⚡ Quick Answer — What is Theo-Asthalin?
Theo-Asthalin bevat theophylline + salbutamol, een methylxanthine bronchodilator with anti-inflammatory effects, used as add-on therapy for chronic asthma and COPD. Theophylline acts on multiple targets — phosphodiesterase inhibition (raising cAMP), adenosine receptor antagonism, and HDAC2 activation (anti-inflammatory). It has a narrow therapeutic index (target serum 10–20 mg/L; toxicity at 20+) and many drug interactions, requiring careful dosing and (in some patients) blood-level monitoring. Each tablet contains theophylline 100 mg + salbutamol 2 mg, geproduceerd door Cipla in WHO-GMP gecertificeerde faciliteiten.
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What Is Theo-Asthalin?
Theo-Asthalin is an oral methylxanthine bronchodilator. Methylxanthines are derived from natural alkaloids (theophylline is the dimethylxanthine present in tea). Their use has declined since the 1990s as inhaled β2-agonists and corticosteroids became first-line — but they retain a role as third-line add-on therapy in difficult asthma and COPD.
How Does Theo-Asthalin Work?
- Phosphodiesterase inhibition (PDE3, PDE4) — raises cyclic AMP in airway smooth muscle and inflammatory cells; net result is bronchodilation and reduced mediator release.
- Adenosine receptor antagonism — blocks adenosine-mediated bronchoconstriction and mast-cell mediator release.
- HDAC2 activation (theophylline at low serum levels 5–10 mg/L) — restores corticosteroid responsiveness in COPD and severe asthma where steroid resistance is partly mediated by reduced HDAC2.
- Diaphragm contractility — methylxanthines reduce diaphragm fatigue, useful in COPD with severe airflow limitation.
Toepassingen en Indicaties
- Severe chronic asthma — add-on to high-dose ICS-LABA where additional bronchodilation is needed
- COPD maintenance — add-on to LAMA-LABA or triple therapy
- Nocturnal asthma — sustained-release formulation provides overnight bronchodilation
- Apnoea of prematurity (theophylline) — neonatal use
- Cor pulmonale and pulmonary hypertension — adjunct
Theo-Asthalin Dosage
| Patiënt | Dosering | Frequentie |
|---|---|---|
| Adults | 1 tablet | Three to four times daily |
| Children >12 yr | 1 tablet | Three times daily |
Side Effects of Theo-Asthalin
- Nausea, vomiting, dyspepsia
- Hoofdpijn
- Tremor
- Insomnia, restlessness
- Tachycardia, palpitations
- Mild hypokalaemia at high doses
Toxic levels (>20 mg/L) — emergency:
- Severe nausea, persistent vomiting
- Cardiac arrhythmia (atrial fibrillation, supraventricular tachycardia)
- Seizures (often without warning)
- Hypotension, hyperglycaemia, hypokalaemia, hypercalcaemia
Waarschuwingen en voorzorgsmaatregelen
- Narrow therapeutic index. Target serum 10–20 mg/L. Check blood level 5 days after starting, after dose change, with new interacting drug, with smoking cessation, and during illness/fever (clearance falls).
- Many drug interactions — see interactions table. Most metabolised by CYP1A2; many inhibitors and inducers shift levels significantly.
- Smoking induces CYP1A2 and lowers theophylline levels by ~50% — re-titrate at smoking cessation.
- Cardiac disease: use cautiously in arrhythmias, heart failure, severe hypertension.
- Hyperthyroidism: increased clearance plus exaggerated adrenergic effects.
- Zwangerschap en borstvoeding: generally avoided; use only if benefit clear.
- Leveraandoening: reduce dose — methylxanthines are hepatically metabolised.
Contra-indicaties
- Hypersensitivity to theophylline or other xanthines (caffeine, theobromine)
- Actieve maagzweer
- Uncontrolled tachyarrhythmias
- Severe heart failure (NYHA IV)
Geneesmiddelinteracties
| Interagerend geneesmiddel | Effect | Wat te doen |
|---|---|---|
| Ciprofloxacin, erythromycin, clarithromycin, fluvoxamine | Inhibit CYP1A2 → raise theophylline levels → toxicity (nausea, arrhythmia, seizures) | Avoid or reduce theophylline dose 50%; check serum levels |
| Cimetidine, allopurinol | Raise theophylline levels | Reduce dose; monitor levels |
| Phenytoin, carbamazepine, rifampicin | Induce CYP — lower levels | Higher dose may be needed |
| Smoking | Induces CYP1A2 — lower levels | Re-titrate dose at smoking cessation |
| β-agonists, diuretics | Additieve hypokaliëmie | Monitor potassium |
Opslag
- Bewaren beneden 25°C in a cool, dry place away from direct sunlight.
- Keep in original packaging until use to protect from moisture and light.
- Do not use after the expiry date printed on the strip.
- Buiten bereik van kinderen houden.
Gerelateerde alternatieven op MedsBase
- Asthalin Inhaler — salbutamol verlichter
- Budecort Inhaler — budesonide ICS-preventer
- Foracort Inhaler — budesonide + formoterol ICS-LABA
- Tiova Inhaler — tiotropium LAMA voor COPD
- Montair — montelukast LTRA-tablet
Veelgestelde vragen
Why combine theophylline with salbutamol?
The combination delivers β2 agonism (bronchodilation) plus methylxanthine effect (additional bronchodilation, anti-inflammatory, diaphragm contractility) in one tablet — historically convenient for compliance.
Is this combination still used?
Less commonly than separate components. Modern practice prefers inhaled therapy (β2 agonist + ICS) over oral combinations, both for safety (lower systemic exposure) and efficacy.
Are the side effects of both drugs additive?
Yes — tremor, tachycardia, headache, insomnia, hypokalaemia are amplified by both components. Monitor cardiovascular tolerance.
How fast does Theo-Asthalin start working?
Salbutamol component begins in 15–30 min; theophylline reaches steady state over days.
Can I take it with my inhaler?
Possibly — discuss with your prescriber. Stacking oral and inhaled β2-agonists can increase tremor, tachycardia, and hypokalaemia.
Werkt het samen met mijn hartmedicatie?
Theophylline interacts with many drugs (see interaction table). Always tell your doctor what you are taking.
Is het veilig tijdens de zwangerschap?
Generally avoided; inhaled therapy is preferred.
How long does each tablet last?
Both components last 4–6 hours; dosing 3–4 times daily.
Can I crush the tablet?
Standard tablets can be crushed; controlled-release versions cannot. Check the label.
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