Management overview for theophylline and caffeine poisonings

Note: Contact a clinical toxicologist or poisons information centre for theophylline ingestions of more than 30 mg/kg, and caffeine ingestions of more than 50 mg/kg.

Theophylline and caffeine are methylxanthines that are central nervous system (CNS) stimulants. They have a narrow therapeutic index and act by blocking adenosine receptors that cause smooth muscle relaxation and increased cardiac output. Both drugs also raise catecholamine concentrations. In significant poisonings, they can cause life-threatening seizures and arrhythmias, but susceptibility varies depending on the individual.

Theophylline is available as a modified-release tablet and liquid formulation. Most theophylline poisonings involve modified-release preparations.

For all theophylline ingestions of more than 30 mg/kg, and caffeine ingestions of more than 50 mg/kg, contact a clinical toxicologist or poisons information centre (13 11 26). Management includes gastrointestinal decontamination, prevention of seizures with intravenous benzodiazepines and supportive care. Severe poisonings may require haemodialysis.