BRICANYL
Clinical safety rating
cautionComprehensive clinical and safety monograph for BRICANYL (BRICANYL).
Comprehensive clinical and safety monograph for BRICANYL (BRICANYL).
Treatment or prevention of bronchospasm in patients with reversible obstructive airway diseaseAcute asthma exacerbationOff-label: Management of acute hyperkalemiaOff-label: Prevention of preterm labor (terbutaline)
Headache, Tremors, Dizziness, Nausea, Increased heart rate, Upper abdominal pain, Vomiting, Diarrhea, Rash, Urticaria, Itching, Sweating, Changes in serum aminotransferase levels, Bloating, Indigestion
Beta-2 adrenergic receptor agonist; stimulates adenyl cyclase, increasing cyclic AMP, leading to bronchodilation.
| Metabolism | Metabolized in the liver via sulfonation (sulfotransferase enzymes) and to a minor extent by catechol-O-methyltransferase (COMT). |
| Excretion | Primarily renal (60-70% as unchanged drug and metabolites); fecal elimination accounts for a minor fraction (<5%). |
| Half-life | 3-4 hours (terminal); prolonged in renal impairment (up to 8-10 hours) and in elderly patients. |
| Protein binding | Approximately 25% bound to albumin. |
| Volume of Distribution | ~0.6 L/kg; indicates distribution into total body water. |
| Bioavailability | Inhalation: ~10-20% (dependent on device and technique); Oral: ~15-20% (due to extensive first-pass metabolism). |
| Onset of Action | Subcutaneous: 5-10 minutes; Inhalation: 1-5 minutes; Oral: 30-60 minutes. |
| Duration of Action | Subcutaneous: 2-4 hours; Inhalation: 3-6 hours; Oral: 4-8 hours (dose-dependent). |
| Molecular Weight | 225.28 |
| Action Class | Short acting β2-agonists |
Subcutaneous: 0.25-0.5 mg every 1-2 hours as needed; Intravenous: 0.25-0.5 mg over 1 minute, may repeat every 1-2 hours; Inhalation (metered-dose inhaler): 2 inhalations (0.4 mg) every 6 hours; Nebulized: 2.5-5 mg every 6-8 hours.
| Dosage form | INJECTABLE |
| Renal impairment | No specific dose adjustment recommended for renal impairment; use with caution in severe renal impairment (eGFR <30 mL/min/1.73 m²) due to potential for increased systemic exposure. |
| Liver impairment | No specific dose adjustment recommended; caution in severe hepatic impairment (Child-Pugh Class C) due to reduced clearance. |
| Pediatric use | Subcutaneous: 5-10 mcg/kg every 1-2 hours as needed (max 0.5 mg); Intravenous: 5-10 mcg/kg over 1 minute (max 0.5 mg); Inhalation (MDI): 1-2 inhalations (0.2-0.4 mg) every 4-6 hours; Nebulized: 0.01-0.03 mg/kg (max 1 mg) every 6-8 hours. |
| Geriatric use | Initiate at lower end of dosing range (e.g., subcutaneous 0.125 mg); monitor for tachycardia, hypertension, and tremor; consider age-related decline in renal and hepatic function. |
| 1st trimester | Limited data; teratogenic risk cannot be excluded. Use only if clearly needed. |
| 2nd trimester | Use with caution; monitor fetal heart rate and uterine activity. |
| 3rd trimester | Avoid near term due to potential for maternal tachycardia, hyperglycemia, and fetal tachycardia. |
Clinical note
Comprehensive clinical and safety monograph for BRICANYL (BRICANYL).
| Placental transfer | Terbutaline crosses the placenta; achieves fetal concentrations approximately 50-80% of maternal levels. |
| Breastfeeding | Excreted into breast milk in small amounts; monitor infant for signs of beta-agonism (tachycardia, agitation). Use with caution. |
| Lactation Rating | L3 (Moderately Safe) |
| Teratogenic Risk | Insufficient human data; animal studies show no evidence of teratogenicity at clinically relevant doses. Risk cannot be excluded; use only if clearly needed. First trimester: limited data suggest no major malformations. Second and third trimesters: may cause fetal tachycardia, hypoglycemia, and transient hypocalcemia. Avoid in preterm labor due to maternal and fetal adverse effects. |
| Fetal Monitoring | Monitor maternal heart rate, blood pressure, blood glucose, and serum potassium. Fetal heart rate monitoring should be considered during use in pregnancy, especially when used tocolytically. Assess for signs of pulmonary edema in maternal prolonged use. |
| Fertility Effects | No specific data on human fertility. Animal studies show no impairment of fertility at doses up to 50 mg/kg/day. Clinically, no known adverse effects on fertility. |
■ FDA Black Box Warning
Not available
| Serious Effects |
Hypersensitivity to terbutaline or any beta-agonistTachyarrhythmiasSevere thyrotoxicosisUncontrolled hypertension
| Precautions | Paradoxical bronchospasm may occur, Cardiovascular effects (e.g., tachycardia, arrhythmias, increased blood pressure) use caution with cardiovascular disorders, Hypokalemia may occur, Hyperglycemia reported, Immediate hypersensitivity reactions |
| Food/Dietary | No significant food interactions. However, avoid excessive caffeine intake (coffee, tea, cola) as it may exacerbate beta-agonist side effects like palpitations and tremor. |
| Clinical Pearls | BRICANYL (terbutaline sulfate) is a beta-2 adrenergic agonist used for bronchodilation in asthma and COPD. It can cause transient hypokalemia, hyperglycemia, and tremor. Use with caution in patients with diabetes, hypertension, or hyperthyroidism. Monitor serum potassium in patients on diuretics or with hypoxia. Not recommended for acute severe asthma as monotherapy; prefer short-acting beta-agonists like albuterol. |
| Patient Advice | Use exactly as prescribed; do not increase dose or frequency without consulting your doctor. · Shake the inhaler well before each use. · Rinse mouth with water after inhalation to prevent oral thrush. · Seek emergency medical help if breathing problems worsen or if you have chest pain or irregular heartbeat. · Monitor blood sugar if diabetic as this medication may raise blood glucose levels. · Avoid caffeine as it may increase side effects like nervousness and rapid heart rate. |
Loading safety data…