The Theophylline-Erythromycin Interaction

Abstract

In a recent study (Chest 1982; 81:563-65), Maddux et al concluded that “theophylline pharmacokinetics are not altered by erythromycin” and “severe pulmonary disease often coincident with erythromycin therapy is the more likely cause of decreased theophylline elimination.” However, in an accompanying editorial, Dr. John Jenne 1 Jenne JW Theophylline, a remarkable window to the hepatic microsomal oxidases (editorial). Chest. 1982; 81: 529-530 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar cited four other studies, three of which were performed in healthy volunteers, demonstrating a significant interaction. 2 Zarowitz BJM Szefler SJ Lasezkay GM Effect of erythromycin base on theophylline kinetics. Clin Pharm Ther. 1981; 29: 601-605 Crossref PubMed Scopus (63) Google Scholar , 3 LaForce CF Miller MF Chai H. Effect of erythromycin on theophylline clearance in asthmatic children. J Pediatr. 1981; 99: 153-156 Abstract Full Text PDF PubMed Scopus (42) Google Scholar , 4 Renton KW Gary JD Orlando RH Depression of theophylline elimination by erythromycin. Clin Pharmacol Ther. 1981; 30: 422-426 Crossref PubMed Scopus (60) Google Scholar , 5 Prince RA Wing DW Weinberger MM Hendeles LS Riegelman S. Effect of erythromycin on theophylline kinetics. J Allergy Clin Immunol. 1981; 68: 427-432 Abstract Full Text PDF PubMed Scopus (62) Google Scholar Since their articles have appeared, data from additional studies have become available and the results continue to be conflicting. 6 May DC Jarboe CH Ellenburg DT Roe EJ Karibo J. The effects of erythromycin on theophylline elimination in normal males. J Clin Pharmacol. 1982; 22: 125-130 Crossref PubMed Scopus (37) Google Scholar , 7 Kelly SJ Pingleton SK Ryan PB Melethil S. No effect of erythromycin on plasma theophylline levels. Clin Research. 1981; 29 (abstract): 796A Google Scholar , 8 Reisz GR Ryan RB Melethil SK Pingleton SK Erythromycin induced changes in theophylline kinetics in chronic bronchitis. Am Rev Respir Dis. 1982; 125 (abstract): 95 PubMed Google Scholar Therefore, we reviewed each of the nine controlled studies in an attempt to identify the cause of the conflicting results.