[Time-related distribution of delayed-action theophylline in the treatment of chronic obstructive bronchopneumopathies]

Three regimens of sustained-release theophylline (Theostat) were administered to 12 male patients with chronic obstructive lung disease in randomized cross over trial. Each 7 days' treatment consisted of: treatment A: 8 mg/kg/day at 07.00 h and 4 mg/kg/day at 19.00 h; treatment B: 6 mg/kg/day at 07.00 h and 6 mg/kg/day at 19.00 h; treatment C: 4 mg/kg/day at 07.00 h and 8 mg/kg/day at 19.00 h. Peak expiratory flow was recorded each day at 07.00, 11.00, 15.00, 19.00 and 23.00 hours, and theophylline plasma levels were determined on the 7th day of each treatment sequence. Cosinor analysis of the data revealed significant circadian rhythms of 24 hr mean Peak expiratory flow for each treatment: the mesor was significantly higher with C and acrophases were located at 14.26 for A, 14.25 for C; a phase shift of the acrophase was detected for B (09.58). These data suggest that an unequal twice daily sustained-release theophylline dosing with higher dose in the evening may be beneficial in the treatment of chronic obstructive lung disease.

Unequal twice-daily, sustained-release theophylline dosing in chronic obstructive pulmonary disease

Three regimens of sustained-release theophylline (SRT), Theostat were administered to 12 male patients with chronic obstructive pulmonary disease in a randomized cross-over trial. Each 7-day treatment consisted of: treatment A--8 mg/kg at 0700 hr and 4 mg/kg at 1900 hr, treatment B--6 mg/kg at 0700 hr and 6 mg/kg at 1900 hr, treatment C--4 mg/kg at 0700 hr and 8 mg/kg at 1900 hr. Peak expiratory flow (PEF) was recorded each day at 0700, 1100, 1500, 1900 and 2300 hr and theophylline plasma levels were determined on the 7th day of each treatment sequence. Cosinor analysis of the data revealed significant circadian rhythms in PEF for each treatment: the mesor (24-hr average) was significantly higher with C and acrophases (phi, peak time of PEF rhythm) were located at 1426 hr for A and 1425 hr for C; a shift of the acrophase to an earlier timing was detected for B (phi = 0958 hr. These findings suggest that an unequal, twice-daily SRT dosing with the greater amount of drug at night may be beneficial in the treatment of COPD.