Chronic Obstructive Lung Disease Medications

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Nausea and vomiting occur in a third of patients, and can be serious side effects in COLD patients. Headache and insomnia are common. Cardiac arrhythmias and convulsions are possible. A physician should be contacted immediately if any of these side effects occur. Certain conditions (e.g., liver disease) and medications increase the risk for toxicity. Such medications include some antibiotics, calcium channels blockers, and H2 blockers such as famotidine (Pepcid AC), cimetidine (Tagamet HB), or ranitidine (Zantac 75).

Theophylline. Theophylline (Theodur, Slo-bid, Uniphyl, Theo-24) is the standard methylxanthine and is available in oral and rectal forms. The oral form is preferred. Absorption is inconsistent using the rectal form, therefore posing a higher risk for overdose. Chronic smokers metabolize theophylline much more quickly and require higher doses of the drug than nonsmokers. Prolonged-release versions are helpful for such people. If theophylline is taken as prescribed, no major problems should arise. If theophylline is not taken exactly as prescribed, an overdose and toxicity can easily occur.

Doxofylline. Doxofylline is a unique xanthine that may prove to be an effective bronchodilator without the adverse effects on the heart that theophylline and beta2-agonists have. More research is needed.

Corticosteroids

Corticosteroids, commonly called steroids, are powerful anti-inflammatory drugs.

Oral Corticosteroids. Oral corticosteroids are used to treat acute exacerbations of COLD. A major study also indicated patients who take them for 10 days after an exacerbation (along with antibiotics and bronchodilators) significantly reduce their risk for a relapse.

They are also often prescribed for patients with stable COLD in order to prevent acute exacerbations and reduce symptoms. It is not clear, however, if these benefits outweigh the potential side effects of steroids. In one analysis, patients given steroids were only 10% more likely to improve than those on placebo. Patients should be monitored regularly and should take the lowest dose possible for improvement.