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The patientor parent/care givershould be instructed to seek medical advice whenever nauseavomitingpersistent headacheinsomnia or rapid heart beat occurs during treatment with theophyllineeven if another cause is suspectedThe patientor parent/care givershould be instructed to contact their clinician if they develop a new illnessespecially if accompanied by a persistent feverif they experience worsening of a chronic illnessif they start or stop smoking cigarettes or marijuanaor if another clinician adds a new medication or discontinues a previously prescribed medicationPatients should be instructed to inform all clinicians involved in their care that they are taking theophyllineespecially when a medication is being added or deleted from their treatmentPatients should be instructed to not alter the dosetiming of the doseor frequency of administration without first consulting their clinicianIf a dose is missedthe patient should be instructed to take the next dose at the usually scheduled time and to not attempt to make up for the missed dose.

Abdominal or stomach pain blurred vision confusion confusion about identityplaceand time dark-colored urine decrease in frequency of urination decreased urine diarrhea difficulty in passing urinedribblingdizzinessfaintnessor lightheadedness when getting up suddenly from a lying or sitting position dry mouth fastpoundingor irregular heartbeat or pulse fever increased thirst irregular heartbeat loss of appetite mood changes muscle cramps or spasms muscle pain or stiffness nausea or vomiting nervousness numbness or tingling in the handsfeetor lips pain or discomfort in the armsjawbackor neck painful urination shakiness in the legsarmshandsor feet shortness of breath sweating unusual tiredness or weakness vomiting of blood or material that looks like coffee grounds.

Check with your doctor immediately if any of the following side effects occur:

Serum Theophylline Concentration Monitoring The serum theophylline concentration should be measured immediately upon presentation2-4 hours laterand then at sufficient intervalse.gevery 4 hoursto guide treatment decisions and to assess the effectiveness of therapySerum theophylline concentrations may continue to increase after presentation of the patient for medical care as a result of continued absorption of theophylline from the gastrointestinal tractSerial monitoring of serum theophylline serum concentrations should be continued until it is clear that the concentration is no longer rising and has returned to non-toxic levels.

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