Your Patients Can't Find Theophylline — Here's How You Can Help

When a patient calls your office saying their pharmacy is out of Theophylline, the clinical burden shifts to your team. With ongoing supply disruptions affecting this essential methylxanthine bronchodilator, you need a systematic approach to help patients maintain treatment continuity.

This guide provides five concrete steps your practice can implement, along with alternative medication options and workflow tips to streamline the process.

Current Availability Overview

As of 2026, Theophylline supply remains inconsistent across formulations and regions. Key points:

• Generic extended-release tablets (100 mg, 200 mg) are the most consistently available
• Higher-strength ER tablets (300 mg, 400 mg+) face more frequent gaps
• The oral solution remains in limited supply
• Availability varies significantly by geography — urban areas generally fare better than rural

For a full timeline and analysis, see our provider shortage briefing.

Why Patients Can't Find Theophylline

Understanding the root causes helps you advise patients appropriately:

• Consolidated manufacturing: Few generic manufacturers produce Theophylline, making supply vulnerable to single-point-of-failure disruptions
• Distributor allocation: During shortages, wholesalers allocate limited supply based on a pharmacy's historical ordering, meaning pharmacies that don't regularly stock Theophylline may be unable to order it
• Chain pharmacy limitations: Large chain pharmacies are often locked into a single wholesale distributor, reducing their sourcing flexibility
• Patient timing: Patients who wait until they've run out before attempting to refill have no buffer to search for stock

5 Steps Providers Can Take

Step 1: Check Availability Before Prescribing

Use Medfinder for Providers to verify pharmacy stock before sending a prescription. This prevents the common scenario where a patient arrives at the pharmacy only to be told their medication isn't available. Your front desk or nursing staff can make this a standard step in the prescription workflow.

Step 2: Prescribe Flexible Strengths

If a patient's target dose can be achieved with multiple tablet combinations, write the prescription for the strength that's most available. For example:

• If 300 mg tablets are unavailable, prescribe 200 mg + 100 mg tablets with appropriate dosing instructions
• Consider the total daily dose rather than locking into a specific tablet strength
• Document the rationale for strength substitution in the patient's chart

Remember that switching between different manufacturers' ER products may require serum level monitoring due to potential bioequivalence differences.

Step 3: Direct Patients to Independent Pharmacies

Educate your patients that independent pharmacies often have access to multiple wholesalers and may carry Theophylline when chains don't. Maintain a list of independent pharmacies in your area that regularly stock Theophylline or are willing to special-order it.

Step 4: Set Up Proactive Refill Reminders

Through your EHR or patient portal, remind Theophylline patients to refill 7-10 days before their supply runs out. This buffer allows time to locate stock if their primary pharmacy is out. A simple patient instruction: "Always try to refill your Theophylline with at least a week of pills remaining."

Step 5: Have a Documented Backup Plan

For every patient on Theophylline, document a contingency plan in their chart:

• Preferred alternative medication (with dose and monitoring plan)
• Acceptable strength substitutions
• Patient's preferred pharmacies and backup pharmacies
• Instructions for the patient if they can't fill within 48 hours

This ensures continuity even when the primary prescriber isn't available to make real-time decisions.

Alternative Medications to Consider

When a therapeutic switch is necessary, these are the most common alternatives:

• Dyphylline: Same drug class, fewer interactions, but less potent and shorter-acting. Best for patients who respond specifically to methylxanthine therapy.
• Tiotropium (Spiriva): LAMA inhaler; excellent for COPD, also approved for asthma maintenance. Once-daily dosing.
• Montelukast (Singulair): Oral leukotriene antagonist; widely available and affordable. Note FDA neuropsychiatric boxed warning.
• LABA/ICS combinations (Advair, Symbicort, Breo): For patients using Theophylline as add-on therapy, adjusting the inhaled combination may provide equivalent control.

For your patients, you can share this resource: Alternatives to Theophylline.

Workflow Tips for Your Practice

Batch Theophylline Management

Consider running a quarterly report from your EHR to identify all active Theophylline patients. This allows you to:

• Proactively review each patient's backup plan
• Reach out before refill issues arise
• Identify patients who may be candidates for a therapeutic switch

Leverage Your Pharmacist Relationships

Build a relationship with 2-3 pharmacists (including at least one independent pharmacy) who can alert your office when Theophylline stock changes. Many pharmacists are willing to serve as early warning systems for shortage-affected medications.

Use Medfinder in Your Workflow

Integrate Medfinder for Providers into your clinical workflow. Whether it's a bookmark on clinic computers or a standard step before e-prescribing, real-time availability checking reduces fill failures and callback volume.

Educate Patients at Every Visit

During routine follow-ups, briefly address the shortage situation with Theophylline patients. Patients who understand the supply landscape are more likely to refill early, check multiple pharmacies, and communicate proactively with your office when issues arise.

Final Thoughts

The Theophylline shortage requires a team effort between providers, pharmacists, and patients. By building proactive systems — availability checking, flexible prescribing, documented backup plans, and patient education — you can minimize treatment gaps and maintain your patients' respiratory health.

Medfinder for Providers is designed to help you and your staff navigate exactly these challenges. Bookmark it, share it with your team, and make it part of your shortage management toolkit.

For the patient-facing version of this information, share: How to find Theophylline in stock near you.