LAUSR

withdraw theophylline from the ongoing treatment regimen. Although concomitant use of theophylline and roflumilast is not supported by existing literature, it is intriguing to note that there is no scientific basis behind this. In a recent study, administration of roflumilast with theophylline did not alter the pharmacokinetics of theophylline. When both the drugs were given together in healthy control subjects, the area under the curve of roflumilast increased only by 28%, whereas other pharmacokinetic parameters (like half life, peak serum concentration, and time taken to achieve peak concentration) of roflumilast and its metabolites remained unchanged. Moreover, no clinically significant interaction in terms of safety and tolerability were observed (3). It is also imperative to mention here that theophylline is an integral component of pharmacological therapy of COPD. Being a nonselective phosphodiesterase inhibitor, theophylline has many beneficial mechanisms of action, which may be indispensable, and withdrawing it might prove counterproductive. Further studies may be needed to address this issue in a systematic manner. n