With improvement to Grade 1 or less, initiate corticosteroid taper and continue to taper over at least 1 month. Permanently discontinue ipilimumab and initiate systemic high-dose corticosteroid therapy (e.g., 1 to 2 mg/kg/day of prednisone or equivalent) for severe immune-mediated reactions (e.g., Grades 3 to 4). Keep physician informed of all side effects.
Shelly Rainforth Collins PharmD, BCGP, in Gahart's 2022 Intravenous Medications, 2022 ANTIDOTE Peritoneal dialysis is ineffective, and exchange transfusions in neonates have been minimally effective. Serum theophylline concentrations may rebound 5 to 10 mcg/mL after either treatment is discontinued due to redistribution of theophylline from the tissue compartment. Consider hemodialysis when charcoal hemoperfusion is not feasible and multiple-dose oral-activated charcoal is ineffective because of intractable emesis. Hemodialysis is about as efficient as multiple-dose oral-activated charcoal and has a lower risk of serious complications. Charcoal hemoperfusion is the most effective and increases theophylline clearance up to sixfold, but hypotension, hypocalcemia, and platelet consumption and bleeding diatheses may occur. Monitor the patient and obtain serial theophylline concentrations every 2 to 4 hours to determine the effectiveness of therapy and to determine further treatment decisions. Consider extracorporeal removal, even if the patient has not experienced a seizure. Administer multiple-dose oral-activated charcoal and measures to control emesis.
Consider prophylactic anticonvulsant therapy. Institute extracorporeal removal if emesis, seizures, or cardiac arrhythmias cannot be adequately controlled.Īcute overdose with a serum concentration greater than 100 mcg/mL or chronic overdose with serum concentrations greater than 30 mcg/mL in patients 60 years or older: Administer multiple-dose, oral-activated charcoal and measures to control emesis. Stop the infusion, monitor the patient, and obtain a serum theophylline concentration in 2 to 4 hours to ensure that the concentration is decreasing.Īcute overdose with a serum concentration of 30 to 100 mcg/mL or chronic overdose with serum concentrations greater than 30 mcg/mL in patients less than 60 years of age:
Manufacturer’s Specific Recommendations for Acute and Chronic OverdoseĪcute overdose (e.g., excessive loading dose or excessive infusion rate for less than 24 hours) or chronic overdose (e.g., excessive infusion rate for more than 24 hours): Serum concentration 20 to 30 mcg/mL:
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