Is Acebrophylline (a bronchodilator) effective in treating Paroxysmal Supraventricular Tachycardia (PSVT)?

Acebrophylline Has No Role in PSVT Treatment

Acebrophylline, a bronchodilator containing theophylline derivatives, should NOT be used to treat PSVT and may actually worsen the condition by requiring higher doses of adenosine (the first-line treatment) due to drug interactions.

Why Acebrophylline is Contraindicated

• Theophylline antagonizes adenosine's effects, requiring significantly larger doses of adenosine to terminate PSVT 1
• Acebrophylline contains theophylline-like compounds that directly interfere with the primary treatment mechanism for PSVT 1
• Adenosine is the gold-standard first-line pharmacologic treatment for PSVT with 90-95% success rates, and theophylline-containing medications undermine this therapy 2, 3

Correct PSVT Management Algorithm

Acute Hemodynamically Stable PSVT:

1. Vagal maneuvers first (Valsalva maneuver, carotid sinus massage) - terminates up to 25% of cases 1, 4

2. Adenosine 6 mg IV rapid push through large vein followed by 20 mL saline flush 1, 2

   • If unsuccessful after 1-2 minutes, give 12 mg IV rapid push 1, 4
   • Success rate: 91% 3

3. If adenosine fails or is contraindicated:

   • IV diltiazem or verapamil (calcium channel blockers) 1, 2
   • IV beta-blockers (less effective than diltiazem but excellent safety profile) 1

Acute Hemodynamically Unstable PSVT:

• Immediate synchronized cardioversion at 50-100 Joules with essentially 100% success rate 2, 4

Chronic Prevention:

• First-line: Oral verapamil/diltiazem (240 mg/day typical maintenance) or beta-blockers (metoprolol 25-50 mg BID) 1, 2
• Second-line: Propafenone 150 mg TID or flecainide (only in patients WITHOUT structural heart disease) 1, 2
• Definitive treatment: Catheter ablation with 94.3-98.5% single-procedure success rates 3

Critical Safety Considerations

• Adenosine should be avoided in severe asthma (not PSVT treatment) 1, 4
• If a patient with PSVT requires bronchodilation, use short-acting beta-2 agonists (like salbutamol) or ipratropium, which do not interfere with PSVT treatment 5
• Never use calcium channel blockers in Wolff-Parkinson-White syndrome with pre-excitation, as this can precipitate ventricular fibrillation 2, 4

Bottom Line

Acebrophylline is a bronchodilator with no antiarrhythmic properties and actively interferes with proper PSVT management. If a patient has both PSVT and bronchospasm requiring treatment, manage each condition separately with appropriate medications that don't interfere with each other 5.