2.4 What kinds of tablets are there?

2.4.1 Why do I need a blood test when taking theophylline?
2.4.2 Why are combination pills not commonly prescribed?

2.4 What kinds of tablets are there?

CR
controlled release. This means that the drug has a constant rate of release.
DR
delayed release. This generally refers to enteric- coated tablets which are designed to release the drug in the intestine where the pH is in the alkaline range.
ER
extended release. Dosage forms which are designed to release the drug over an extended period of time, such as implants which release the drug over a period of months or years.
SA
sustained action. Used interchangeably with CR (above), except that SA usually refers to the pharmacologic action while CR refers to the drug release process.
TD
time delayed. This is slightly different from DR in that the drug release is designed to occur after a certain period of time, such as pellets coated to a certain thickness, multi-layered tablets, tablets within a capsule, or double-compressed tablets.

Contributed by:

Susan Graham / sgraham@hpb.hwc.ca

2.4.1 Why do I need a blood test when taking theophylline?

Theophylline is commonly used as a third-line agent in the management of asthma, after beta-agonists and anti-inflammatories. Unfortunately, its therapeutic level is quite close to its toxic level. This means that the dose that the asthmatic needs to get the full benefit of the drug is not very much lower than the dose which causes side effects which range from unpleasant to dangerous. This would not be such a problem if there weren't such large variations in the rate at which people metabolize theophylline. Apparently, if a group of people are given the same dose of theophylline, the concentration of the drug in their bloodstreams may vary by up to a factor of seven. Therefore, the best way to monitor that the asthmatic is receiving the optimal amount of theophylline is to take a blood level concentration.

2.4.2 Why are combination pills not commonly prescribed?

The combination drugs such as Tedral and Marax commonly contain theophylline, ephedrine, and some form of sedative such as phenobarbital. These combination pills are no longer commonly prescribed because the amount of theophylline in the pill cannot be varied with respect to the other drugs. Since there is great variation in the rate at which an individual metabolizes theophylline, it is now considered better to take theophylline separately, for better adjustment of theophylline levels. In fact, Tedral is no longer manufactured by Parke-Davis in the U.S.

Also, ephedrine is no longer considered the bronchodilator of choice. From Drs. Haas, The Essential Asthma Book, "ephedrine initiates the release of catecholamines -- including adrenaline -- that are already stored in the body. This is its biggest drawback. Its effects depend on the availability of catecholamine in the body at the time it is given, and these concentrations vary." Since much better bronchodilators are now available, ephedrine is no longer commonly prescribed.

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