A fixed-dose combination syrup containing a selective beta-2 adrenergic agonist (Terbutaline) and a mucolytic agent (Bromhexine). It is primarily indicated for the symptomatic treatment of acute and chronic bronchospastic conditions associated with excessive, viscous mucus, such as in bronchitis, asthma, and COPD. Terbutaline provides rapid bronchodilation, while Bromhexine thins and loosens bronchial secretions, facilitating expectoration.
Adult: 10 ml (one 5ml spoonful twice) two to three times daily. Maximum: 30 ml (6 spoonfuls) per day.
Note: Should be taken orally, preferably after meals to minimize gastric irritation. Use the measuring cup or spoon provided. Drink a full glass of water after each dose to help loosen mucus. Do not take immediately before bedtime to avoid disruption of sleep due to cough expectoration.
Terbutaline selectively stimulates beta-2 adrenergic receptors on bronchial smooth muscle, leading to activation of adenylate cyclase, increased intracellular cAMP, and subsequent relaxation of smooth muscle, resulting in bronchodilation. Bromhexine depolymerizes and lyses acid mucopolysaccharide fibers in bronchial mucus, reducing its viscosity. It also stimulates the production of serous (less viscous) secretions and activates the ciliary apparatus, improving mucociliary clearance.
Pregnancy: Category B (US FDA). Terbutaline: Should be used only if clearly needed. Avoid in late pregnancy due to risk of maternal pulmonary edema and effects on fetal heart rate. Bromhexine: Data limited; use if benefit outweighs risk. Not recommended for routine use.
Driving: May cause dizziness, nervousness, or tremor. Patients should not drive or operate machinery until they know how the medicine affects them.
| Beta-blockers (e.g., Propranolol) | Antagonizes bronchodilator effect of terbutaline; may cause severe bronchospasm in asthmatics. | Major |
| Diuretics (especially loop and thiazide) | Increased risk of hypokalemia due to additive effect with terbutaline. | Major |
| Monoamine Oxidase Inhibitors (MAOIs) & Tricyclic Antidepressants (TCAs) | Potentiates the cardiovascular effects (tachycardia, hypertension) of terbutaline. | Major |
| Other Sympathomimetics (e.g., decongestants, other asthma drugs) | Additive sympathetic effects, increasing risk of tachycardia and hypertension. | Moderate |
| Digoxin | Hypokalemia induced by terbutaline may increase risk of digoxin toxicity. | Moderate |
| Xanthine derivatives (Theophylline) | Additive stimulant effects; increased risk of tachycardia and CNS stimulation. | Moderate |
| Corticosteroids (systemic) | Increased risk of hypokalemia. | Moderate |
Same composition (Terbutaline (2.5mg/5ml) + Bromhexine (8mg/5ml)), different brands: