Bricanyl

Generic Name: Terbutaline sulfate
Product Name: Bricanyl

Indication

Bricanyl (terbutaline) belongs to a class of fast-acting beta 2 antagonist which work to dilate airways and relieve airway obstruction. It is mainly used as a reliever medication for asthmatic symtoms and acute asthmatic exacerabations. It is also used in other conditions where acute bronchospasm is a possible complication such as chronic bronchitis (chronic cough and sputum production), emphysema (destruction of the air spaces) and chronic obstructive pulmonary disease (COPD). In particular, bricanyl is used for prevention against acute exercise induced asthma attacks where it can be taken before exercise to open up the airways in patients who experience wheezing from exerting themselves. There are different bricanyl formulations discussed below. Bricanyl Turbuhaler is intended for short-term management of bronchospasm as well as maintenance therapy, whilst Bricanyl injection solution is recommended for acute use only.

Action

Bricanyl acts by activating specific receptors in the airways known as beta 2 adrenoreceptors. This leads to reduced airway constiction (bronchoconstriction) and an increased airway diameter making breathing much easier. It has a rapid onset of action (particularly the injection form) which means it can be used to relieve acute and life-threatening asthma attacks and other conditions where the airways are suddenly narrowed. The effects of the drug last for 4-5 hours.

Dose advice

You should only use Bricanyl when yo need it to relieve wheezing or difficulty breathing. It tends not to be used on a regular basis unless you doctor has tole you specifically to do so. It should be used as part of your Asthma Action Plan which you would likely have devised with your doctor. This should be followed at all times. Currently, Bricanyl is available in inhaled, oral and injected forms. Your doctor will prescribe an appropriate dose and formulation based on your age, severity of symptoms and weight in some cases. Some typical doses are listed below:

Adults:

• Bricanyl Turbuhaler: The dose is 500 micrograms when needed up to every 4 to 6 hours. If you have severe breathing problems three inhalations may be given as a single dose (with a space of a few minutes between).
• Nebuliser/ Respules: The dose can range from 2.5 to 5micrograms (1-2 mL) as required up to every 6 hours. This may be increased to 4 mL (10 micrograms) in severe cases.
• Oral: 2.5-5mg up to 3 times daily. (Oral route of administration is rarely used)
• Bricanyl Elixir (flavoured solution): The dose can range from 10 to 15 mL (3 to 4.5 mg), up to three times a day.
• Bricanyl Injection: Is given below the skin by a trained doctor or nurse mainly for relief of acute and serious asthma attacks. The injection can be repeated every 6 hours if required.

Children: (Generally regarded as less than 12 years).

• Bricanyl Turbuhaler: The dose is 500 micrograms per inhalation and should be used when needed up to every 4 to 6 hours. In the case of severe breathing problems, the dose may be increased up to 3 inhalations (1000 micrograms) at a given time (separeated by a few minutes). A child should not take more than 8 inhalations in any 24 hour period.
• Nebuliser/Respules: The dose of Bricanyl nebulising solution is worked out by using the weight of the child. Doses of 0.2 micrograms/kg are given when needed up to every 6 hours. (Nebulizers are not recommended for maintenance treatment or treatment of acute asthma in adults or children. Nebulizers may be used by doctors for treatment of life-threatening asthma).
• Bricanyl elixir (flavoured solution): The dose is worked out by the weight of the child. Doses are usually 0.25 mL (0.075 mg)/kg given when needed up to every 6 hours.
• Injections may be administered below the skin in acute severe asthma.

Elderly:

• Elderly people are usually started on a lower initial dosage than the recommended adult dosage. This may be gradually increased depending on the response and degeree of bronchodilation achieved.

Schedule

S3

Common side effects

• Tremor
• Palpitations (awareness of the heart beating)
• Nervousness and restlessness.
• Headache

Uncommon side effects

• Increased heart rate (which can also lead to paroxysmal tachyarrhythmias such as atrial fibrillation or paroxysmal supraventricular tachycardia)
• Muscle cramps
• Agitation
• Diarrhoea
• Bad taste
• Hyperactivity in children
• Insomnia
• Skin rash
• Hyperglycaemia (high blood sugar) and hypokalaemia (low blood potassium) when drug taken in high doses.

The majority of people taking Bricanyl will not experience any side effects or only experience the mild side effects listed above as common side effects. However, if you experience any side effects which worry you, discuss these with your pharmacist or doctor. In particular, worsening of your breathing and a fast or irregular heart beat may indicate serious side effects so medical advice should be sought.

References

1. Australian Medicines Handbook, Chapter 19.1.1. Terbutaline, AMH Pty Ltd. 2006.
2. Consumer Medicine Information- Bricanyl(R) Elixir and Injection.
3. Consumer Medicine Information- Bricanyl(R) for Inhalation.
4. MIMS Online- Prescribing Information, Bricanyl Elixir and Injection, MIMS Australia Pty Ltd 2003.
5. MIMS Online- Precribing Information, Bricanyl for Inhalation, MIMS Australia Pty Ltd 2003.
6. UpToDate, Terbutaline: Drug information, Lexi-Comp, Inc. 2005.

For further information talk to your doctor.