Who can administer
May be administered by registered competent doctor or nurse/midwife
Important information
- See monitoring requirements
- In situations where the inhaled route is not appropriate for bronchodilation, the preferred route is the intramuscular or subcutaneous route
Available preparations
Bricanyl 2,500 microgram per 5mL ampoule (2.5mg in 5mL)
Bricanyl 500 microgram per 1mL ampoule
Reconstitution
Already in solution
- Must be further diluted before use - diluent depends on indication
- Draw up using a 5 micron filter needle
Infusion fluids
- Bronchodilator: can use either Glucose 5% or Sodium chloride 0.9%
- Management of premature labour: Glucose 5% ONLY
- Sodium chloride should be avoided during pregnancy due to increased risk of pulmonary oedema. If it must be used, patients should be carefully monitored
Methods of intravenous administration
Bronchodilator dose
- Slow intravenous injection (ref 1)
- Dilute to 10mL with infusion fluid and administer required dose over 3 to 5 minutes
- Continuous intravenous infusion (administer using an electronically controlled infusion device)
- Add 1.5 to 2.5mg to 500mL infusion fluid and administer over several hours (see 'dose')
Premature labour
- Continuous intravenous infusion (administer using an electronically controlled infusion device)
- Use a small volume of infusion, with a syringe driver to avoid the risk of maternal pulmonary oedema e.g. add 5mg (5,000 micrograms) to 40mL Glucose 5% to produce a concentration of 100 micrograms/mL
- Dose as per schedule below
- Rate does not usually exceed 10 micrograms/minute, with a maximum rate of 20 micrograms/minute
Dose in adults
Bronchodilator dose
- Slow intravenous injection dose: 0.25 to 0.5mg up to four times daily
- Infusion dose: Add 1.5 to 2.5mg to 500mL infusion fluid and administer at 30 to 60mL/hour for 8 to 10 hours (more than one bag may be required depending on each patients individual requirements)
Premature labour dose
- Prepare a concentration of 100 micrograms/ml as above
- Initial dose 5 micrograms per minute for the first 20 minutes, increasing by 2.5 micrograms per minute at 20 minute intervals until the contractions stop
- Rate does not usually exceed 10 micrograms/minute, with a maximum rate of 20 micrograms/minute
- The infusion should be stopped if labour progresses despite treatment at the maximum dose
- If successful, the infusion should continue for 1 hour at the chosen rate and then be decreased by 2.5 micrograms per minute, every 20 minutes to the lowest dose that produces suppression of contractions
- Duration of treatment should not exceed 48 hours
- A maximum maternal heart rate of 120 beats per min should not be exceeded
Monitoring
- Patients at risk of hypokalaemia should have serum potassium levels monitored
- Diabetic patients should have additional blood glucose measurements performed when therapy is initiated
- Lactic acidosis has been reported with high doses of intravenous terbutaline, particularly in patients being treated for acute asthma exacerbation
- Premature labour
- The amount of IV fluids administered and rate of administration should be monitored to avoid fluid overload
- A maternal heart rate of more than 120bpm should be avoided
- Dose should be individually titrated with reference to suppression of contractions, increases in pulse rate and changes in blood pressure, which are limiting factors
- To minimise the risk of hypotension, keep patient in left or right lateral position throughout the infusion (ref 1)
Storage
Store below 250C
References
SPC November 2020
1: Injectable medicines guide, downloaded from Medusa 28th Oct 2021
Therapeutic classification
Selective beta2-adrenoreceptor agonist
