Turbuhaler: Adults and Children >12 years: 1 inhalation (0.5 mg) as required up to every 4-6 hrs. In severe cases, the single dose may be increased to 3 inhalations (1.5 mg). The total daily dose should not exceed 12 inhalations (6 mg). Children 3-12 yrs: 1 inhalation (0.5 mg) as required up to every 4-6 hrs. In severe cases, the single dose may be increased to 2 inhalations (1 mg). The total daily dose should not exceed 8 inhalations (4 mg).
Injection: Adults and Children >12 years: 0.5 mL SC. Repeat as required up to every 6 hrs.
Dosage should be individualised. Inhaled bronchodilators should be used as required rather than regularly.
If long-term use of terbutaline is proposed, particularly if the patient is asked to take terbutaline in conjunction with other medications, objective pulmonary function testing (eg, by peak flow meter or spirometer) may be useful as part of assessment of the efficacy of treatment.
Children: Dosage schedules for children for oral formulations of terbutaline should be prescribed on a mg/kg basis. The larger safety margins with the dry powder formulation permit a less specific dosage schedule.
Oral administration is indicated in children who are unable to inhale satisfactorily via a metered dose inhaler and who do not have access to a compressor/nebuliser unit.
Bricanyl turbuhaler is suitable for use by children since it is breath-activated and does not require coordination of dose release and inhalation as with use of aerosol inhalers. When prescribing the turbuhaler to young children, it is necessary to ascertain that they can follow the instructions for use as follows.
Administration: Turbuhaler: Directions for Use: Turbuhaler is insipatory flow-driven which means that, when the patient inhales through the mouthpiece, the substance will follow the inspired air into the airway. Follow the instructons given:
1. Unscrew and lift off the cover.
2. Hold the inhaler upright with the grip downwards. Load the inhaler with a dose by turning the grip as far as it will go and then back to the original position.
3. Breathe out. Do not breathe out through the mouthpiece.
4. Place the mouthpiece between your teeth, close your lips and breathe in forcefully and deeply through your mouth. Do not chew or bite hard on the mouthpiece.
5. Before breathing out, remove the inhaler from your mouth. If more than 1 dose has been prescribed, repeat steps 2-5.
6. Replace the cover.
Note: It is important to instruct the patient to breathe in forcefully and deeply through the mouthpiece; to ensure that an optimal dose is delivered to the lungs; never to breathe out through the mouthpiece; always replace the cover properly after use; clean the outside of the mouthpiece regularly (weekly) with a dry tissue. Do not use water for cleaning the mouthpiece.