Theophylline is a drug that was first used for treating asthma. It is a methylxanthine, which is a category that includes substances found in coffee, chocolate, and tea like caffeine and theobromine. However theophylline is much stronger than these substances. Research has shown that theophylline applied intranasally can help improve sense of smell for individuals with olfactory impairment. There has been renewed interest in this medication as many patients who recover from COVID have an impaired sense of smell that does not go away after other symptoms subside. Work is being done now to turn theophylline nasal spray into a commercially available medication. Until it becomes available on the market in an FDA approved drug, it can be made by a compounding pharmacy with a prescription.

Loss of Smell Varies by Degree and Type

There varying levels and types of olfactory impairment. These can range from a complete loss of smell to partial or altered sense of smell.

Hyposmia – A reduced ability to smell.

Hypogeusia – A reduced ability to taste

Dysosmia – An alteration or distortion in the perception of smell.

Anosmia – A complete lack of ability to smell.

Once hyposmia is diagnosed, it tends to persist at the same level of insensitivity to smells. That means that treatment can start at any time, and does not need to necessarily begin at the same time that the loss of smell occurs.

A sudden loss of the sense of smell is a symptom of COVID. Although other symptoms subside, the olfactory impairment sometimes lingers after recovery. Most patients will regain their sense of smell and taste naturally. Although the research is not conclusive, it is estimated that around 10-15% of patients may have continued loss of smell and taste after recovery.

Theophylline

Theophylline is a phosphodiesterase inhibiting drug that has primarily been used for treating asthma and COPD. Related to caffeine, the drug is found in tea, coffee, and chocolate. It was first identified and extracted from tea leaves in the late 1800s. A small amount of theophylline is one of the products of caffeine metabolic processing in the liver. In treating lung diseases, it works by relaxing the muscles around the airways so that they open up to make breathing easier. Interest has increased recently in studying theophylline as a treatment for hyposmia and hypogeusia. This is partly due to the prevalence of smell and taste impairment following recovery from COVID, however the research has been ongoing for several years now.

Theophylline for Hyposmia and Hypogeusia

Oral theophylline has been studied and is effective at improving hyposmia. However oral administration of theophylline, as with most orally administered medications, produces some adverse side effects. That does not mean that topical or intranasal medications have no side effects, but that they often produce fewer side effects due to decreased systemic effects. Side effects with oral administration of theophylline may include restlessness, gastrointestinal tract discomfort, sleep difficulties, tachycardia, and other unwanted symptoms. As prolonged use is often necessary to see an improvement in symptoms, oral administration may be undesirable. However with intranasal administration there have been few reported side effects besides mild nasal irritation. Blood levels of theophylline are generally low in patients using the medication intranasally.

In addition, some studies have shown that intranasal theophylline is actually more effective than oral theophylline at improving sense of smell. In one study, after oral theophylline treatment, 6 patients reported overall increased taste and smell function, whereas 4 reported no improvement. After intranasal theophylline treatment, 8 of the 10 patients reported overall improvement in taste and smell functions, whereas 2 reported no improvement. An interesting result from this trial was that the patients who responded well to treatment also experienced a slight weight gain, which was likely due to the increased enjoyment of food with improved smell and taste.

In another study of 94 patients, subjective  improvement  in  smell,  flavor  and  taste  function  improved  in  65% of patients after only 4 weeks of treatment. With continued treatment, patients experienced further improvement.

Compounded Intranasal Theophylline

Our pharmacy compounds theophylline in capsules that are used with a nasal atomizer for treating hyposmia and hypogeusia. The atomizer disperses medication better than a nasal spray bottle and storing medication in capsules makes it more stable.

60 theophylline capsules gives you:

• 30 day supply when used twice daily
• 60 day supply when used once daily

Theophylline can improve smell as soon as four to six weeks after initiating treatment but may take several months or longer for some individuals. After sense of smell and taste improves, treatment is often continued to maintain the results.

The Rhino Clear Sprint atomizer is a battery-powered device that disperses medication into the nasal passages. It has a 15mL atomization flask and a discharge chamber. You can order both your medication and the atomizer from the pharmacy and have them shipped together.

Treating Loss of Smell and Taste

The research on theophylline intranasal for loss of smell and taste is still being conducted. However, the evidence available is promising and the low incidence of side effects makes it one option for individuals suffering from olfactory impairment. This may include patients suffering from loss of smell and taste related to COVID. While it is possible that this medication may be available at your local retail pharmacy sometime in the next few years, you can obtain it now using the services of a compounding pharmacy.