-ADRENOCEPTOR AGONISTS, SELECTIVE

Beta

-2-

adrenoceptor

f

agonists, selective

12.2.2016

lCONTRA-INDICATIONSSevere pre-eclampsia

lCAUTIONSArrhythmias

.

cardiovascular disease

.

diabetes (risk of hyperglycaemia and ketoacidosis, especially with intravenous use)

.

high doses of beta2agonists can be dangerous in some children

.

hypertension

.

hyperthyroidism

.

hypokalaemia

.

susceptibility to QT-interval prolongation

CAUTIONS, FURTHER INFORMATION

▶HypokalaemiaPotentially serious hypokalaemia may result from beta₂agonist therapy. Particular caution is required in severe asthma, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, diuretics, and by hypoxia.

lINTERACTIONS→Appendix1(sympathomimetics, beta₂).

Hypokalaemia may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics.

lSIDE-EFFECTSAngioedema

.

arrhythmias

.

behavioural disturbances

.

collapse

.

_fine tremor (particularly in the hands)

.

headache

.

hyperglycaemia (especially when given intravenously)

.

hypersensitivity reactions

.

hypokalaemia (with high doses)

.

hypotension

.

ketoacidosis (especially when given intravenously)

.

muscle cramps

.

myocardial ischaemia

.

nervous tension

.

palpitation

.

paradoxical bronchospasm (occasionally severe)

.

peripheral vasodilation

.

rash

.

sleep disturbances

.

tachycardia

.

urticaria

lPREGNANCYWomen planning to become pregnant should be counselled about the importance of taking their asthma medication regularly to maintain good control.

lMONITORING REQUIREMENTS

▶In severe asthma, plasma-potassium concentration should be monitored (risk of hypokalaemia).

▶In patients with diabetes, monitor blood glucose (risk of hyperglycaemia and ketoacidosis, especially when beta₂ agonist given intravenously).

lPATIENT AND CARER ADVICE

▶When used by inhalationThedose, the frequency, and the maximum number of inhalations in24hours of the beta₂ agonist should bestated explicitlyto the patient or their carer. The patient or their carer should be advised to seek medical advice when the prescribed dose of beta2agonist fails to provide the usual degree of symptomatic relief because this usually indicates a worsening of the asthma and the patient may require a prophylactic drug. Patients or their carers should be advised to follow manufacturers’ instructions on the care and cleansing of inhaler devices.

BETA2-ADRENOCEPTOR AGONISTS, SELECTIVE

›

LONG-ACTING

eiii^Fabovei

Formoterol fumarate

(Eformoterol fumarate)

lINDICATIONS AND DOSE

Reversible airways obstruction in patients requiring long-term regular bronchodilator therapy|Nocturnal asthma in patients requiring long-term regular bronchodilator therapy|Prophylaxis of exercise-induced bronchospasm in patients requiring long-term regular bronchodilator therapy|Chronic asthma in patients who regularly use an inhaled corticosteroid

▶BY INHALATION OF POWDER

▶Child 6–11 years:12micrograms twice daily, a daily dose of24micrograms of formoterol should be sufficient for the majority of children, particularly for younger age-groups; higher doses should be used rarely, and only when control is not maintained on the lower dose

▶Child 12–17 years:12micrograms twice daily, dose may be increased in more severe airway obstruction;

increased to24micrograms twice daily, a daily dose of 24micrograms of formoterol should be sufficient for the majority of children, particularly for younger age-groups; higher doses should be used rarely, and only when control is not maintained on the lower dose

▶BY INHALATION OF AEROSOL

▶Child 12–17 years:12micrograms twice daily, dose may be increased in more severe airway obstruction;

increased to24micrograms twice daily, a daily dose of 24micrograms of formoterol should be sufficient for the majority of children, particularly for younger age-groups; higher doses should be used rarely, and only when control is not maintained on the lower dose OXIS^®

Chronic asthma

▶BY INHALATION OF POWDER

▶Child 6–17 years:6–12^micrograms1–2times a day (max. per dose12micrograms), occasionally doses up to the maximum daily may be needed, reassess treatment if additional doses required on more than 2days a week; maximum48micrograms per day Relief of bronchospasm

▶BY INHALATION OF POWDER

▶Child 6–17 years:6–12^micrograms

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Prophylaxis of exercise-induced bronchospasm

▶BY INHALATION OF POWDER

▶Child 6–17 years:6–12micrograms, dose to be taken before exercise

PHARMACOKINETICS

At recommended inhaled doses, the duration of action of formoterol is about12^hours.

IMPORTANT SAFETY INFORMATION CHM ADVICE

To ensure safe use, the CHM has advised that for the management of chronic asthma, long-acting beta₂ agonist (formoterol) should:

.be added only if regular use of standard-dose inhaled corticosteroids has failed to control asthma adequately;

.not be initiated in patients with rapidly deteriorating asthma;

.be introduced at a low dose and the effect properly monitored before considering dose increase;

.be discontinued in the absence of benefit;

.not be used for the relief of exercise-induced asthma symptoms unless regular inhaled corticosteroids are also used;

.be reviewed as clinically appropriate: stepping down therapy should be considered when good long-term asthma control has been achieved.

lSIDE-EFFECTS

▶Very rareQT-interval prolongation

▶Frequency not knownDizziness

.

nausea

.

pruritus

.

taste disturbances

lPREGNANCYInhaled drugs for asthma can be taken as normal during pregnancy.

lBREAST FEEDINGInhaled drugs for asthma can be taken as normal during breast-feeding.

lPATIENT AND CARER ADVICEAdvise patients not to exceed prescribed dose, and to follow manufacturer’s directions; if a previously effective dose of inhaled formoterol fails to provide adequate relief, a doctor’s advice should be obtained as soon as possible. Patients should be advised to report any deterioration in symptoms following initiation of treatment with a long-acting beta₂agonist. Patient or carer should be given advice on how to administer formoterol fumarate inhalers.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines containing the same drug.

Pressurised inhalation

▶Atimos Modulite(Chiesi Ltd)

Formoterol fumarate dihydrate 12 microgram per 1 doseAtimos Modulite12micrograms/dose inhaler|100dose^P£30.06DT price = £30.06

Inhalation powder

▶Easyhaler (formoterol)(Orion Pharma (UK) Ltd) Formoterol fumarate dihydrate 12 microgram per

1 doseFormoterol Easyhaler12micrograms/dose dry powder inhaler

|120dose^P£23.75DT price = £23.75

▶Foradil(Novartis Pharmaceuticals UK Ltd)

Formoterol fumarate dihydrate 12 microgramForadil 12microgram inhalation powder capsules with device| 60capsule^P£28.06DT price = £28.06

▶Oxis Turbohaler(AstraZeneca UK Ltd)

Formoterol fumarate dihydrate 6 microgram per 1 doseOxis6 Turbohaler|60dose^P£24.80DT price = £24.80

Formoterol fumarate dihydrate 12 microgram per 1 doseOxis12 Turbohaler|60dose^P£24.80DT price = £24.80

Combinations available:Budesonide with formoterol,p.152

.

Fluticasone with formoterol,p.153

eiii^F144i

Salmeterol

lINDICATIONS AND DOSE

Reversible airways obstruction in patients requiring long-term regular bronchodilator therapy|Nocturnal asthma in patients requiring long-term regular bronchodilator therapy|Prevention of exercise-induced bronchospasm in patients requiring long-term regular bronchodilator therapy|Chronic asthma only in patients who regularly use an inhaled corticosteroid (not for immediate relief of acute asthma)

▶BY INHALATION OF AEROSOL, OR BY INHALATION OF POWDER

▶Child 5–11 years:50micrograms twice daily

▶Child 12–17 years:50micrograms twice daily, dose may be increased in more severe airway obstruction;

increased to100micrograms twice daily PHARMACOKINETICS

At recommended inhaled doses, the duration of action of salmeterol is about12^hours.

lUNLICENSED USENeovent^®not licensed for use in children under12^years.

IMPORTANT SAFETY INFORMATION CHM ADVICE

To ensure safe use, the CHM has advised that for the management of chronic asthma, long-acting beta₂ agonist (salmeterol) should:

.be added only if regular use of standard-dose inhaled corticosteroids has failed to control asthma adequately;

.not be initiated in patients with rapidly deteriorating asthma;

.be introduced at a low dose and the effect properly monitored before considering dose increase;

.be discontinued in the absence of benefit;

.not be used for the relief of exercise-induced asthma symptoms unless regular inhaled corticosteroids are also used;

.be reviewed as clinically appropriate: stepping down therapy should be considered when good long-term asthma control has been achieved.

lSIDE-EFFECTSArthralgia

.

dizziness

.

nausea lPREGNANCYInhaled drugs for asthma can be taken as

normal during pregnancy.

lBREAST FEEDINGInhaled drugs for asthma can be taken as normal during breast-feeding.

lPATIENT AND CARER ADVICE

Advise patients that salmeterol shouldnotbe used for relief of acute attacks, not to exceed prescribed dose, and to follow manufacturer’s directions; if a previously effective dose of inhaled salmeterol fails to provide adequate relief, a doctor’s advice should be obtained as soon as possible.

Patients should be advised to report any deterioration in symptoms following initiation of treatment with a long-acting beta₂agonist.

Medicines for Children leaflet: Salmeterol inhaler for asthma prevention (prophylaxis)www.medicinesforchildren.org.uk/

salmeterol-inhaler-for-asthma-prevention lMEDICINAL FORMS

There can be variation in the licensing of different medicines containing the same drug.

Pressurised inhalation

▶Salmeterol (Non-proprietary)

Salmeterol (as Salmeterol xinafoate) 25 microgram per 1 doseSalmeterol25micrograms/dose inhaler CFC free| 120dose^P £29.26DT price = £29.26

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▶Neovent(Kent Pharmaceuticals Ltd)

Salmeterol (as Salmeterol xinafoate) 25 microgram per 1 doseNeovent25micrograms/dose inhaler CFC free| 120dose^P £29.26DT price = £29.26

▶Serevent Evohaler(GlaxoSmithKline UK Ltd) Salmeterol (as Salmeterol xinafoate) 25 microgram per 1 doseSerevent25micrograms/dose Evohaler|120dose^P

£29.26DT price = £29.26

▶Vertine(Teva UK Ltd)

Salmeterol (as Salmeterol xinafoate) 25 microgram per 1 doseVertine25micrograms/dose inhaler CFC free|120dose^P

£23.40DT price = £29.26 Inhalation powder

▶Serevent Accuhaler(GlaxoSmithKline UK Ltd) Salmeterol (as Salmeterol xinafoate) 50 microgram per 1 doseSerevent50micrograms/dose Accuhaler|60dose^P

£29.26DT price = £29.26

Combinations available:Fluticasone with salmeterol,p.153 BETA2-ADRENOCEPTOR AGONISTS,

SELECTIVE

›

SHORT-ACTING eiii^F144i

Salbutamol

(Albuterol)

lINDICATIONS AND DOSE Acute asthma

▶BY INTRAVENOUS INJECTION

▶Child 1–23 months:5micrograms/kg for1dose, dose to be administered over5minutes, reserve intravenous beta₂agonists for those in whom inhaled therapy cannot be used reliably or there is no current effect

▶Child 2–17 years:15micrograms/kg (max. per dose 250micrograms) for1dose, dose to be administered over5minutes, reserve intravenous beta2agonists for those in whom inhaled therapy cannot be used reliably or there is no current effect

▶BY CONTINUOUS INTRAVENOUS INFUSION

▶Child:1–2micrograms/kg/minute, adjusted according to response and heart rate, increased if necessary up to 5micrograms/kg/minute, doses above

2micrograms/kg/minute should be given in an intensive care setting, reserve intravenous beta₂ agonists for those in whom inhaled therapy cannot be used reliably or there is no current effect

Moderate, severe, or life-threatening acute asthma

▶BY INHALATION OF NEBULISED SOLUTION

▶Child 1 month–4 years:2^.5mg, repeat every 20–30minutes or when required, give via oxygen-driven nebuliser if available

▶Child 5–11 years:2^.5–5mg, repeat every20–30^minutes or when required, give via oxygen-driven nebuliser if available

▶Child 12–17 years:5mg, repeat every20–30^{minutes or} when required, give via oxygen-driven nebuliser if available

Moderate and severe acute asthma

▶BY INHALATION OF AEROSOL

▶Child:2–10puffs, each puff is to be inhaled separately, repeat every10–20minutes or when required, give via large volume spacer (and a close-fitting face mask in children under3years), each puff is equivalent to 100^micrograms

Exacerbation of reversible airways obstruction (including nocturnal asthma)|Prophylaxis of allergen- or exercise-induced bronchospasm

▶BY INHALATION OF AEROSOL

▶Child:100–200micrograms, up to4times a day for persistent symptoms

▶BY MOUTH

▶Child 1 month–1 year:100micrograms/kg3–4^{times a} day (max. per dose2mg), inhalation route preferred over oral route

▶Child 2–5 years:1–2^mg3–4times a day, inhalation route preferred over oral route

▶Child 6–11 years:2^mg3–4times a day, inhalation route preferred over oral route

▶Child 12–17 years:2–4^mg3–4times a day, inhalation route preferred over oral route

Severe hyperkalaemia

▶BY INTRAVENOUS INJECTION

▶Neonate:4micrograms/kg, repeated if necessary, to be administered over5^minutes.

▶Child:4micrograms/kg, repeated if necessary, to be administered over5^minutes

▶BY INHALATION OF NEBULISED SOLUTION

▶Neonate:2^.5–5mg, repeated if necessary, intravenous injection route preferred over inhalation of nebulised solution.

▶Child:2^.5–5mg, repeated if necessary, intravenous injection route preferred over inhalation of nebulised solution

Chronic asthma

▶BY MOUTH USING MODIFIED-RELEASE MEDICINES

▶Child 3–11 years:4mg twice daily

▶Child 12–17 years:8mg twice daily ASMASAL CLICKHALER^®

Acute bronchospasm

▶BY INHALATION OF POWDER

▶Child 5–17 years:1–2puffs, up to4times daily for persistent symptoms

Prophylaxis of allergen- or exercise-induced bronchospasm

▶BY INHALATION OF POWDER

▶Child 5–17 years:1–2^puffs EASYHALER^®SALBUTAMOL Acute bronchospasm

▶BY INHALATION OF POWDER

▶Child 5–11 years:100–200micrograms; maximum 800micrograms per day

▶Child 12–17 years:Initially100–200micrograms, increased if necessary to400micrograms; maximum 800micrograms per day

Prophylaxis of allergen- or exercise-induced bronchospasm

▶BY INHALATION OF POWDER

▶Child 5–11 years:100–200^micrograms

▶Child 12–17 years:200^micrograms PULVINAL^®SALBUTAMOL Acute bronchospasm

▶BY INHALATION OF POWDER

▶Child 5–17 years:Initially200micrograms, up to 800micrograms daily for persistent symptoms Prophylaxis of allergen- or exercise-induced bronchospasm

▶BY INHALATION OF POWDER

▶Child 5–17 years:200^micrograms SALBULIN NOVOLIZER^® Acute bronchospasm

▶BY INHALATION OF POWDER

▶Child 6–11 years:100–200micrograms, up to 400micrograms daily for persistent symptoms

▶Child 12–17 years:Initially100–200micrograms, up to 800micrograms daily for persistent symptoms

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Prophylaxis of allergen- or exercise-induced bronchospasm

▶BY INHALATION OF POWDER

▶Child 6–11 years:100–200^micrograms

▶Child 12–17 years:200^micrograms VENTOLIN ACCUHALER^®

Acute bronchospasm

▶BY INHALATION OF POWDER

▶Child 5–17 years:Initially200micrograms, up to4^times daily for persistent symptoms

Prophylaxis of allergen- or exercise-induced bronchospasm

▶BY INHALATION OF POWDER

▶Child 5–17 years:200^micrograms PHARMACOKINETICS

At recommended inhaled doses, the duration of action of salbutamol is about3^to5^hours.

lUNLICENSED USENot licensed for use in hyperkalaemia.

▶With oral useSyrup and tablets not licensed for use in children under2years. Modified-release tablets not licensed for use in children under3^years.

▶With intravenous use or subcutaneous useInjection and solution for intravenous infusion not licensed for use in children under12^years.

▶With intravenous useAdministration of undiluted salbutamol injection through a central venous catheter is not licensed.

lSIDE-EFFECTSLactic acidosis (with high doses)

.

nausea lBREAST FEEDINGInhaled drugs for asthma can be taken as

normal during breast-feeding.

lDIRECTIONS FOR ADMINISTRATION

▶With intravenous useForcontinuous intravenous infusion, dilute to a concentration of200micrograms/mL with Glucose5^%orSodium Chloride0^.9^{%. If}fluid-restricted, can be given undiluted through central venous catheter [unlicensed]. Forintravenous injection, dilute to a concentration of50micrograms/mL with Glucose5^%, Sodium Chloride0^.9^%,orWater for injections.

▶When used by inhalationFornebulisation, dilute nebuliser solution with a suitable volume of sterile Sodium Chloride 0^.9% solution according to nebuliser type and duration of administration; salbutamol and ipratropium bromide solutions are compatible and can be mixed for nebulisation.

lPATIENT AND CARER ADVICE

Medicines for Children leaflet: Salbutamol inhaler for asthma and wheeze www.medicinesforchildren.org.uk/salbutamol-inhaler-for-asthma-and-wheeze

▶When used by inhalationFor inhalation by aerosol or dry powder, advise patients and carers not to exceed prescribed dose and to follow manufacturer’s directions; if a previously effective dose of inhaled salbutamol fails to provide at least3hours relief, a doctor’s advice should be obtained as soon as possible.For inhalation by nebuliser, the dose given by nebuliser is substantially higher than that given by inhaler. Patients should therefore be warned that it is dangerous to exceed the prescribed dose and they should seek medical advice if they fail to respond to the usual dose of the respirator solution.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines containing the same drug.

Tablet

▶Salbutamol (Non-proprietary)

Salbutamol (as Salbutamol sulfate) 2 mgSalbutamol2mg tablets

|28tablet^P £113.09DT price = £104.95

Salbutamol (as Salbutamol sulfate) 4 mgSalbutamol4mg tablets

|28tablet^P £115.76DT price = £107.43

Oral solution

▶Salbutamol (Non-proprietary)

Salbutamol (as Salbutamol sulfate) 400 microgram per 1 mlSalbutamol2mg/5ml oral solution sugar free sugar-free| 150ml^Pno price available DT price = £0.72

▶Ventolin(GlaxoSmithKline UK Ltd)

Salbutamol (as Salbutamol sulfate) 400 microgram per 1 mlVentolin2mg/5ml syrup sugar-free|150ml^P £0.72DT price = £0.72

Solution for injection

▶Ventolin(GlaxoSmithKline UK Ltd)

Salbutamol (as Salbutamol sulfate) 500 microgram per 1 mlVentolin500micrograms/1ml solution for injection ampoules| 5ampoule^P £1.91

Solution for infusion

▶Ventolin(GlaxoSmithKline UK Ltd)

Salbutamol (as Salbutamol sulfate) 1 mg per 1 mlVentolin 5mg/5ml solution for infusion ampoules|10ampoule^P £24.81 Pressurised inhalation

▶Salbutamol (Non-proprietary)

Salbutamol (as Salbutamol sulfate) 100 microgram per 1 doseSalbutamol100micrograms/dose inhaler CFC free| 200dose^P £1.50DT price = £1.50

▶AirSalb(Sandoz Ltd)

Salbutamol (as Salbutamol sulfate) 100 microgram per 1 doseAirSalb100micrograms/dose inhaler CFC free| 200dose^P £1.50DT price = £1.50

▶Airomir(Teva UK Ltd)

Salbutamol (as Salbutamol sulfate) 100 microgram per 1 doseAiromir100micrograms/dose inhaler|200dose^P £1.97 DT price = £1.50

▶Airomir Autohaler(Teva UK Ltd)

Salbutamol (as Salbutamol sulfate) 100 microgram per 1 doseAiromir100micrograms/dose Autohaler|200dose^P

£6.02DT price = £6.30

▶Asmavent(Kent Pharmaceuticals Ltd)

Salbutamol (as Salbutamol sulfate) 100 microgram per 1 doseAsmavent100micrograms/dose inhaler CFC free| 200dose^P £1.50DT price = £1.50

▶Salamol(Teva UK Ltd)

Salbutamol (as Salbutamol sulfate) 100 microgram per 1 doseSalamol100micrograms/dose inhaler CFC free| 200dose^P £1.46DT price = £1.50

▶Salamol Easi-Breathe(Teva UK Ltd)

Salbutamol (as Salbutamol sulfate) 100 microgram per 1 doseSalamol100micrograms/dose Easi-Breathe inhaler| 200dose^P £6.30DT price = £6.30

▶Ventolin Evohaler(GlaxoSmithKline UK Ltd)

Salbutamol (as Salbutamol sulfate) 100 microgram per 1 doseVentolin100micrograms/dose Evohaler|200dose^P

£1.50DT price = £1.50 Inhalation powder

▶Easyhaler (salbutamol)(Orion Pharma (UK) Ltd) Salbutamol 100 microgram per 1 doseEasyhaler Salbutamol sulfate100micrograms/dose dry powder inhaler|200dose^P

£3.31DT price = £3.31

Salbutamol 200 microgram per 1 doseEasyhaler Salbutamol sulfate200micrograms/dose dry powder inhaler|200dose^P

£6.63DT price = £6.63

▶Salbulin Novolizer(Meda Pharmaceuticals Ltd) Salbutamol (as Salbutamol sulfate) 100 microgram per 1 doseSalbulin Novolizer100micrograms/dose inhalation powder| 200dose^P £4.95

Salbulin Novolizer100micrograms/dose inhalation powder refill| 200dose^P £2.75

▶Ventolin Accuhaler(GlaxoSmithKline UK Ltd) Salbutamol 200 microgram per 1 doseVentolin 200micrograms/dose Accuhaler|60dose^P £3.00DT price =

£3.00 Nebuliser liquid

▶Salbutamol (Non-proprietary)

Salbutamol (as Salbutamol sulfate) 1 mg per 1 mlSalbutamol 2.5mg/2.5ml nebuliser liquid unit dose vials|20unit dose^P

£7.00DT price = £1.91

Salbutamol (as Salbutamol sulfate) 2 mg per 1 mlSalbutamol 5mg/2.5ml nebuliser liquid unit dose vials|20unit dose^P £7.35 DT price = £3.82

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▶Salamol Steri-Neb(Teva UK Ltd)

Salbutamol (as Salbutamol sulfate) 1 mg per 1 mlSalamol 2.5mg/2.5ml nebuliser liquid Steri-Neb unit dose vials|20unit dose^P £1.91DT price = £1.91

Salbutamol (as Salbutamol sulfate) 2 mg per 1 mlSalamol 5mg/2.5ml nebuliser liquid Steri-Neb unit dose vials|20unit dose^P £3.82DT price = £3.82

▶Ventolin(GlaxoSmithKline UK Ltd)

Salbutamol (as Salbutamol sulfate) 5 mg per 1 mlVentolin 5mg/ml respirator solution|20ml^P £2.18DT price = £2.18

▶Ventolin Nebules(GlaxoSmithKline UK Ltd)

Salbutamol (as Salbutamol sulfate) 1 mg per 1 mlVentolin2.5mg Nebules|20unit dose^P £1.65DT price = £1.91

Salbutamol (as Salbutamol sulfate) 2 mg per 1 mlVentolin5mg Nebules|20unit dose^P £2.78DT price = £3.82

eiii^F144i

Terbutaline sulfate

lINDICATIONS AND DOSE Acute asthma

▶BY SUBCUTANEOUS INJECTION, OR BY SLOW INTRAVENOUS INJECTION

▶Child 2–14 years:10micrograms/kg up to4times a day (max. per dose300micrograms), reserve intravenous beta₂agonists for those in whom inhaled therapy cannot be used reliably or there is no current effect

▶Child 15–17 years:250–500micrograms up to4^{times a} day, reserve intravenous beta2agonists for those in whom inhaled therapy cannot be used reliably or there is no current effect

▶BY CONTINUOUS INTRAVENOUS INFUSION

▶Child:Loading dose2–4micrograms/kg, then 1–10micrograms/kg/hour, dose to be adjusted according to response and heart rate, close monitoring is required for doses above10micrograms/kg/hour, reserve intravenous beta₂agonists for those in whom inhaled therapy cannot be used reliably or there is no current effect

Moderate, severe, or life-threatening acute asthma

▶BY INHALATION OF NEBULISED SOLUTION

▶Child 1 month–4 years:5mg, repeat every 20–30minutes or when required, give via oxygen-driven nebuliser if available

▶Child 5–11 years:5–10mg, repeat every20–30^minutes or when required, give via oxygen-driven nebuliser if available

▶Child 12–17 years:10mg, repeat every20–30^{minutes or} when required, give via oxygen-driven nebuliser if available

Exacerbation of reversible airways obstruction (including nocturnal asthma)|Prevention of exercise-induced bronchospasm

▶BY INHALATION OF POWDER

▶Child 5–17 years:500micrograms up to4times a day, for occasional use only

▶BY MOUTH

▶Child 1 month–6 years:75micrograms/kg3times a day (max. per dose2^.5mg), administration by mouth is not recommended

▶Child 7–14 years:2^.5^mg2–3times a day, administration by mouth is not recommended

▶Child 15–17 years:Initially2^.5^mg3times a day, then increased if necessary to5^mg3times a day, administration by mouth is not recommended PHARMACOKINETICS

At recommended inhaled doses, the duration of action of terbutaline is about3^to5^hours.

lUNLICENSED USE

▶With oral useTablets not licensed for use in children under 7^years.

▶With intravenous use or subcutaneous useInjection not licensed for use in children under2^years.

lSIDE-EFFECTSNausea

lPREGNANCYInhaled drugs for asthma can be taken as normal during pregnancy.

lBREAST FEEDINGInhaled drugs for asthma can be taken as normal during breast-feeding.

lDIRECTIONS FOR ADMINISTRATION

▶With intravenous useForcontinuous intravenous infusion, dilute to a concentration of5micrograms/mL with Glucose 5^%orSodium Chloride0^.9^{%; if}fluid-restricted, dilute to a concentration of100micrograms/mL.

▶When used by inhalationFornebulisation, dilute nebuliser solution with sterile Sodium Chloride0^.9^{% solution} according to nebuliser type and duration of administration; terbutaline and ipratropium bromide solutions are compatible and may be mixed for nebulisation.

lPATIENT AND CARER ADVICE

▶When used by inhalationFor inhalation by dry powder, advise patients and carers not to exceed prescribed dose and to follow manufacturer’s directions; if a previously effective dose of inhaled terbutaline fails to provide at least3^hours relief, a doctor’s advice should be obtained as soon as possible.For inhalation by nebuliser, the dose given by nebuliser is substantially higher than that given by inhaler.

Patients should therefore be warned that it is dangerous to exceed the prescribed dose and they should seek medical advice if they fail to respond to the usual dose of the respirator solution.

lMEDICINAL FORMS

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: solution for injection

Tablet

▶Bricanyl(AstraZeneca UK Ltd)

Terbutaline sulfate 5 mgBricanyl5mg tablets|100tablet^P

£4.91DT price = £4.91 Oral solution

▶Bricanyl(AstraZeneca UK Ltd)

Terbutaline sulfate 300 microgram per 1 mlBricanyl1.5mg/5ml syrup sugar-free|100ml^P £2.80DT price = £2.80 Solution for injection

▶Bricanyl(AstraZeneca UK Ltd)

Terbutaline sulfate 500 microgram per 1 mlBricanyl2.5mg/5ml solution for injection ampoules|10ampoule^P £16.74 Bricanyl500micrograms/1ml solution for injection ampoules| 5ampoule^P £2.16

Inhalation powder

▶Bricanyl Turbohaler(AstraZeneca UK Ltd)

Terbutaline sulfate 500 microgram per 1 doseBricanyl 500micrograms/dose Turbohaler|100dose^P £6.92DT price =

£6.92 Nebuliser liquid

▶Terbutaline sulfate (Non-proprietary)

Terbutaline sulfate 2.5 mg per 1 mlTerbutaline5mg/2ml nebuliser liquid unit dose vials|20unit dose^P£4.04DT price = £4.04

▶Bricanyl Respules(AstraZeneca UK Ltd)

Terbutaline sulfate 2.5 mg per 1 mlBricanyl5mg/2ml Respules| 20unit dose^P£5.82DT price = £4.04

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