Why is theophylline rarely used for asthma management?

Theophylline is rarely used for asthma management due to its narrow therapeutic index and the potential for multiple drug interactions. The narrow therapeutic index means that there is a small margin between the effective dose and the dose that can cause toxicity. Because of this, patients require careful monitoring of their theophylline levels to avoid adverse effects, such as cardiac arrhythmias or seizures, which can occur if the drug levels become too high.

Additionally, theophylline can interact with various medications, which can influence its metabolism and lead to either increased toxicity or decreased effectiveness. For example, certain antibiotics, anticonvulsants, and even dietary components like caffeine can affect the clearance of theophylline from the body, complicating its use in patients who may already be taking other medications for asthma or concurrent conditions.

In light of these factors, healthcare providers often prefer newer, safer, and more effective asthma medications that do not require the same level of monitoring or pose such a risk for interactions, making theophylline less favored for routine asthma management.