Usage
This combination medication is prescribed for the relief of productive cough (cough with mucus) associated with bronchospasm (tightening of the airways) in conditions like bronchitis, bronchial asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, and emphysema.
It is classified as a mucolytic-expectorant-bronchodilator combination. Specifically, it combines a mucolytic (Bromhexine), an expectorant (Guaifenesin), and a bronchodilator (Terbutaline).
Bromhexine works by breaking down the thick mucus in the airways, making it less viscous. Guaifenesin thins and loosens the mucus further, facilitating its expulsion. Terbutaline, a beta-2 adrenergic agonist, relaxes and widens the airways, making it easier to breathe.
Alternate Names
There are no officially recognized alternate names for this specific combination. It is commonly referred to by the generic names of its components. Brand names vary depending on the manufacturer and region. Common examples including Broncorex® and TusQ®-X.
How It Works
Pharmacodynamics: Terbutaline relaxes bronchial smooth muscle by stimulating beta-2 adrenergic receptors, leading to bronchodilation. Bromhexine breaks down mucopolysaccharides in the mucus, reducing its viscosity. Guaifenesin increases respiratory tract fluid, further thinning the mucus.
Pharmacokinetics:
- Absorption: All three components are absorbed from the gastrointestinal tract after oral administration.
- Metabolism: Bromhexine is metabolized in the liver to ambroxol, which is also pharmacologically active. Terbutaline is primarily metabolized by conjugation. Guaifenesin is metabolized in the liver.
- Elimination: The metabolites of all three components are primarily eliminated through the kidneys.
Mode of Action:
- Bromhexine: Increases the activity of lysosomal enzymes within cells that break down complex sugars in the mucus. This reduces mucus viscosity.
- Guaifenesin: Thought to stimulate receptors in the gastric mucosa, reflexively increasing respiratory tract secretions, thereby thinning the mucus.
- Terbutaline: Stimulates beta-2 adrenergic receptors on bronchial smooth muscle cells, leading to muscle relaxation and bronchodilation.
Receptor Binding/Enzyme Interactions:
- Terbutaline binds to beta-2 adrenergic receptors.
- Bromhexine indirectly influences lysosomal enzyme activity.
Elimination Pathways: Primarily renal excretion of metabolites for all three drugs.
Dosage
Standard Dosage
Adults: 10ml (2 teaspoons) three times a day.
Children:
- 6-12 years: 5-7.5ml (1-1½ teaspoons) three times a day.
- 2-6 years: 2.5-5ml (½-1 teaspoon) three times a day.
- Below 2 years: Use with caution and only as directed by a physician.
Special Cases:
- Elderly Patients: Start with a lower dose and monitor for adverse effects.
- Patients with Renal Impairment: Dose adjustments may be necessary. Consult a nephrologist.
- Patients with Hepatic Dysfunction: Dose adjustments may be necessary. Consult a hepatologist.
- Patients with Comorbid Conditions: Exercise caution in patients with diabetes, cardiovascular disease, hypertension, hyperthyroidism, and peptic ulcer disease. Dosage adjustment may be needed depending on the specific condition and severity.
Clinical Use Cases
The use of this fixed-dose combination in specific clinical settings like intubation, surgical procedures, mechanical ventilation, or ICU is not routinely recommended, as individual components may be preferred and titrated separately for optimal management. It’s crucial to manage underlying conditions with appropriate therapies.
Dosage Adjustments
Adjustments may be necessary based on individual patient factors like renal/hepatic function, presence of other medical conditions, and response to therapy. Always consider patient-specific characteristics and monitor clinical response.
Side Effects
Common Side Effects
Nausea, vomiting, headache, dizziness, skin rash, tremor, stomach upset, fast heartbeat, drowsiness, dry mouth.
Rare but Serious Side Effects
Allergic reactions (including angioedema, bronchospasm, and anaphylaxis), paradoxical bronchospasm, cardiac arrhythmias, myocardial ischemia, hypotension, hyperglycemia, hypokalemia.
Long-Term Effects
Chronic complications are unlikely with short-term use. Long-term use may exacerbate underlying cardiovascular or metabolic conditions.
Adverse Drug Reactions (ADR)
Any signs of allergic reaction or cardiovascular complications warrant immediate discontinuation and appropriate medical intervention.
Contraindications
Hypersensitivity to any of the components. Patients with pre-existing ischemic heart disease, severe cardiac arrhythmias, hypertrophic obstructive cardiomyopathy, or uncontrolled hyperthyroidism. Gastric ulceration.
Drug Interactions
Beta-blockers (e.g., propranolol) may antagonize the bronchodilating effect of terbutaline. Concomitant use of other sympathomimetic bronchodilators or epinephrine may increase the risk of cardiovascular side effects. Corticosteroids may enhance metabolic effects of terbutaline. Theophylline clearance may be increased by terbutaline. Caution is advised with diuretics, digitalis, and other medications that can cause hypokalemia.
Pregnancy and Breastfeeding
The safety of this combination during pregnancy and breastfeeding has not been definitively established. Terbutaline can have tocolytic effects. Use only if the potential benefit outweighs the risk to the fetus/infant. Exercise caution.
Drug Profile Summary
- Mechanism of Action: Mucolytic, expectorant, and bronchodilator.
- Side Effects: Nausea, vomiting, tremor, headache, tachycardia, dizziness. Serious side effects: Allergic reactions, paradoxical bronchospasm, cardiac arrhythmias.
- Contraindications: Hypersensitivity, ischemic heart disease, arrhythmias, hypertrophic cardiomyopathy, uncontrolled hyperthyroidism, gastric ulcer.
- Drug Interactions: Beta-blockers, sympathomimetics, corticosteroids, theophylline, diuretics, digitalis.
- Pregnancy & Breastfeeding: Use with caution.
- Dosage: See dosage section.
- Monitoring Parameters: Respiratory rate, heart rate, blood pressure, potassium levels, blood glucose (in diabetics).
Popular Combinations
This medication itself is a combination product. Further combinations are generally not recommended without careful consideration of potential drug interactions and clinical necessity.
Precautions
Assess for underlying cardiovascular, respiratory, or metabolic disorders. Monitor potassium levels, especially in patients on diuretics. Caution is advised in patients with diabetes, hypertension, hyperthyroidism, or peptic ulcers. Avoid concomitant use of other sympathomimetics.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Bromhexine + Guaifenesin + Terbutaline?
A: See the detailed dosage section above.
Q2: Can this combination be used in children under 2 years?
A: Use with extreme caution and only under strict medical supervision in children under 2 years of age. The safety and efficacy haven’t been fully established.
Q3: What are the common side effects?
A: Common side effects include nausea, vomiting, headache, dizziness, tremor, tachycardia, and drowsiness.
Q4: What should I do if a patient experiences an allergic reaction?
A: Discontinue the medication immediately and provide appropriate medical care. Allergic reactions can range from mild skin rash to severe anaphylaxis.
Q5: Can this medication be used during pregnancy?
A: Use with caution during pregnancy only if potential benefit outweighs the risk. Terbutaline has tocolytic properties.
Q6: Does this drug interact with other medications?
A: Yes, see the Drug Interactions section for details. It can interact with beta-blockers, other sympathomimetics, corticosteroids, and theophylline, among others.
Q7: How does this combination help relieve cough?
A: Bromhexine breaks down mucus, guaifenesin thins and loosens it, and terbutaline expands the airways, making it easier to cough up the mucus.
Q8: What conditions is this combination typically prescribed for?
A: It is used for productive cough associated with bronchospasm in conditions like bronchitis, asthma, COPD, bronchiectasis, and emphysema.
Q9: Are there any long-term side effects?
A: Long-term use may exacerbate underlying cardiovascular or metabolic disorders. Regular monitoring is essential.
Q10: Can patients with diabetes take this medication?
A: Use with caution. Monitor blood glucose levels closely, as terbutaline may cause hyperglycemia.
