Usage
- Bromhexine + Terbutaline is prescribed for the symptomatic treatment of productive cough associated with bronchospasm in conditions such as bronchitis, bronchial asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, and emphysema.
- Pharmacological Classification: Mucolytic (Bromhexine) and Bronchodilator (Terbutaline). Terbutaline is a beta-2 adrenergic agonist, while Bromhexine is a mucolytic expectorant.
- Mechanism of Action: Bromhexine works by breaking down the thick mucus secretions in the airways, making it easier to cough them up. Terbutaline relaxes the smooth muscles in the airways, relieving bronchospasm and improving airflow.
Alternate Names
- No widely recognized alternate generic names.
- Brand Names: Broncorex, TusQ-X, Redkof (and many others depending upon region)
How It Works
- Pharmacodynamics: Terbutaline stimulates beta-2 adrenergic receptors in the lungs, leading to bronchodilation. Bromhexine reduces the viscosity of mucus by breaking down mucopolysaccharide fibers.
- Pharmacokinetics:
- Absorption: Both drugs are absorbed orally.
- Metabolism: Primarily hepatic metabolism for both drugs.
- Elimination: Mainly renal excretion.
- Mode of Action: Terbutaline activates intracellular adenyl cyclase, increasing cyclic AMP levels. This results in smooth muscle relaxation in the airways. Bromhexine depolymerizes mucopolysaccharides, decreasing sputum viscosity.
- Receptor Binding: Terbutaline binds to beta-2 adrenergic receptors.
- Elimination Pathways: Both drugs undergo hepatic metabolism followed by renal excretion.
Dosage
Standard Dosage
Adults:
- 10 ml (2 teaspoons) three times a day.
- Maximum daily dose should not exceed 30 ml.
Children:
- 6-12 years: 5-7.5 ml (1-1½ teaspoons) three times a day.
- 2-6 years: 2.5-5 ml (½-1 teaspoon) three times a day.
- Not recommended for children below 2 years of age without close medical supervision.
Special Cases:
- Elderly Patients: Start with a lower dose and titrate upwards as needed.
- Patients with Renal Impairment: Dose reduction may be necessary.
- Patients with Hepatic Dysfunction: Dose reduction may be necessary.
- Patients with Comorbid Conditions: Careful monitoring for drug interactions and adverse effects is advised, especially in those with diabetes, cardiovascular diseases, and hyperthyroidism.
Clinical Use Cases
- Dosing in specific clinical situations like intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations is not specifically indicated for this combination and should be guided by clinical judgment and patient condition. Terbutaline may be used in these situations, but not necessarily with bromhexine.
Dosage Adjustments
- Dose adjustments may be required based on patient response, renal or hepatic function, and the presence of comorbidities.
Side Effects
Common Side Effects
- Tremor, headache, tachycardia, palpitations, muscle cramps, hypokalemia, nausea, vomiting, dizziness, and skin rash.
Rare but Serious Side Effects
- Arrhythmias, myocardial ischemia, angioedema, paradoxical bronchospasm, hypersensitivity reactions, seizures, and hypotension.
Long-Term Effects
- Potential for tolerance to terbutaline with prolonged use.
Adverse Drug Reactions (ADR)
- Severe allergic reactions (anaphylaxis), significant cardiovascular effects (arrhythmias, ischemia), and severe respiratory adverse effects (paradoxical bronchospasm).
Contraindications
- Hypersensitivity to bromhexine, terbutaline, or any component of the formulation.
- Severe heart disease (e.g., unstable angina, severe tachyarrhythmias).
- Hyperthyroidism.
Drug Interactions
- Beta-blockers (may reduce the effectiveness of terbutaline).
- Diuretics (may enhance hypokalemia).
- Xanthine derivatives (may enhance hypokalemia).
- Corticosteroids (may enhance hypokalemia and metabolic effects of terbutaline).
- Other sympathomimetics (may have additive effects on the cardiovascular system).
- MAO inhibitors and tricyclic antidepressants (may potentiate the cardiovascular effects of terbutaline).
Pregnancy and Breastfeeding
- Pregnancy Safety Category: C. Use with caution during pregnancy only if the potential benefit justifies the potential risk to the fetus.
- Terbutaline may decrease milk production. It is unclear if Bromhexine is secreted in breast milk. Caution should be exercised when administering this medication to nursing mothers.
Drug Profile Summary
- Mechanism of Action: Terbutaline: Bronchodilation via beta-2 adrenergic receptor stimulation. Bromhexine: Mucolytic action.
- Side Effects: Common: Tremor, headache, tachycardia. Serious: Arrhythmias, angioedema.
- Contraindications: Hypersensitivity, severe heart disease, hyperthyroidism.
- Drug Interactions: Beta-blockers, diuretics, xanthines, corticosteroids, sympathomimetics.
- Pregnancy & Breastfeeding: Category C; use with caution if benefits outweigh risks.
- Dosage: Adults: 10 ml TID. Children: Consult guidelines above.
- Monitoring Parameters: Heart rate, blood pressure, potassium levels, respiratory function.
Popular Combinations
- This combination itself is a popular combination of a mucolytic and a bronchodilator. It is often prescribed as a single formulation.
Precautions
- General Precautions: Monitor for cardiovascular and metabolic side effects. Assess renal and hepatic function before initiating treatment.
- Specific Populations: Use with caution in pregnancy and breastfeeding. Dose adjustment may be needed in elderly patients and those with renal or hepatic impairment.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Bromhexine + Terbutaline?
A: Adults: 10ml TID, Children (6-12 yrs): 5-7.5ml TID, Children (2-6 yrs): 2.5-5ml TID.
Q2: How does Bromhexine + Terbutaline work?
A: Bromhexine thins and loosens mucus, while terbutaline dilates the airways.
Q3: What are the common side effects?
A: Tremor, headache, tachycardia, palpitations, nausea, dizziness.
Q4: Who should not take this medication?
A: Patients with hypersensitivity, severe heart disease, or uncontrolled hyperthyroidism.
Q5: Are there any drug interactions I should be aware of?
A: Yes, including beta-blockers, diuretics, and certain antidepressants.
Q6: Can this medication be used during pregnancy?
A: Use with caution only if the potential benefits justify the potential risks to the fetus.
Q7: Is it safe to take this medication while breastfeeding?
A: It is unclear if Bromhexine passes into breast milk. Terbutaline may affect milk production. Consult with a doctor to weight risk and benefits.
Q8: What should I monitor in patients taking this medication?
A: Heart rate, blood pressure, potassium levels, and respiratory function.
Q9: Can I take this medication with other cough syrups?
A: It’s best to avoid combining with other cough medications without consulting a doctor.
Q10: What should I do if a patient experiences an allergic reaction?
A: Discontinue the medication immediately and seek medical attention.
