Propranolol with Theophylline Interaction Details

Brand Names Associated with Propranolol

Brand Names Associated with Theophylline

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 15, 2023

Interaction Effect

Decreased theophylline clearance and pharmacological antagonism

Interaction Summary

Coadministration of propranolol and theophylline may increase the plasma level of theophylline by 100%, decrease oral clearance of theophylline by 30 to 52%, and increase plasma concentration and/or toxicity of propranolol . Additionally, the beta blocking effect of propranolol may decrease the efficacy of theophylline . If coadministration of propranolol is required with a drug that has an effect on CYP1A2, such as theophylline, use with caution .

Severity

Moderate

Onset

Rapid

Evidence

Theoretical

How To Manage Interaction

Coadministration of propranolol and theophylline may increase the plasma level of theophylline, decrease oral clearance of theophylline, and increase plasma concentration and/or toxicity of propranolol . Additionally, the beta blocking effect of propranolol may decrease the efficacy of theophylline . If coadministration is required, use with caution .

Mechanism Of Interaction

Unknown, antagonistic pharmacological effects

Literature Reports

A) Theophylline has been reported to result in inhibition of propranolol's cardiovascular effects. Beta-adrenergic stimulation may occur due to the inhibition of phosphodiesterase by theophylline. Propranolol has been shown to inhibit theophylline-induced increases in plasma free fatty acids and insulin and the theophylline-induced decrease in growth hormone levels .

B) Propranolol has been shown to decrease theophylline clearance. Nine healthy men, six of whom were smokers, were administered theophylline 5.7 to 6.4 mg/kg intravenously (as aminophylline) and oral propranolol 40 mg every six hours and, two weeks later, the same dosage of theophylline and metoprolol 50 mg every six hours. Propranolol reduced theophylline clearance in all subjects. The greatest reduction occurred in smokers whose clearance of theophylline is initially high. Theophylline clearance averaged 0.464 L/kg/hr before beta blockade with propranolol, and 0.0294 L/kg/hr on propranolol. Metoprolol did not affect theophylline clearance of the group, but it may have an effect intermediate to that of propranolol in some smokers in whom cigarette smoking has induced theophylline clearance .

Propranolol Overview

• Propranolol is used to treat high blood pressure, irregular heart rhythms, pheochromocytoma (tumor on a small gland near the kidneys), certain types of tremor, and hypertrophic subaortic stenosis (a heart muscle disease). It is also used to prevent angina (chest pain), migraine headaches, and to improve survival after a heart attack. Propranolol is in a class of medications called beta blockers. It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure.

• High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

Theophylline Overview

• Theophylline is used to prevent and treat wheezing, shortness of breath, and chest tightness caused by asthma, chronic bronchitis, emphysema, and other lung diseases. It relaxes and opens air passages in the lungs, making it easier to breathe.

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Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.