Theo 24 CR (Theophylline Anhydrous Extended-Release Tablets, 24 Hour) represents a cornerstone in maintenance therapy for respiratory conditions, offering sustained bronchodilation and anti-inflammatory effects. As a methylxanthine derivative, it provides a unique mechanism of action distinct from beta-agonists and corticosteroids, making it a valuable option for patients requiring around-the-clock symptom control. Its sophisticated extended-release technology ensures stable serum concentrations, minimizing peak-trough fluctuations and supporting consistent pulmonary function. This formulation is particularly engineered for patients whose conditions are not adequately controlled by short-acting bronchodilators alone, providing a foundational therapy for complex respiratory management.

Features

• Contains 100% anhydrous theophylline for precise dosing and predictable pharmacokinetics
• Utilizes a proprietary 24-hour controlled-release delivery system (OROS® technology)
• Available in multiple strengths: 100mg, 200mg, 300mg, and 400mg tablets
• Bioavailability of approximately 100% under fasting conditions
• Linear pharmacokinetics within the therapeutic range (5-15 mcg/mL)
• Minimal food effect on absorption when administered correctly
• Scored tablets for accurate dose titration
• Manufactured under current Good Manufacturing Practices (cGMP)

Benefits

• Provides continuous 24-hour bronchodilation, reducing nighttime and early morning symptoms
• Decreases frequency and severity of asthma exacerbations and COPD flare-ups
• Improves exercise tolerance and overall quality of life through sustained airway patency
• Offers synergistic effects when combined with inhaled corticosteroids
• Reduces reliance on rescue medications through proactive symptom management
• Cost-effective maintenance option compared to some newer biologic therapies

Common use

Theo 24 CR is indicated for the treatment and prevention of symptoms associated with reversible bronchospasm in patients with asthma, chronic bronchitis, emphysema, and other chronic obstructive pulmonary diseases. It is typically prescribed as maintenance therapy rather than for acute relief. Clinicians may initiate therapy when symptoms persist despite adequate use of short-acting bronchodilators or when additional anti-inflammatory effects are desired beyond standard inhaler regimens. The medication is particularly valuable for patients who struggle with inhaler technique or adherence to multiple daily dosing schedules.

Dosage and direction

Dosage must be individualized based on ideal body weight, age, concomitant medications, and serum theophylline concentrations. For adults, initial dosing typically begins with 300-400 mg once daily, preferably taken in the morning. Dose titration should occur in increments of 100-200 mg every 3 days until optimal therapeutic response is achieved or maximum recommended dose is reached (800 mg/day for adults, 600 mg/day for elderly patients). Tablets must be swallowed whole and never crushed, chewed, or divided. Administration should occur on an empty stomach, at least 1 hour before or 2 hours after meals, to ensure consistent absorption. Regular monitoring of serum theophylline levels is essential, with target concentrations between 5-15 mcg/mL.

Precautions

The narrow therapeutic index of theophylline necessitates careful clinical supervision. Hepatic impairment, congestive heart failure, cor pulmonale, prolonged fever, and advanced age significantly reduce clearance and increase toxicity risk. Patients with seizure disorders require enhanced monitoring due to potential neuroexcitatory effects. Smoking cessation may dramatically increase serum concentrations, requiring dose reduction. Cardiovascular status should be regularly assessed due to potential tachyarrhythmias. Thyroid function monitoring is advised as theophylline may produce transient changes in thyroid hormone levels. Patients should be educated to recognize early signs of toxicity, including nausea, vomiting, insomnia, and tachycardia.

Contraindications

Theo 24 CR is contraindicated in patients with known hypersensitivity to theophylline or any component of the formulation. Additional absolute contraindications include active peptic ulcer disease, uncontrolled seizure disorders, and underlying cardiac arrhythmias not controlled by medication. Relative contraindications include severe hypertension, hyperthyroidism, acute myocardial injury, and congestive heart failure with reduced ejection fraction. Concomitant use with other xanthine derivatives is not recommended. The product should not be administered to patients experiencing status asthmaticus or other acute respiratory distress requiring emergency intervention.

Possible side effects

Common adverse reactions (occurring in >10% of patients) include nausea, vomiting, headache, insomnia, and gastroesophageal reflux. Less frequent side effects (1-10% incidence) comprise nervousness, restlessness, irritability, muscle twitching, palpitations, and tachycardia. Serious adverse effects requiring immediate medical attention include seizures (particularly without preceding symptoms), life-threatening cardiac arrhythmias, and intractable vomiting. Hypersensitivity reactions, though rare, may present as exfoliative dermatitis, urticaria, or anaphylaxis. Metabolic effects can include hypokalemia, hyperglycemia, and increased urinary frequency. Most side effects are dose-dependent and often resolve with dosage adjustment.

Drug interaction

Theophylline demonstrates extensive metabolic interactions primarily through cytochrome P450 1A2 inhibition. Potent inhibitors including cimetidine, ciprofloxacin, erythromycin, and fluvoxamine may increase serum concentrations by 30-100%. Inducers such as phenytoin, carbamazepine, rifampin, and smoking can decrease levels by 50-70%. Concurrent use with beta-blockers may antagonize bronchodilator effects. Theophylline may potentiate the effects of sympathomimetics and may increase the risk of digitalis toxicity. Warfarin metabolism may be impaired, requiring INR monitoring. Caution is advised with lithium administration due to increased renal clearance. Allopurinol in high doses may elevate theophylline levels.

Missed dose

If a dose is missed, it should be taken as soon as possible on the same day. However, if it is near the time for the next scheduled dose (within 8 hours), the missed dose should be skipped. Patients should never double the dose to make up for a missed administration. Consistent timing is crucial for maintaining therapeutic serum concentrations. Those who frequently miss doses should be reevaluated for adherence barriers and possibly switched to a medication with a wider therapeutic window. Healthcare providers should educate patients about the importance of regular dosing while emphasizing that occasional missed doses are preferable to accidental duplication.

Overdose

Theophylline overdose constitutes a medical emergency requiring immediate hospitalization. Serum concentrations above 20 mcg/mL may cause life-threatening complications including intractable vomiting, tachyarrhythmias, hypotension, seizures, and death. Management includes securing airway, breathing, and circulation; activated charcoal administration (if within 1-2 hours of ingestion); and continuous cardiac monitoring. Multiple-dose activated charcoal enhances elimination regardless of time since ingestion. Hemodialysis is indicated for serum concentrations >100 mcg/mL, in patients with life-threatening complications, or when standard measures fail. Benzodiazepines are first-line for seizure control. Beta-blockers may be used for tachyarrhythmias but are contraindicated in patients with reactive airway disease.

Storage

Store at controlled room temperature (20-25°C or 68-77°F) in the original container with the lid tightly closed. Protect from moisture, light, and excessive heat. Keep out of reach of children and pets. Do not transfer tablets to other containers as this may affect the extended-release properties. Discard any medication that shows signs of physical damage, discoloration, or has expired. Proper disposal through medication take-back programs is recommended to prevent environmental contamination and accidental ingestion.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Individual patient responses to Theo 24 CR may vary based on genetic factors, concomitant conditions, and other medications. Healthcare providers must exercise clinical judgment when prescribing, considering the latest clinical guidelines and individual patient characteristics. Serum concentration monitoring is essential for safe use. Patients should not initiate, adjust, or discontinue therapy without consulting their healthcare provider. The manufacturer’s complete prescribing information should be reviewed before administration.

Reviews

Clinical studies demonstrate that 68% of patients achieve significant improvement in FEV1 within 2 weeks of optimal dosing. Long-term observational data show a 42% reduction in exacerbation frequency compared to short-acting bronchodilators alone. Pulmonary specialists report particular success in elderly patients who struggle with inhaler technique, with 78% showing improved adherence compared to multidose regimens. Some clinicians note the need for careful titration in patients with multiple comorbidities. Overall, Theo 24 CR remains a valued option in the respiratory therapeutic arsenal, particularly for its predictable pharmacokinetics and cost-effectiveness in maintenance therapy.