Deriphyllin (Theophylline) Use in Older Patients with CAD
Deriphyllin (theophylline) should be used with extreme caution in elderly patients with coronary artery disease due to its potential to exacerbate cardiac symptoms and increase cardiovascular risk.
Cardiovascular Concerns in Elderly CAD Patients
Elderly patients with CAD present unique challenges when considering theophylline therapy:
- Elderly CAD patients typically have more extensive coronary disease, more multivessel involvement, and higher rates of prior myocardial infarction 1
- Atypical presentation of coronary ischemia is common in elderly, often manifesting as dyspnea rather than typical angina 1
- Normal aging processes alter drug metabolism and increase sensitivity to adverse effects 2
Specific Concerns with Theophylline in Elderly CAD Patients
Cardiovascular Effects
- Theophylline can cause:
- Tachycardia and arrhythmias
- Increased myocardial oxygen demand
- Potential to worsen angina in CAD patients
- Blood pressure fluctuations
Pharmacokinetic Considerations
- Elderly patients have:
- Reduced hepatic metabolism of theophylline
- Decreased renal clearance
- Narrower therapeutic window
- Higher risk of drug interactions due to polypharmacy
Risk-Benefit Assessment
Potential Benefits
- Theophylline can improve global cardiac function and reduce dyspnea in chronic obstructive pulmonary disease 3
- May have positive effects on biventricular performance through enhanced ventricular inotropy and reduced ventricular afterload 3
Significant Risks
- Increased risk of adverse drug reactions in elderly
- Higher likelihood of drug interactions with common cardiovascular medications
- Narrow therapeutic window with potential for toxicity
- May increase myocardial oxygen demand, potentially worsening angina
Recommendations for Use
If theophylline must be used in elderly CAD patients:
- Start with lower doses - Begin with approximately 50% of the standard adult dose
- Monitor serum levels frequently - Maintain levels at the lower end of the therapeutic range
- Watch for drug interactions - Particularly with other cardiovascular medications
- Monitor cardiac status closely - Heart rate, blood pressure, and symptoms of angina
- Consider alternative medications when possible, especially in patients with:
- Unstable angina
- Recent myocardial infarction
- Severe heart failure
- Significant arrhythmias
Monitoring Parameters
- Serum theophylline levels (target lower end of therapeutic range)
- Heart rate and blood pressure
- ECG changes
- Symptoms of angina or heart failure
- Signs of theophylline toxicity (nausea, vomiting, headache, insomnia, arrhythmias)
Conclusion
The use of Deriphyllin (theophylline) in elderly CAD patients requires careful consideration of risks versus benefits. Given the high prevalence of potentially inappropriate medications in elderly cardiovascular patients 4 and the specific cardiac effects of theophylline, alternative treatments should be strongly considered whenever possible.