A fixed-dose combination (FDC) oral liquid expectorant and bronchodilator. Ambroxol is a mucolytic agent that thins and loosens thick mucus. Guaifenesin is an expectorant that increases the volume and reduces the viscosity of respiratory tract secretions. Terbutaline is a selective beta-2 adrenergic agonist that relaxes bronchial smooth muscle, providing relief from bronchospasm. This combination is specifically formulated for the symptomatic management of productive cough associated with bronchospasm in conditions like acute and chronic bronchitis.
Adult: 10 ml (2 teaspoonfuls) three times a day. Maximum: 30 ml per day.
Note: Should be taken after food to minimize gastric irritation from guaifenesin. Use the measuring cup/spoon provided. Drink a full glass of water with each dose to aid expectoration. Do not take at bedtime if it causes insomnia due to terbutaline. Shake the bottle well before use.
The combination works synergistically. Ambroxol reduces the viscosity of sputum by breaking down acid mucopolysaccharide fibers and stimulating surfactant production. Guaifenesin enhances the output of respiratory tract fluid by reducing surface tension and adhesiveness, facilitating ciliary clearance. Terbutaline stimulates intracellular adenyl cyclase, increasing cyclic AMP, leading to relaxation of bronchial smooth muscle and inhibition of mediator release from mast cells.
Pregnancy: Category C (US FDA). Terbutaline: Should be avoided, especially in 1st trimester, except if clearly needed. It is a tocolytic and may cause fetal tachycardia. Ambroxol & Guaifenesin: Limited data, use only if benefit outweighs risk. Not recommended for routine use.
Driving: May cause dizziness, drowsiness, or blurred vision. Patients should not drive or operate machinery until they know how the medicine affects them, especially at treatment initiation.
| Beta-blockers (e.g., Propranolol) | Antagonizes bronchodilator effect of terbutaline; may cause severe bronchospasm in asthmatics. | Major |
| Diuretics (e.g., Furosemide, Hydrochlorothiazide) | Enhanced risk of hypokalemia with terbutaline. | Major |
| Monoamine Oxidase Inhibitors (MAOIs) & Tricyclic Antidepressants (TCAs) | Potentiates cardiovascular effects (hypertension, tachycardia) of terbutaline. | Major |
| Other Sympathomimetics (e.g., Salbutamol, Ephedrine, Decongestants) | Additive cardiovascular and CNS stimulant effects, increased risk of side effects. | Major |
| Digoxin | Hypokalemia induced by terbutaline may increase risk of digoxin toxicity. | Moderate |
| Theophylline | Additive bronchodilation but also additive risk of tachycardia and other side effects. | Moderate |
| CNS Depressants (Alcohol, Benzodiazepines) | Guaifenesin may have mild additive sedative effect. | Minor |
Same composition (Ambroxol (15mg/5ml) + Guaifenesin (50mg/5ml) + Terbutaline (1.5mg/5ml)), different brands: