Deriphylline is NOT Appropriate for First-Line Treatment of Acute Asthma
Deriphylline (a methylxanthine derivative) should not be used as first-line treatment for acute asthma attacks in adults, as methylxanthines are no longer recommended due to erratic pharmacokinetics, known side effects, and lack of evidence of benefit. 1, 2
First-Line Treatment Algorithm
The appropriate first-line management for acute asthma consists of:
Short-acting β2-agonists (albuterol/salbutamol or terbutaline) are the definitive treatment of choice, administered as nebulized salbutamol 5 mg or terbutaline 10 mg, repeated 4-6 hourly if improving 2
Systemic corticosteroids (oral prednisolone 30-60 mg daily or IV hydrocortisone) should be given early to address airway inflammation 1, 2
Oxygen therapy should be administered simultaneously, using oxygen as the driving gas for nebulizers whenever possible 2
Ipratropium bromide (500 mcg nebulized) provides additive benefit to short-acting β2-agonists in moderate or severe exacerbations 1, 2
Why Methylxanthines (Including Deriphylline) Are Not Recommended
The evidence against methylxanthines as first-line therapy is strong and consistent across multiple high-quality guidelines:
American Heart Association (2010) explicitly states that methylxanthines are no longer recommended because of their erratic pharmacokinetics, known side effects, and lack of evidence of benefit 1
Meta-analyses examining aminophylline (another methylxanthine) in both children and adults found no outstanding difference between aminophylline and standard therapy, with some studies showing no benefit at all 3, 4
Current expert consensus indicates methylxanthines have a minimum role as therapy for asthma exacerbations and may only be considered in refractory cases of status asthmaticus with careful monitoring of toxicity 5
When Methylxanthines Might Be Considered (Not First-Line)
Aminophylline (IV theophylline) should only be considered if progress is unsatisfactory after initial treatments with nebulized β-agonists, systemic corticosteroids, and ipratropium 2, 6
This means methylxanthines are reserved for:
- Patients with life-threatening features who fail to improve with first-line therapies 6
- Refractory cases of status asthmaticus where standard treatments have failed 5, 7
Critical Pitfalls to Avoid
Never use methylxanthines as first-line acute treatment, as this delays appropriate therapy with short-acting β2-agonists and corticosteroids 2
Do not give bolus aminophylline to patients already taking oral theophyllines, as most patients on maintenance theophylline already have therapeutic levels and additional IV dosing may induce serious toxicity 6, 8
Recognize the narrow therapeutic range and frequency of side effects with methylxanthines, which make them unsuitable for initial emergency management 8