How does it work?

Bricanyl turbohaler, respules, tablets and syrup all contain the active ingredient terbutaline, which is a type of medicine known as a short-acting beta 2 agonist. (NB. Terbutaline is also available without a brand name, ie as the generic medicine.)

Terbutaline works by acting on receptors in the lungs called beta 2 receptors. When terbutaline stimulates these receptors it causes the muscles in the airways to relax. This allows the airways to open.

In conditions where there is narrowing of the airways, such as asthma or chronic obstructive pulmonary disease (COPD, eg emphysema and chronic bronchitis), it is difficult for air to get in and out of the lungs. By opening the airways, terbutaline makes it easier to breathe.

Terbutaline is most commonly taken using an inhaler device. Inhaling the medicine allows it to act directly in the lungs where it is needed most. It also reduces the potential for side effects occurring in other parts of the body, as the amount absorbed into the blood through the lungs is lower than if it is taken by mouth.

Terbutaline when used as an inhaler is known as a reliever. This is because it works very quickly to relieve asthma attacks, wheezing, chest tightness or shortness of breath. Terbutaline inhalers can also be used to open the airways shortly before exercising to prevent wheezing.

Terbutaline is sometimes prescribed to be taken by mouth, eg as tablets or syrup, for people who cannot use inhalers very well. It must be taken regularly in this way to help keep the airways open all the time.

Respules of terbutaline are used in a nebuliser machine to treat acute asthma attacks in hospital. A nebuliser is a machine that converts the liquid medicine inside the respules into particles that can be inhaled. It is used to deliver higher doses of the medicine than a standard inhaler.

People with severe asthma or COPD who have been shown to benefit from regular use of high doses of terbutaline are sometimes prescribed respules to be used in a nebuliser at home.

What is it used for?

• Asthma
• Chronic obstructive pulmonary disease (COPD)

Warning!

• Do not exceed the dose of terbutaline that your doctor has prescribed you to use.
• If your inhaler doesn't relieve wheezing or chest tightness as well as usual, or for as long as usual, or you need to use it more often than usual, you should consult your doctor as soon as possible. It may be that your asthma or COPD is getting worse and your doctor might need to give you another medicine. The same applies if you are taking terbutaline by mouth or nebuliser and it doesn't seem to be working as well.
• Inhalers may cause an unexpected increase in wheezing (paradoxical bronchospasm) straight after using them. If this happens, stop using the inhaler immediately and consult your doctor. The medicine should be stopped and an alternative treatment found.
• People with severe asthma should have regular blood tests to monitor the amount of potassium in their blood. This is because low oxygen levels in the blood (hypoxia) and various asthma medicines, including this one, can lower blood potassium levels.

Use with caution in

• Diabetes
• Heart failure
• Heart disease
• Irregular heart beats (arrhythmias)
• High blood pressure (hypertension)
• Thyrotoxicosis

Not to be used in

• Known sensitivity or allergy to any ingredient

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

• It is important that asthma is well controlled in pregnant women. Wherever possible, asthma medications should be taken by inhaler, as this minimises the amount of medicine that enters the bloodstream and crosses the placenta. Seek medical advice from your doctor.
• Terbutaline passes into breast milk, but in such small amounts that it is unlikely to harm the baby. In general, terbutaline tablets, syrup and inhalers can be used as normal during breastfeeding. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Shaking, usually of the hands (tremor)
• Headache
• Nausea
• Awareness of your heart beat (heart palpitations)
• Muscle cramps
• Tense feeling
• Sleep disturbances
• Increased heart rate (tachycardia)
• Low blood potassium level (hypokalaemia)
• Mouth or throat irritation (with inhaler devices)
• Unexpected narrowing of the airways (paradoxical bronchospasm, with inhaler devices)

The side effects listed above may not include all of the side effects reported by the drug's manufacturer.For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.

This medicine should not be taken with beta-blockers, such as atenolol, propranolol or timolol. This is because beta-blockers have an opposite action to this medicine and cause the airways to narrow. This can result in breathing difficulties for people with asthma or COPD. This problem has sometimes been seen with eye drops containing beta-blockers, eg used for glaucoma.

Terbutaline can potentially cause a serious decrease in the levels of potassium in the blood (hypokalaemia), which may result in adverse effects. This effect can be increased by the following medicines, which can also lower potassium in the blood:

• xanthine derivates, such as theophylline or aminophylline
• corticosteroids, such as beclometasone and prednisolone
• other beta 2 agonists, such as salmeterol
• diuretics, such as bendroflumethiazide and furosemide.

This is why people with severe asthma or COPD, who may be taking several of these medicines, should have their blood potassium levels monitored regularly.

Other medicines containing the same active ingredient

Terbutaline oral solution and nebuliser solution are also available without a brand name, ie as the generic medicine.