A man ingests 40 tablets of slow-release theophylline. What is the most appropriate initial management?

In the case of an overdose of slow-release theophylline, activated charcoal is the most appropriate initial management. This is because activated charcoal can effectively adsorb theophylline in the gastrointestinal tract, thereby potentially reducing its systemic absorption and mitigating toxicity. Theophylline has a narrow therapeutic index, and due to its pharmacokinetics, especially with slow-release formulations, there is a significant risk of serious side effects, including cardiovascular and central nervous system toxicity.

The timing of administration is crucial; activated charcoal should ideally be administered within an hour of ingestion to maximize its effectiveness. However, if it has been longer than that, its use may still be considered in cases where high levels of the drug are expected, but the risk of complications must be weighed.

Other management options, while they may have their place in different contexts, are not typically the first-line response to a theophylline overdose situation. Alkaline diuresis aims to enhance the excretion of certain toxins but is less effective for theophylline. Gastric lavage is less recommended in modern practice for overdose cases due to potential complications and is generally not favored over activated charcoal. Whole bowel irrigation is more suitable for the ingestion of substances that are not effectively absorbed by charcoal, and it is