A fixed-dose combination (FDC) expectorant, mucolytic, and bronchodilator syrup/tablet primarily used for symptomatic relief in productive cough associated with bronchospasm in conditions like acute and chronic bronchitis, asthma, and COPD. Bromhexine thins viscous sputum, guaifenesin increases respiratory tract fluid, menthol provides soothing relief, and terbutaline relieves bronchoconstriction.
Adult: 10 ml (2 teaspoonfuls) of syrup or 1 tablet, three to four times daily. Maximum: 4 doses in 24 hours.
Note: Syrup: To be taken orally, preferably after meals with a full glass of water to aid expectoration. Tablet: Swallow whole with water. Do not crush or chew. Maintain adequate hydration.
Combined action: Bromhexine depolymerizes mucopolysaccharide fibers in sputum, reducing viscosity. Guaifenesin stimulates gastric vagal receptors, reflexively increasing respiratory tract fluid secretion, lubricating airways. Menthol acts as a mild local anesthetic and counter-irritant, providing a cooling sensation and soothing cough reflex. Terbutaline selectively stimulates beta-2 adrenergic receptors in bronchial smooth muscle, causing relaxation and bronchodilation.
Pregnancy: Category B (US FDA). Terbutaline: Not recommended for tocolysis. Use only if clearly needed and benefit outweighs risk, especially in 1st trimester. Bromhexine/Guaifenesin: Limited data. Avoid in late pregnancy due to theoretical risk of uterine relaxation from terbutaline.
Driving: May cause dizziness, nervousness. 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 |
| Monoamine Oxidase Inhibitors (MAOIs) / Tricyclic Antidepressants (TCAs) | Potentiates cardiovascular effects (hypertension, tachycardia) of terbutaline. | Major |
| Other Sympathomimetics (Decongestants like Pseudoephedrine) | Additive cardiovascular and CNS stimulant effects, increasing risk of tachycardia, hypertension. | Major |
| Diuretics (e.g., Furosemide, Hydrochlorothiazide) | Concurrent use with terbutaline may potentiate hypokalemia. | Moderate |
| Digoxin | Hypokalemia from terbutaline may increase risk of digoxin toxicity. | Moderate |
| Theophylline | Additive stimulant effects; increased risk of tachycardia, arrhythmias. | Moderate |
| CNS Depressants (Alcohol, Benzodiazepines) | Menthol may have mild additive sedative effect. | Minor |
Same composition (Bromhexine (4mg) + Guaifenesin (50mg) + Menthol (2.5mg) + Terbutaline (1.25mg)), different brands: