can occur. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. If you are taking the capsules, swallow them whole. If you are unable to swallow them, you may open the capsule and sprinkle the contents onto a spoonful of cool, soft food such as applesauce or pudding. Eat the entire mixture immediately without chewing. Then drink a full glass of liquid 8 ounces or 240 milliliters. Do not prepare a supply for future use. generic acnotin buy now otc
Take this medication exactly as it was prescribed for you. Begin the maintenance dose 24 hours after the loading dose. This is not a complete list of side effects and others may occur. Theophylline is excreted into human milk and may cause irritability or other signs of mild toxicity. The concentration of theophylline in breast milk is approximately equivalent to the maternal serum concentration. The manufacturer states that serious adverse effects in the infant are unlikely unless the mother has toxic serum theophylline concentrations. The American Academy of Pediatrics considers theophylline to be compatible with breast-feeding. Decreases theophylline clearance by inhibiting hydroxylation and demethylation. Decreases theophylline clearance and pharmacologic interaction. Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding. Notify your doctor if you develop a new illness, especially if it is accompanied by fever; if a chronic illness becomes worse; if you start or stop smoking cigarettes or marijuana; or if another doctor prescribes a new medication or tells you to stop using a medication that you have already been taking. For various North American patient populations from literature reports. Different rates of elimination and consequent dosage requirements have been observed among other peoples. Extended-release capsules meet Drug Release Test 6 as published in the current USP monograph for Theophylline Extended-release Capsules. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split the tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing. Prior to treatment initiation of caffeine citrate, measure baseline serum levels of caffeine in infants previously treated with theophylline and those born to mothers who consumed caffeine prior to delivery. Association américaine des endocrinologues cliniques grâce Knoll Pharmaceutical Company pour une subvention à l'éducation pour soutenir le développement des lignes directrices de pratique, 1996. Congestive Heart Failure CHF Theophylline clearance is decreased by 50% or more in patients with CHF. The extent of reduction in theophylline clearance in patients with CHF appears to be directly correlated to the severity of the cardiac disease. Since theophylline clearance is independent of liver blood flow, the reduction in clearance appears to be due to impaired hepatocyte function rather than reduced perfusion. Case reports of theophylline overdose in humans and animal studies suggest that phenytoin is ineffective in terminating theophylline-induced seizures. The doses of benzodiazepines and phenobarbital required to terminate theophylline-induced seizures are close to the doses that may cause severe respiratory depression or respiratory arrest; the clinician should, therefore, be prepared to provide assisted ventilation. Elderly patients and patients with COPD may be more susceptible to the respiratory depressant effects of anticonvulsants. Barbiturate-induced coma or administration of general anesthesia may be required to terminate repetitive seizures or status epilepticus. General anesthesia should be used with caution in patients with theophylline overdose because fluorinated volatile anesthetics may sensitize the myocardium to endogenous catecholamines released by theophylline. Enflurane appears to less likely to be associated with this effect than halothane and may, therefore, be safer. Neuromuscular blocking agents alone should not be used to terminate seizures since they abolish the musculoskeletal manifestations without terminating seizure activity in the brain. Guaifenesin and theophylline can be taken with food to lessen stomach upset.
Sometimes it is not safe to use certain drugs at the same time. Some medicines can affect how theophylline works, which could make it less effective or cause side effects. Theophylline could also affect how other medicines work, making them less effective or causing side effects. If the serum sample is drawn more than two hours after the dose, the results must be interpreted with caution since the concentration may not be reflective of the peak concentration. In contrast, when signs or symptoms of theophylline toxicity are present, the serum sample should be obtained as soon as possible, analyzed immediately, and the result reported to the clinician without delay. Treatment of cardiac arrhythmias Sinus tachycardia and simple ventricular premature beats are not harbingers of life-threatening arrhythmias, they do not require treatment in the absence of hemodynamic compromise, and they resolve with declining serum theophylline concentrations. Other arrhythmias, especially those associated with hemodynamic compromise, should be treated with antiarrhythmic therapy appropriate for the type of arrhythmia. What should I avoid while taking Quibron guaifenesin and theophylline? Get medical help right away if you have any very serious side effects, including: seizures. Older adults may be more likely to have side effects from theophylline. Overview Theophylline is rapidly and completely absorbed after oral administration in solution or immediate-release solid oral dosage form. Theophylline does not undergo any appreciable pre-systemic elimination, distributes freely into fat-free tissues and is extensively metabolized in the liver. order generic perindopril europe
What happens if I miss a dose Theo-24? Co-administration of theophylline with food or antacids does not cause clinically significant changes in the absorption of theophylline from immediate-release dosage forms. Decrease in theophylline plasma concentrations. Infasurf calfactant Intratracheal Suspension is supplied sterile in single-use, rubber-stoppered glass vials containing 3 mL NDC 61938-456-03 and 6 mL NDC 61938-456-06 off-white suspension. RxList is part of the WebMD Health Network. The opinions expressed in the WebMD User Reviews are solely those of the User, who may or may not have medical or scientific training, and do not represent the opinions of WebMD. These member reviews have not been reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other purpose except for compliance with our Terms and Conditions. Fever, regardless of its underlying cause, can decrease the clearance of theophylline. Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. F. THE 3mL VIAL MUST BE STORED UPRIGHT. Date and time need to be recorded on the carton when Infasurf is removed from the refrigerator. Warming of Infasurf before administration is not necessary. Smyrna, GA 30080. by Pfizer Pharmaceuticals LLC Caguas, PR 00725. The information contained in the Truven Health Micromedex products as delivered by Drugs. PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Quibron while you are pregnant. Quibron is found in breast milk. If you are or will be breast-feeding while you use Quibron, check with your doctor. Discuss any possible risks to your baby. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist. Avoid large amounts of food or drink that have caffeine eg, coffee, tea, cocoa, cola, chocolate. Store vials in carton until time of use; protect from light. Take this medication by mouth with or without food, usually once or twice daily or as directed by your doctor. If this medication upsets your stomach, you may take it with food. This medicine works best when the amount in your body is kept at a constant level. Therefore, use this drug at evenly spaced intervals. Since different manufacturers have different recommendations, check with your doctor or pharmacist about the best times to take your particular brand of theophylline. kaiser brand truvada
Erythromycin steady-state serum concentrations decrease by a similar amount. Theophylline may antagonize non-depolarizing neuromuscular blocking effects; possibly due to phosphodiesterase inhibition. Table V. Dosing initiation and titration as anhydrous theophylline. Theophylline overdose can occur if you accidentally take too much at one time. Overdose can also occur slowly over time if your daily doses are too high. To be sure you are using the correct dose, your blood will need to be tested often. During administration of Infasurf liquid suspension into the airway, infants often experience bradycardia, reflux of Infasurf into the endotracheal tube, airway obstruction, cyanosis, dislodgement of the endotracheal tube, or hypoventilation. SR Tablets should not be chewed or crushed. Children 1-15 years and adults 16-60 years without risk factors for impaired clearance. Tell your doctor or dentist that you take Quibron before you receive any medical or dental care, emergency care, or surgery. Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Available data suggests that drug administration at the time of food ingestion may influence the absorption characteristics if some or all theophylline controlled-release products, resulting in serum values different from those found after administration in the fasting state. Disclaimer: Every effort has been made to ensure that the information provided by Multum, Truven Health Analytics, Inc. sominex
Pharmacokinetic differences in theophylline clearance due to race have not been studied. Larger dose of pancuronium may be required to achieve neuromuscular blockade. Heinonen O, Slone D, Shapiro S; Kaufman DW ed. "Birth Defects and Drugs in Pregnancy. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. Whenever a patient receiving theophylline develops nausea or vomiting, particularly repetitive vomiting, or other signs or symptoms consistent with theophylline toxicity even if another cause may be suspected additional doses of theophylline should be withheld and a serum theophylline concentration measured immediately. The pharmacokinetics of theophylline vary widely among similar patients and cannot be predicted by age, sex, body weight or other demographic characteristics. In addition, certain concurrent illnesses and alterations in normal physiology see and co-administration of other drugs see can significantly alter the pharmacokinetic characteristics of theophylline. Within-subject variability in metabolism has also been reported in some studies, especially in acutely ill patients. Take Quibron at evenly spaced times throughout the day. Taking Quibron at the same time each day will help you remember to take it. Contact your doctor with any questions or concerns about the best way to take Quibron. Safety and efficacy have not been established in patients younger than 12 years. Cord serum concentrations and infant serum concentrations have been reported to approximate the mother's serum concentrations immediately following birth. Contact your healthcare provider if after taking the oral formulation, symptoms are not relieved within 1 hour or worsen. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Guaifenesin and theophylline can pass into breast milk and may harm a nursing baby. Some MEDICINES MAY INTERACT with Quibron. IV over 10 minutes every 24 hours. cordarone
Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of theophylline in children. However, children younger than 1 year of age are more likely to have serious side effects, which may require caution and an adjustment in the dose for patients receiving theophylline. Phenobarbital may cause respiratory depression, particularly in elderly patients and patients with COPD. FDA pregnancy category C. It is not known whether theophylline will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. Store Quibron-T at room temperature, between 59 and 86 degrees F 15 and 30 degrees C in a tightly closed container. Store away from heat, moisture, and light. Do not store in the bathroom. Do not refrigerate. Keep Quibron-T out of the reach of children and away from pets. Children 6-15 years and adults 16-60 years without risk factors for impaired clearance. Before making a dose increase to determine whether the serum concentration is subtherapeutic in a patient who continues to be symptomatic. Drug information contained herein may be time sensitive. Table III. Drugs that have been documented not to interact with theophylline or drugs that produce no clinically significant interaction with theophylline.
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Your pharmacist can provide more information about theophylline. If you have any questions about Quibron-T, please talk with your doctor, pharmacist, or other health care provider. One study has shown an increase in fetal breathing movements when theophylline was ingested by pregnant women at 33 to 38 weeks gestation. Since fetal breathing movements are routinely used to assess fetal status in late gestation, maternal theophylline intake should be taken into account.
Monitor the patient and obtain a serum theophylline concentration in 2-4 hours to insure that the concentration is not increasing. Dose is based on body weight and must be determined by your doctor. At first, the dose is 12 to 14 milligrams mg per kg of body weight per day, divided and given every 12 hours. Your doctor may adjust your dose as needed. However, the total dose is usually not more than 20 mg per kg of body weight per day or 600 mg per day. After multiple doses of theophylline, steady state is reached in 30-65 hours average 40 hours in adults. At steady state, on a dosage regimen with 6-hour intervals, the expected mean trough concentration is approximately 60% of the mean peak concentration, assuming a mean theophylline half-life of 8 hours. The difference between peak and trough concentrations is larger in patients with more rapid theophylline clearance. In patients with high theophylline clearance and half-lives of about 4-5 hours, such as children age 1 to 9 years, the trough serum theophylline concentration may be only 30% of peak with a 6-hour dosing interval.
Notify your doctor if you develop a new illness, especially if it is accompanied by fever; if a chronic illness becomes worse; or if you start or stop smoking cigarettes or marijuana. Skip next dose and decrease subsequent doses at least 25% even if no adverse effects are present. Recheck serum concentration after 3 days to guide further dosage adjustment. If symptomatic, consider whether overdose treatment is indicated see recommendations for chronic overdosage. Theophylline can pass into breast milk and may harm a nursing baby. The brand name Uniphyl is discontinued, but versions may be available.
Turner ES, Greenberger PA, Patterson R "Management of the pregnant asthmatic patient. The patient should be instructed to contact their clinician if they develop a new illness, especially if accompanied by a persistent fever, if they experience worsening of a chronic illness, if they start or stop smoking cigarettes or marijuana, or if another clinician adds a new medication or discontinues a previously prescribed medication. Patients should be instructed to inform all clinicians involved in their care that they are taking theophylline, especially when a medication is being added or deleted from their treatment. Patients should be instructed to not alter the dose, timing of the dose, or frequency of administration without first consulting their clinician. If a dose is missed, the patient should be instructed to take the next dose at the usually scheduled time and to not attempt to make up for the missed dose.