Bricanyl (terbutaline) Turbohaler

• asthma
• chronic obstructive pulmonary disease (COPD).

How does Bricanyl 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.
• 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.

How is Bricanyl taken?

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 inhalers are known as 'relievers'. This is because when terbutaline is breathed into the lungs it works very quickly to relieve asthma attacks, wheezing, coughing, chest tightness or shortness of breath. Terbutaline inhalers can also be used shortly before exercising or exposure to allergens (things that trigger wheezing, such as pet fur or pollen) to open the airways and prevent wheezing.

You should follow the instructions given by your doctor regarding when to use your terbutaline inhaler and how many inhalations you can use each day. Don't exceed the prescribed dose.

It is very important to learn how to use your inhaler correctly, as otherwise you won't be breathing the right dose of medicine into your lungs. Instructions will be provided with your inhaler. However, your doctor, nurse or pharmacist can also show you how to use your inhaler and can check that you are using it correctly.

Bricanyl turbohaler is a dry powder inhaler. It contains the medicine in powder form ready for you to breathe in. To take a dose you first need to prepare a dose inside the inhaler. To do this, turn the blue grip at the base of the turbohaler as far as it will go in one direction. Then turn it as far as it will go in the other direction (it doesn't matter which way you turn it first). You should hear a click sound; the turbohaler is now loaded and ready to use. You then breathe out fully, put the mouthpiece to your lips and breathe in steadily and deeply through your mouth. More detailed instructions are provided with the turbohaler.
You should rinse your mouth out with water after taking each dose of Bricanyl turbohaler. This is because some of the medicine may stick to the inside of your mouth and throat with each inhalation. Rinsing it away reduces unecessary absorption of the medicine into the bloodstream and so reduces the chance of side effects.
Terbutaline tablets or syrup are sometimes prescribed for people who can't use inhalers very well. As these don't start to work very quickly, oral forms of terbutaline must be taken regularly to help keep the airways open all the time.

Bricanyl tablets are usually taken two or three times a day. Follow the instructions given by your doctor regarding the dose and how often to take the tablets. The tablets can be taken either with or without food.
Bricanyl syrup is usually taken three times a day. Follow the instructions given by your doctor regarding the dose to take. The syrup can be taken either with or without food.
If you forget to take a dose take it as soon as you remember, unless it is nearly time for your next dose. In this case, just leave out the missed dose and take your next dose as usual. Don't take a double dose to make up for a missed dose.
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.

Terbutaline may also be given by injection in hospital to treat severe asthma attacks.

Important information about Bricanyl​

• 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 (at least three hours), 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.

Bricanyl should be used with caution in

• Heart disease.
• Irregular heartbeats (arrhythmias).
• High blood pressure (hypertension).
• Overactive thyroid gland (hyperthyroidism).
• Diabetes.

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 because severe asthma attacks can be dangerous to the pregnancy. Wherever possible, asthma medications should be taken by inhaler, as this minimises the amount of medicine that enters the bloodstream and crosses the placenta. Bricanyl turbohaler can be taken as usual during pregnancy. For further medical advice talk to your doctor or pharmacist.
• 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 further medical advice from your doctor.

Possible side effects of Bricanyl

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. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

Very common (affect more than 1 in 10 people)

• Shaking, usually of the hands (tremor).
• Headache.

Common (affect between 1 in 10 and 1 in 100 people)

• Increased heart rate (tachycardia).
• Awareness of your heartbeat (palpitations).
• Muscle cramps.
• Low level of potassium in your blood (hypokalaemia - see warning section above).
• Unknown frequency
• Nausea.
• Mouth or throat irritation.
• Tense feeling.
• Agitation or restlessness.
• Sleep disturbances.
• Increased blood flow to your extremities - this may cause flushing.
• Irregular heartbeat (arrhythmia).
• Unexpected narrowing of the airways.

The side effects listed above may not include all of the side effects reported by the medicine'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.

If you think you have experienced a side effect from a medicine or vaccine you should check the patient information leaflet. This lists the known side effects and what to do if you get them. You can also get advice from your doctor, nurse or pharmacist. If they think it's necessary they'll report it for you.

How can Bricanyl 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 make sure that the combination is safe.

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

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

• corticosteroids, such as beclometasone and prednisolone
• diuretics, such as bendroflumethiazide and furosemide.
• other beta 2 agonists, such as salmeterol
• xanthine derivates, such as theophylline or aminophylline.
• Since a low blood potassium level can have serious adverse effects, people with severe asthma or COPD, who may be taking several of these medicines, should have their blood potassium levels monitored regularly.

If you have any more questions please ask your Pharmacist.

Remember to keep all medicines out of reach of children
Please Note: We have made every effort to ensure that the content of this information sheet is correct at time of publish, but remember that information about drugs may change. This sheet does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet which comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects which may be relevant in your particular case.

References:

http://www.medsafe.govt.nz/consumers/cmi/b/bricanyl.pdf

http://www.netdoctor.co.uk/medicines/allergy-and-asthma/a6332/bricanyl-terbutaline/

https://www.medicines.org.uk/emc/medicine/155

https://www.drugs.com/mtm/bricanyl.html

https://www.drugs.com/sfx/bricanyl-side-effects.html