Efficacy of L-carnitine and propranolol in the management of acute theophylline toxicity

Naima A Sherif, Asmaa S El-Banna, Marwan M ElBourini, Nancy O Khalil, Naima A Sherif, Asmaa S El-Banna, Marwan M ElBourini, Nancy O Khalil

Abstract

Theophylline toxicity results in substantial morbidity and mortality particularly due to its narrow therapeutic index. The development of new treatments for acute theophylline toxicity is a point of research interest. The aim of the present work was to assess the efficacy of L-carnitine (LC) and propranolol in the management of patients with acute theophylline toxicity. The study was conducted on 60 patients with acute theophylline toxicity admitted to the Poison Control Center or Intensive Care Unit at Alexandria Main University Hospital. The studied patients were equally classified into four groups (GPs, 15 patients each): the first group was the control group who received standard treatment protocol for theophylline toxicity. The other three GPs also received standard treatment protocol for theophylline toxicity in addition. The second group (LC group) received LC with a loading dose of 100 mg/kg IV over 30-60 min (maximum 6 g) and the maintenance dose was 50 mg/kg IV every 8 h. The third group (propranolol group) received propranolol, administered slowly intravenous 0.5-1 mg over 1 min; it may be repeated if necessary up to a total maximum dose of 0.1 mg/kg. The fourth group (propranolol and LC) received both IV propranolol and LC in the same doses as previous. Treatment with LC alone or in combination with propranolol resulted in a significant improvement of both clinical and laboratory findings. Although combined therapy yields the best results and outcome, LC can serve as an antidote for acute theophylline toxicity if there is any contraindication to propranolol administration.

Keywords: L-carnitine; acute theophylline toxicity; antioxidants; propranolol; β-blocker.

© The Author(s) 2020. Published by Oxford University Press.

Figures

Figure 1
Figure 1
Comparison between the four studied GPs according to heart rhythm on admission (GP I, Control group; GP III, propranolol group; GP II, LC group; GP IV, propranolol and LC).
Figure 2
Figure 2
Comparison between the four studied GPs according to heart rhythm after 24 h.
Figure 3
Figure 3
Comparison between the four studied GPs according to mean MDA level (nmol/ml)
Figure 4
Figure 4
Comparison between the four studied GPs according to mean GSH level (mg/dl)
Figure 5
Figure 5
Comparison between the four studied GPs according to mean PH
Figure 6
Figure 6
Comparison between the four studied GPs according to mean PaCO2 level (mmHg)

Source: PubMed

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