| Composition |
syrup: Each 10 ml syrup contains:
– Bromhexine hydrochloride: 8 mg.
– Terbutaline sulphate: 2.5 mg.
– Guaiphenesin: 100 mg. |
| Pharmacodynamics properties |
Bromhexine hydrochloride is a mucolytic agent, which liquifies thick sputum. Viscosity of sputum is reduced by dissolving mucopolysaccharide fibres. It also improves mucocilliary clearance of secretions.
Guaiphenesin is an expectorant. It increases the output of sputum and bronchial secretions by reducing adhesiveness and surface tension. By increasing the volume of bronchial secretions, it reduces the viscosity of sputum. The increased flow of less viscid secretions also promotes ciliary
action.
Terbutaline sulphate is a directly acting sympathomimetic agent with selective stimulant effect of beta-2 receptors. It helps in alleviating bronchospasm associated with cough and facilitates drainage of accumulated bronchial secretions. |
| Therapeutic indications |
| Bilcavon is indicated in the treatment of productive cough when associated with bronchospasm in conditions such as bronchitis, bronchial asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, and emphysema.Bilcavon is indicated in the treatment of productive cough when associated with bronchospasm in conditions such as bronchitis, bronchial asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis, and emphysema. |
| Side effect |
Bromhexine: Gastrointestinal side effects may occur occasionally with bromhexine and a transient rise in serum aminotransferase values has been reported.
Guaiphenesin: Gastrointestinal discomfort has occasionally been reported with guaiphenesin.
Terbutaline: Tremor and nervousness. The frequency of these side effects appear to diminish with continued therapy. Other commonly reported reactions include increased heart rate, palpitations, and dizziness. |
| Contraindication |
| Patients with a history of hypersensitivity to sympathetic amines and any other components in the expectorant. |
| Warnings and precautions |
Caution should be observed while prescribing Bilcavon to patients with hypertension, cardiovascular disease, uncontrolled diabetes mellitus, and patients with hyperthyroidism, history of seizures.
Patients susceptible to hypokalemia should be monitored because transient early falls in serum potassium levels have been reported with beta-2 agonists. Since mucolytics, such as bromhexine, may disrupt the gastric mucosal barrier, bromhexine should be used with care in patients with a history of peptic ulceration. |
| Pregnancy and lactation |
Safety of Bilcavon has not been studied in pregnancy and lactation.
Therefore, probable benefits should be weighed against possible risks, before prescribing Bilcavon during pregnancy and lactation. |
| Drug interactions |
Adverse metabolic effects of high dose beta-2 agonists such as terbutaline may be exacerbated by concomitant administration of high doses of corticosteroids.
Hypokalemia with high doses of beta-2 agonists may result in increased susceptibility to digitalis induced cardiac arrhythmias.
Hypokalemia may be enhanced by concomitant administration of aminophyllin or other xanthines, corticosteroids or by diuretic therapy.
Terbutaline sulphate should be administered with caution in patients being treated with monoamine oxidase (MAO) inhibitors or tricyclic antidepressants, since the action of terbutaline sulfate on the vascular system may be potentiated.
Hypokalemia with high doses of b-2 agonists may result in increased susceptibility to digitalis induced cardiac arrhythmias.
Hypokalemia may be enhanced by concomitant administration of aminophyllin or other xanthines, corticosteroids or by diuretic therapy. |
| DOSAGE & ADMINISTRATION |
syrup: Syrup is usually given 3 times a day in the following doses:
– Children 2–6 years: 1/2 teaspoon (2.5 ml) three times a day.
– Children 6–12 years: 1 teaspoon (5 ml) three times a day.
adults: 2 teaspoonfuls (10 ml) three times a day.
tablets: One tablet three times a day. |
| Overdose |
| Overdose of terbutaline may lead to significant drop in blood pressure due to peripheral vasodilation. |
| Package |
syrup: Box containing 125 ml glass bottle with inserted leaflet.
tablets: Box of 20 tablets with inserted leaflet. |
| Storage |
– Store between (15–30)°C away from moisture.
– Keep away from reach of children. |
