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Treatment of seizures Because of the high morbidity and mortality associated with theophylline-induced seizurestreatment should be rapid and aggressiveAnticonvulsant therapy should be initiated with an intravenous benzodiazepinee.gdiazepamin increments of 0.1-0.2 mg/kg every 1-3 minutes until seizures are terminatedRepetitive seizures should be treated with a loading dose of phenobarbital20 mg/kg infused over 30-60 minutesCase reports of theophylline overdose in humans and animal studies suggest that phenytoin is ineffective in terminating theophylline-induced seizuresThe doses of benzodiazepines and phenobarbital required to terminate theophylline-induced seizures are close to the doses that may cause severe respiratory depression or respiratory arrestthe clinician shouldthereforebe prepared to provide assisted ventilationElderly patients and patients with COPD may be more susceptible to the respiratory depressant effects of anticonvulsantsBarbiturate-induced coma or administration of general anesthesia may be required to terminate repetitive seizures or status epilepticusGeneral anesthesia should be used with caution in patients with theophylline overdose because fluorinated volatile anesthetics may sensitize the myocardium to endogenous catecholamines released by theophyllineEnflurane appears to less likely to be associated with this effect than halothane and maythereforebe saferNeuromuscular blocking agents alone should not be used to terminate seizures since they abolish the musculoskeletal manifestations without terminating seizure activity in the brain.

Refer to PRECAUTIONSDrug Interactions for further information regarding table.

Theophylline is excreted into breast milk and may cause irritability or other signs of mild toxicity in nursing human infantsThe concentration of theophylline in breast milk is about equivalent to the maternal serum concentrationAn infant ingesting a liter of breast milk containing 10-20 mcg/mL of theophylline a day is likely to receive 10-20 mg of theophylline per daySerious adverse effects in the infant are unlikely unless the mother has toxic serum theophylline concentrations.

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