Drug reference

Bambuterol

Long-acting beta-2 adrenergic agonist (prodrug of terbutaline) · Bronchodilator

Also known as Bambuterol Hydrochloride

START

10 mg PO once daily at bedtime (5 mg if eGFR <50/elderly); maintenance only, with inhaled corticosteroid in asthma

TYPICAL MAX

20 mg/day

STOP IF

Serious arrhythmia, severe hypokalaemia, paradoxical bronchospasm

WATCH

Serum potassium (esp. severe asthma + xanthine/steroid/diuretic), heart rate/arrhythmia, ensure concomitant ICS in asthma, not for acute attacks

CDSCO approvedSchedule HATC R03CC12

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 2h · prodrug conversion (not acute)
PEAK: 4h · terbutaline rise
t½: 13h · bambuterol t½
DURATION: 1d · once-daily effect

EXCRETION

Hydrolysis to terbutaline; renal metabolites

route + CYP

INTERACTIONS

3 major

SEVERE in our sources

PREGNANCY

Use only if clearly needed — limited data (terbutaline experience); avoid near term (tocolytic/cardiac effects)

FDA category + note

Top interactionssee all 5 →

Non Selective Beta BlockersSevereDatabaseKimi deep-research + Cla
SuxamethoniumSevereDatabaseKimi deep-research + Cla
XanthinesSevereDatabaseKimi deep-research + Cla

Available in India

9 branded formulations. Look up specific brands in the Drugs workspace.

Mechanism

Bis-dimethylcarbamate prodrug slowly hydrolysed (partly by butyrylcholinesterase) to terbutaline, giving sustained beta-2 agonist bronchodilation suitable for once-daily oral dosing.

Indications

Bronchial asthma and reversible airflow obstruction (oral maintenance bronchodilation; not for acute relief)

Dosing

Adult: 10 mg PO once daily at bedtime; 20 mg/day if needed in patients with good prior beta-agonist tolerance. Start 5 mg if renal impairment (eGFR <50) or elderly.
Pediatric: ≥2 years (where licensed): weight/age-based (specialist).
Renal adjustment: eGFR <50 mL/min: start 5 mg once daily (reduced clearance of prodrug/terbutaline).
Hepatic adjustment: Cirrhosis/significant hepatic impairment: avoid (unpredictable terbutaline generation).
Geriatric: Start 5 mg; monitor cardiac effects.
Max dose: 20 mg/day

Pharmacokinetics

Onset

Gradual (prodrug conversion) — not for acute use

Peak effect

Terbutaline levels rise over hours; steady effect ~24 h

Duration

~24 h (once daily)

Half-life

Bambuterol ~13 h; generated terbutaline ~21 h

Bioavailability

~20% (prodrug; converted systemically)

Protein binding

Low–moderate (terbutaline)

Metabolism

Hydrolysis/oxidation (butyrylcholinesterase-dependent) to terbutaline

Excretion

Renal (terbutaline and metabolites)

Contraindications

Hepatic cirrhosis/significant hepatic impairment (impaired prodrug handling)
Hypersensitivity to bambuterol/terbutaline
Caution: tachyarrhythmia, severe cardiovascular disease, uncontrolled hyperthyroidism

Side effects

Common

TremorPalpitations/tachycardiaHeadacheMuscle crampsHypokalaemia (dose-related)

Serious

Serious hypokalaemia (potentiated by xanthines, steroids, diuretics — esp. severe asthma)
Tachyarrhythmia/myocardial ischaemia
Paradoxical bronchospasm
LABA-monotherapy risk in asthma (use with inhaled corticosteroid)