Usage
This combination medication is prescribed for the relief of coughs accompanied by mucus (chesty coughs), often associated with respiratory conditions like:
- Chronic Obstructive Pulmonary Disease (COPD)
- Bronchitis (acute and chronic)
- Asthma
- Emphysema
- Bronchiectasis
- Common cold and other respiratory infections
Pharmacological Classification:
This drug is classified as an expectorant and bronchodilator combination. Acebrophylline acts as a mucolytic and bronchodilator, guaifenesin as an expectorant, and terbutaline as a bronchodilator.
Mechanism of Action: Acebrophylline increases mucociliary clearance by reducing mucus viscosity and improving ciliary motility, while also exhibiting some bronchodilating effects. Guaifenesin loosens and thins mucus in the airways by increasing respiratory tract fluid secretions. Terbutaline relaxes the smooth muscles of the airways by stimulating beta-2 adrenergic receptors, leading to bronchodilation.
Alternate Names
While the generic name is Acebrophylline + Guaifenesin + Terbutaline, several brand names exist, some of which include:
- Koffspa Active
- Tufcuf PD Syrup
- Venphylin Plus
- Coughcon-XT
- Pulmonext
- Spartus-AP
- Ifcof-XT
- Mucobrint
- Mucoday
- Rapitus XT
- Pulmoclear
There might be other brand names available regionally or internationally.
How It Works
Pharmacodynamics: Acebrophylline’s mucolytic action reduces sputum viscosity, making it easier to expectorate. Its bronchodilating effect is attributed to phosphodiesterase inhibition and increased cAMP levels, relaxing bronchial smooth muscles. Guaifenesin increases respiratory tract fluid, hydrating the airways and reducing mucus viscosity. Terbutaline, as a beta-2 agonist, activates receptors in bronchial smooth muscle, causing bronchodilation. It also inhibits mast cell degranulation, reducing inflammation and bronchoconstriction.
Pharmacokinetics: Acebrophylline is well-absorbed orally. Guaifenesin is also readily absorbed from the gastrointestinal tract. Terbutaline is absorbed orally but undergoes significant first-pass metabolism, resulting in lower bioavailability. All three drugs are metabolized in the liver and excreted primarily through the kidneys.
Mode of Action: Acebrophylline increases intracellular cAMP, causing smooth muscle relaxation and improving mucociliary function. Guaifenesin’s exact mechanism for increasing respiratory secretions is unknown but is thought to involve vagal stimulation. Terbutaline’s binding to beta-2 adrenergic receptors activates adenylate cyclase, leading to increased cAMP levels, smooth muscle relaxation, and bronchodilation.
Elimination Pathways: All three components are primarily metabolized in the liver and excreted by the kidneys. Specific CYP enzymes involved in metabolism haven’t been clearly identified in the sources.
Dosage
The dosage guidelines provided here are general recommendations. Always adhere to the specific prescription provided by a physician for individual patient cases.
Standard Dosage
Adults: The usual adult dose is one to two tablets or 5-10ml of syrup, two to three times a day, or as prescribed by the physician.
Children: Dosage for children under 12 years of age should be determined and monitored by a physician. Many sources caution against use in children younger than 12. Dosage modifications based on weight or age are required.
Special Cases:
- Elderly Patients: Dosage adjustments may be necessary based on kidney and liver function. Start with a lower dose and monitor for side effects.
- Patients with Renal Impairment: Dose reduction is necessary based on creatinine clearance or estimated glomerular filtration rate (eGFR).
- Patients with Hepatic Dysfunction: Dose adjustments are needed in patients with liver disease due to potential impact on drug metabolism.
- Patients with Comorbid Conditions: Consider individual patient conditions like diabetes, cardiovascular disease, hyperthyroidism, or seizures, and adjust the dosage accordingly. Pre-existing heart conditions, hypertension, diabetes, thyroid disorders, or seizures require careful monitoring.
Clinical Use Cases
The use of this combination in specific clinical situations like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations should be decided on a case-by-case basis by the treating physician, considering the benefits and risks. There are no specific guidelines for these situations from the sources provided.
Dosage Adjustments
Dose modifications should be made for patients with renal or hepatic dysfunction, metabolic disorders, or genetic polymorphisms affecting drug metabolism. Always consult with a physician to determine the appropriate dosage in these situations.
Side Effects
Common Side Effects:
- Nausea, vomiting, stomach pain or discomfort, constipation, heartburn, loss of appetite
- Drowsiness, dizziness, headache
- Skin rash, itching
- Nervousness, tremors
Rare but Serious Side Effects:
- Severe allergic reactions (anaphylaxis)
- Cardiac arrhythmias (tachycardia, palpitations)
- Hypotension
- Hypokalemia
- Seizures (worsening of pre-existing seizures)
- Hyperglycemia
Long-Term Effects:
Long-term use may potentially exacerbate cardiovascular or metabolic conditions. Close monitoring is recommended.
Adverse Drug Reactions (ADR):
Clinically significant ADRs include severe allergic reactions, cardiac arrhythmias, and significant changes in blood glucose levels. Immediate intervention is required if these occur.
Contraindications
- Hypersensitivity to any component of the medication
- Acute asthma attacks
- Pregnancy (unless absolutely necessary, and after careful risk-benefit assessment by a physician)
- Breastfeeding
Drug Interactions
- Other bronchodilators (e.g., salbutamol, albuterol)
- Decongestants (e.g., pseudoephedrine, phenylephrine)
- Beta-blockers (e.g., propranolol, atenolol)
- MAO inhibitors (e.g., selegiline, phenelzine)
- Tricyclic antidepressants (e.g., amitriptyline)
- Diuretics (e.g., furosemide)
- Drugs affecting heart rhythm (e.g., digoxin)
- Corticosteroids
- Oral contraceptives
- Antibiotics (e.g., ciprofloxacin, erythromycin, amoxicillin, doxycycline)
- Antihypertensives (e.g., diltiazem, verapamil)
Pregnancy and Breastfeeding
This medication should generally be avoided during pregnancy and breastfeeding due to potential risks to the fetus or neonate. Terbutaline, in particular, may have adverse effects on the fetus. If absolutely necessary, its use during pregnancy should be under strict medical supervision after a careful risk-benefit assessment by a physician. It’s recommended to consult with a physician for safer alternative options during pregnancy or breastfeeding.
Drug Profile Summary
- Mechanism of Action: Mucolytic, expectorant, and bronchodilator
- Side Effects: Nausea, vomiting, dizziness, headache, nervousness, tremors, skin rash, gastrointestinal upset. Rarely: severe allergic reactions, cardiac arrhythmias.
- Contraindications: Hypersensitivity, acute asthma attacks, pregnancy, breastfeeding
- Drug Interactions: See detailed list above
- Pregnancy & Breastfeeding: Generally avoid. Consult a physician if use is considered essential during pregnancy.
- Dosage: See detailed section above.
- Monitoring Parameters: Respiratory rate, oxygen saturation, lung function tests, blood pressure, heart rate, potassium levels, blood glucose levels.
Popular Combinations
This combination itself is commonly used. Additional medications may be prescribed depending on the specific condition being treated.
Precautions
- General Precautions: Screen for allergies, metabolic disorders, organ dysfunction, particularly renal and hepatic function.
- Specific Populations: Avoid in pregnancy and breastfeeding. Use cautiously in children under 12 and elderly patients, adjusting dosage as needed.
- Lifestyle Considerations: Avoid alcohol as it may worsen side effects. Driving or operating machinery should be avoided if dizziness or drowsiness occur.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Acebrophylline + Guaifenesin + Terbutaline?
A: The usual adult dose is 1-2 tablets or 5-10 ml syrup, two to three times daily. Pediatric dosages should be determined by a physician. Dosages may need adjustment for elderly patients, those with renal or hepatic impairment, or with comorbid conditions.
Q2: Can I take this medication if I am pregnant or breastfeeding?
A: This medication should generally be avoided during pregnancy and breastfeeding. Consult a physician for safer alternatives.
Q3: What are the common side effects?
A: Common side effects include nausea, vomiting, dizziness, headache, nervousness, tremors, skin rash, and gastrointestinal upset.
Q4: How does this medication work?
A: Acebrophylline thins and loosens mucus, guaifenesin increases respiratory fluid secretions, and terbutaline dilates the airways.
Q5: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember, unless it is close to the time for your next dose. Do not double the dose.
Q6: Can I take this medication with other medicines?
A: Several drug interactions exist. Consult a physician or pharmacist before combining it with other medications, including over-the-counter drugs and supplements.
Q7: Are there any specific precautions for patients with diabetes?
A: This medication may raise blood glucose levels. Patients with diabetes should be carefully monitored. Dosage adjustments may be necessary.
Q8: Can this medication be used in children?
A: Use in children younger than 12 should be under strict medical supervision, and many sources caution against use in this age group.
Q9: How long will it take to feel better?
A: Relief may begin within a few hours, but the full benefit might take longer depending on the severity of the condition. Complete the prescribed course even if symptoms improve.
Q10: Can this medicine be taken on an empty stomach?
A: While it can be taken on an empty stomach, taking it with food can minimize potential gastrointestinal side effects like nausea and stomach pain.
