A fixed-dose combination (FDC) expectorant, mucolytic, and bronchodilator used for the symptomatic management of productive cough and bronchospasm associated with acute and chronic respiratory conditions. Guaifenesin promotes mucus clearance, Bromhexine thins and loosens viscous sputum, and Terbutaline relieves bronchoconstriction. This combination is widely used in India for conditions like acute bronchitis and COPD exacerbations with tenacious sputum.
Adult: 10 ml (2 teaspoonfuls) three to four times a day. Tablet forms: 1 tablet three to four times a day.
Note: Should be taken after meals with a full glass of water to improve expectorant effect and reduce GI upset. Shake the syrup well before use. Do not crush or chew tablets.
Triple-action: 1) Terbutaline stimulates bronchial beta-2 adrenergic receptors, causing relaxation of smooth muscle via increased cAMP, leading to bronchodilation. 2) Guaifenesin enhances the output of respiratory tract fluid by reducing adhesiveness and surface tension, facilitating the removal of viscous, inspissated mucus. 3) Bromhexine depolymerizes mucopolysaccharide fibers in sputum, decreases mucus viscosity, and stimulates surfactant production.
Pregnancy: Category B (US FDA) for Terbutaline (but used for tocolysis). Guaifenesin: Category C. Bromhexine: Not recommended, especially in first trimester. Use only if potential benefit justifies potential fetal risk. Avoid in late pregnancy due to risk of uterine relaxation.
Driving: May cause dizziness, nervousness, or tremor. Patients should not drive or operate machinery until their response is known.
| Beta-blockers (e.g., Propranolol) | Antagonizes bronchodilator effect of Terbutaline; may cause severe bronchospasm in asthmatics. | Major |
| Diuretics (e.g., Furosemide, Thiazides) | Increased risk of hypokalemia when combined with Terbutaline. | Moderate |
| Monoamine Oxidase Inhibitors (MAOIs) & Tricyclic Antidepressants (TCAs) | Potentiates the cardiovascular effects (tachycardia, hypertension) of Terbutaline. | Major |
| Other Sympathomimetics (e.g., Decongestants) | Additive cardiovascular and CNS stimulant effects. | Moderate |
| Digoxin | Risk of hypokalemia may increase digoxin toxicity. | Moderate |
| Xanthine derivatives (Theophylline) | Increased risk of cardiac stimulation and hypokalemia. | Moderate |
Same composition (Guaifenesin (50mg) + Terbutaline (1.25mg) + Bromhexine (2mg)), different brands: