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Theophylline and smoking cessation — GPhC CRA MCQ

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ModerateRespiratory TherapeuticsTheophylline and smoking cessationGPhC CRA

A patient stable on modified-release theophylline stops smoking cigarettes and starts nicotine patches. One week later they report nausea and tremor. What should the pharmacist do?

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Correct answer: C — Check theophylline exposure and review the dose after smoking cessation

Check theophylline exposure and review the dose after smoking cessation: Tobacco smoke induces theophylline metabolism; stopping cigarettes removes that induction, whereas nicotine replacement itself does not maintain it. Continue the dose because nicotine patches preserve smoke-related enzyme induction: Polycyclic hydrocarbons in smoke, not nicotine, drive the interaction. Restart cigarettes temporarily and measure theophylline at the routine review: Restarting smoking is unsafe and not an acceptable method of dose control. Increase theophylline after smoking cessation and repeat the level in one week: Stopping smoking reduces clearance and may increase toxicity rather than reduce exposure. Stop nicotine patches and retain the current modified-release theophylline dose: Nicotine patches are not the cause; the change in smoke exposure is clinically relevant.

Reference: BNF: theophylline: https://bnf.nice.org.uk/drugs/theophylline/