bambuterol hydrochloride: clinical use

Prescribing considerations

• For asthma, use only with optimal anti-inflammatory therapy; it is unsuitable as sole regular treatment or for acute relief.
• Avoid initiation or escalation during an acute exacerbation; reassess promptly if benefit decreases.
• Consider renal function because terbutaline is predominantly renally eliminated.
• Conversion to terbutaline is unpredictable in cirrhosis or severe hepatic dysfunction; an alternative beta-2 agonist may be preferable.
• Use caution with thyrotoxicosis, diabetes, severe cardiovascular disease, arrhythmia risk and predisposition to angle-closure glaucoma.
• Do not use in children because clinical documentation is insufficient.

Contraindications and cautions

• Hypersensitivity to bambuterol hydrochloride or any excipient.
• Hypertrophic cardiomyopathy because of beta-2-agonist positive inotropic effects.
• The selected lactose-containing product should not be used in specified rare hereditary disorders of galactose metabolism or absorption.

Monitoring

• Assess asthma control and adherence to anti-inflammatory treatment.
• Check blood glucose more closely when treatment begins in people with diabetes.
• Monitor serum potassium in acute severe asthma or when hypoxia or potassium-depleting medicines increase risk.
• Consider heart rate, rhythm and cardiovascular symptoms in susceptible patients.

Clinical pharmacology

Bambuterol is a racemic bis-carbamate prodrug converted by hydrolysis and oxidation to terbutaline. Its bronchodilator and systemic beta-2 effects are attributable to terbutaline. It also reversibly inhibits plasma cholinesterase, explaining its interaction with suxamethonium.

Formulation and product differences

• The selected product is an oral tablet containing lactose.
• The tablet may be halved but should not be chewed or crushed.
• The selected eMC product listing is marked discontinued.