Can't Find Theophylline? Here Are Your Options.

If your pharmacy is out of Theophylline and you're worried about managing your asthma or COPD, you're right to look into alternatives. While no medication is an exact replacement for Theophylline, there are several options your doctor may consider — depending on your condition and medical history.

Important: Never switch medications on your own. Always talk to your doctor before starting or stopping any treatment. This guide is meant to help you have an informed conversation with your healthcare provider.

What Is Theophylline and How Does It Work?

Theophylline is a methylxanthine bronchodilator that's been used since the 1930s to treat breathing conditions. It works by:

• Inhibiting phosphodiesterase (PDE) enzymes, which increases a molecule called cAMP inside your cells. This relaxes the smooth muscles around your airways, making it easier to breathe.
• Blocking adenosine receptors, which helps open airways and may reduce inflammation.
• Stimulating the respiratory center in the brain, which can help with certain types of breathing problems.

For a deeper explanation, read our article on how Theophylline works.

Theophylline is unique because it's an oral bronchodilator — most other bronchodilators are inhaled. It also has anti-inflammatory properties that make it useful as add-on therapy when inhalers alone aren't enough.

Alternative #1: Montelukast (Singulair)

What it is: Montelukast is a leukotriene receptor antagonist taken as a daily oral tablet. It's FDA-approved for asthma prevention in adults and children.

How it's different: Unlike Theophylline, Montelukast works by blocking leukotrienes — chemicals your body releases during an allergic reaction that cause airway swelling. It doesn't directly relax airway muscles the way Theophylline does.

Pros:

• Once-daily oral tablet — easy to take
• Widely available as a generic ($4-$15/month)
• Fewer drug interactions than Theophylline
• No blood level monitoring needed

Cons:

• FDA boxed warning about serious mental health side effects (mood changes, suicidal thoughts) — discuss risks with your doctor
• May not provide the same level of bronchodilation as Theophylline for some patients
• Primarily for asthma, not first-line for COPD

Alternative #2: Tiotropium (Spiriva)

What it is: Tiotropium is a long-acting anticholinergic inhaler (also called a long-acting muscarinic antagonist or LAMA). It's FDA-approved for both COPD and asthma maintenance.

How it's different: Tiotropium is inhaled, not swallowed. It blocks acetylcholine receptors in the airways, preventing the muscle tightening that makes breathing difficult. It works for 24 hours per dose.

Pros:

• Once-daily inhaler — very convenient
• Well-established for COPD and asthma maintenance
• Fewer systemic side effects than Theophylline
• No blood level monitoring needed

Cons:

• Brand-name Spiriva can cost $300-$500/month without insurance (generic Tiotropium may be cheaper)
• Some patients don't respond as well to inhaled medications
• Dry mouth is a common side effect

Alternative #3: Dyphylline (Lufyllin)

What it is: Dyphylline is another methylxanthine — the same drug class as Theophylline. It's the closest chemical relative and works through a similar mechanism.

How it's different: Dyphylline is not converted to Theophylline in the body. It has a shorter duration of action and is generally considered less potent, but it also has fewer drug interactions.

Pros:

• Same drug class — most similar mechanism to Theophylline
• Fewer drug interactions
• Available as tablets and oral solution

Cons:

• Less commonly prescribed and may also face availability issues
• Shorter acting — requires more frequent dosing
• Less clinical data than Theophylline

Alternative #4: Long-Acting Beta-Agonist Inhalers (LABAs)

What they are: LABAs like Salmeterol (Serevent) and Formoterol are inhaled bronchodilators used for asthma and COPD maintenance. They're often combined with inhaled corticosteroids in products like Advair, Symbicort, and Breo Ellipta.

How they're different: LABAs directly stimulate beta-2 receptors in the airways, causing muscle relaxation. They work faster than Theophylline and are delivered directly to the lungs.

Pros:

• Highly effective bronchodilators
• Available in many combination products
• Well-studied with extensive safety data

Cons:

• Should not be used alone for asthma (must be combined with an inhaled corticosteroid)
• Some patients prefer oral medications over inhalers
• Brand combinations can be expensive without insurance

How to Talk to Your Doctor About Switching

If you can't find Theophylline and need to discuss alternatives, here are some questions to bring to your appointment:

1. "Given my condition, which alternative would work best for me?"
2. "Can I use a substitute temporarily until Theophylline is back in stock?"
3. "Are there any formulations or strengths of Theophylline that might be easier to find?"
4. "Will I need any new monitoring or tests if I switch medications?"

You can also use Medfinder to check if Theophylline is available anywhere near you before making a switch.

Final Thoughts

Theophylline is a unique medication, and finding an exact replacement isn't always straightforward. But you have options. Whether it's Montelukast for asthma, Tiotropium for COPD, Dyphylline as a close relative, or a LABA inhaler for bronchodilation, your doctor can help you find what works.

The most important thing is to not go without treatment. If you can't find Theophylline, reach out to your doctor right away. And keep checking Medfinder.com — supply can change quickly, and your medication may become available sooner than you think.

For the latest on supply, see our Theophylline shortage update for 2026.