Theophylline for Chronic Symptomatic Bradycardia in the Elderly

摘要: The treatment of choice for chronic, symptomatic bradycardia is the placement a cardiac pacemaker. Individuals who refuse or cannot tolerate pacemaker insertion usually require pharmacologic therapy. Hydralazine, prazosin, anticholinergics, and sympathomimetic agents have been administered this indication, but adverse effects limited data hinder routine, long-term use. Theophylline has emerged as reasonable alternative strategy. For medical management in elderly, literature supports theophylline dosages between 400 600 mg/d (approximately 8 mg/kg/d) divided doses. This dosage range should result steady-state serum concentration 5 15 mg/L. While some investigators recommend potentially higher initial doses (up to 12 mg/kg/d), lower are more appropriate elderly due decreased clearance. Initial titration may be indicated prolonged therapy expected on basis common etiologies patient group. Patient specifics such altered metabolism (e.g., smoking), drug interactions ciprofloxacin), concomitant disease states hepatic disease, heart failure) always considered recommendations. Clinicians adjust dose response, including rate clinical symptomatology, well measurement occasional concentrations, if deemed appropriate. avoided bradycardia-tachycardia manifestations sick sinus syndrome when ventricular ectopy frequent. Additional investigation will further define role patients with bradycardia.