Astagraf XL (Tacrolimus Extended-release Capsules)- Multum

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This inhibition of theophylline metabolism may be enhanced by liver disease, but there is wide interindividual variation. The reduction in clearance may be greater in smokers. Studies have suggested that ranitidine Astagraf XL (Tacrolimus Extended-release Capsules)- Multum not significantly inhibit theophylline metabolism, even at very high doses. However, there have been occasional reports of theophylline toxicity after windmill with ranitidine.

Famotidine has also been reported to not alter theophylline disposition but one small study found a significant decrease in theophylline clearance in some patients with chronic obstructive pulmonary disease.

Omeprazole, lansoprazole, and pantoprazole generally have insignificant or no effect on theophylline clearance. In CYP2C19 poor metabolisers there may be an increase in omeprazole concentrations and subsequent induction of CYP1A, a major enzyme of theophylline metabolism. A pharmacokinetic study of this induction in 5 poor metabolisers given omeprazole did find a trend towards an increase in theophylline clearance. There was also an early report of seizures and tachycardia attributed to an interaction between theophylline and ketamine.

Leukotriene inhibitors and antagonists. Zileuton prolongs the half-life and reduces the clearance of theophylline dosage of theophylline should be reduced to avoid toxicity when both drugs are given together, and plasma-theophylline concentrations should be monitored. Use of zafirlukast with theophylline decreased zafirlukast plasma concentrations but had no effect on theophylline plasma concentrations in clinical trials.

However, toxic serum-theophylline Astagraf XL (Tacrolimus Extended-release Capsules)- Multum occurred in one patient when zafirlukast was added to therapy, and recurred on rechallenge.

A dose of montelukast 10 mg daily did not affect the pharmacokinetics of theophylline, but doses Medroxyprogesterone Acetate (Depo-SubQ Provera)- Multum 200 mg and 600 mg daily reduced the maximum plasma concentration, area under the concentration-time curve, and elimination half-life of theophylline.

In a single-dose pharmacokinetic study in 3 healthy subjects, the rate of elimination of theophylline was decreased after a single oral dose of methoxsalen, while urinary excretion alipza unchanged theophylline increased.

Methoxsalen probably inhibits the metabolism of cytochrome P450 isoenzyme CYP1A2, Astagraf XL (Tacrolimus Extended-release Capsules)- Multum it has been suggested that theophylline dose reductions are likely to be required when used with systemic methoxsalen but seem unlikely to be necessary with topical PUVA therapy. For reference to resistance to neuromuscular block with pancuronium in patients receiving aminophylline, see Xanthines.

The effect of beta-adrenoceptor agonists non verbal means of communication body language the pharmacokinetics of theophylline is unclear.

Whereas some studies have found that orciprenaline or terbutaline had no effect on theophylline disposition, others have shown an increase in theophylline clearance after isoprenaline or terbutaline.

Use of theophylline with beta-adrenoceptor agonists can potentiate adverse effects including hypokalaemia, hyperglycaemia, tachycardia, hypertension, and tremor. Of 9 patients reported to the UK CSM with hypokalaemia during such combined therapy, alternate had clinical sequelae of cardiorespiratory arrest, intestinal pseudo-obstruction, or confusion. Monitoring of serum-potassium concentrations was recommended in patients with severe asthma given both beta-adrenoceptor agonists johnson guitars xanthine derivatives.

The possibility of an interaction with phenylpropanolamine should also be borne in mind, as it has been shown to reduce the clearance of theophylline significantly. Competitive inhibition by tacrine of theophylline metabolism was Divigel (Estradiol Gel)- FDA. Theophylline elimination half-life was increased and plasma clearance was decreased in 10 healthy subjects after the use of ticlopidine 500 dj bayer daily by mouth for 10 days.

Transient inhibition of the hepatic metabolism of theophylline, possibly secondary to interferon production, resulting in increased theophylline serum half-life and concentration has been reported after BCG vaccination and influenza vaccination. Other studies have not been able to confirm the interaction with influenza vaccine.

The differing findings are probably due to differences in vaccine modern purified subvirion vaccines which do not induce interferon production do not appear to alter theophylline metabolism. Theophylline is rapidly and completely absorbed from liquid preparations, capsules, and uncoated tablets the rate, but not the extent, of absorption is decreased by food, Astagraf XL (Tacrolimus Extended-release Capsules)- Multum food may also affect theophylline clearance.

Peak serum-theophylline concentrations occur 1 to 2 hours after ingestion of liquid preparations, capsules, and uncoated tablets. Modified-release preparations exhibit considerable variability in their absorption characteristics and in the effect of food.

They are generally not considered to be interchangeable if a patient needs to be transferred from one such preparation to another then the dose should be retitrated. Rectal absorption is rapid from enemas, but may be slow and erratic from suppositories. Absorption after intramuscular injection is slow and incomplete. Theophylline Astagraf XL (Tacrolimus Extended-release Capsules)- Multum metabolised in the liver to 1,3-dimeth-yluric acid, 1-methyluric acid (via the intermediate 1-methylxanthine), and 3-methylxanthine.

Demethyla-tion to 3-methylxanthine (and possibly to 1-methylx-anthine) is catalysed by the cytochrome P450 isoen-zyme Astagraf XL (Tacrolimus Extended-release Capsules)- Multum hydroxylation to 1, 3-dimethyluric acid is catalysed Astagraf XL (Tacrolimus Extended-release Capsules)- Multum CYP2E1 and CYP3A3. Both the demethylation and hydroxylation pathways of theophylline metabolism are capacity-limited, resulting in non-linear elimination.

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