Bambuterol

Oral
Persistent reversible airways obstruction

CrCl (mL/min)	Dosage
<50	Initial dose should be halved.

Severe: Not recommended.

Patient w/ liver cirrhosis and other causes of severely impaired liver function; underlying severe heart disease (e.g. ischaemic heart disease, arrhythmia or severe heart failure); thyrotoxicosis, DM, hypertrophic cardiomyopathy, predisposition to angle closure glaucoma. Not intended for relief of acute bronchospasm or in patients w/ unstable resp disease. Moderate to severe renal impairment. Pregnancy and lactation.

Behavioural disturbances (e.g. restlessness, agitation), tremor, headache, sleep disturbances, palpitations, muscle cramps, hypersensitivity reactions, hypokalaemia, hyperglycaemia, dizziness, hyperactivity, tachycardia, cardiac arrhythmias, myocardial ischaemia, paradoxical bronchospasm, nausea.

Symptoms: Headache, anxiety, tremor, nausea, tonic muscle cramps, palpitations, tachycardia and cardiac arrhythmias. Management: Consider gastric lavage and activated charcoal in severe cases. Determine acid-base balance, blood glucose and electrolytes. Monitor BP, heart rate and rhythm. For haemodynamically significant cardiac arrhythmias, the preferred antidote is a cardioselective β-blocker, but should be used w/ caution in patients w/ history of bronchospasm. Admin a vol expander when the β₂-mediated reduction in peripheral vascular resistance significantly contributes to the fall in BP.

Prolonged muscle-relaxing effect of other sympathomimetics (e.g. suxamethonium). Increased risk of hypokalaemia by co-admin w/ corticosteroids, diuretics or xanthine derivatives. Partial or total inhibition of effects w/ non-selective β-blockers.

Description: Bambuterol is a prodrug of terbutaline. It relaxes bronchial smooth muscle by selectively acting on β₂-receptors.
Duration: At least 24 hr.
Pharmacokinetics:
Absorption: Absorbed from the GI tract (approx 20%). Bioavailability: Approx 10%. Time to peak plasma concentration: Approx 4-7 hr (terbutaline).
Distribution: Plasma protein binding: 40-50%.
Metabolism: Slowly metabolised in the liver to its active metabolite, terbutaline via hydrolysis and oxidation.
Excretion: Terminal half-life: 9-17 hr.

Source: National Center for Biotechnology Information. PubChem Database. Bambuterol, CID=54766, https://pubchem.ncbi.nlm.nih.gov/compound/Bambuterol (accessed on Jan. 21, 2020)

Store below 30°C.

Antiasthmatic & COPD Preparations

R03CC12 - bambuterol ; Belongs to the class of adrenergics for systemic use, selective beta-2-adrenoreceptor agonists. Used in the treatment of obstructive airway diseases.

Anon. Bambuterol. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 20/10/2015.

Buckingham R (ed). Bambuterol Hydrochloride. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 20/10/2015.