Long-acting beta-2 agonist (oral prodrug of terbutaline) Pregnancy: Avoid 1st trimester. Inhaled β2 agonists preferred where possible.

Bambuterol

Brand names: Bambec

Adult dose

Dose: 10 mg ON; if previously responsive to other beta-2 agonists, start 20 mg ON.

Route: Oral

Frequency: Once daily at night

Max: 20 mg/day

Start 5 mg ON if eGFR <50 ml/min. Tablet swallowed whole.

Dose adjustments

Renal

eGFR <50: start 5 mg ON. eGFR <30: avoid.

Hepatic

Avoid in moderate–severe hepatic impairment — bambuterol activated by plasma cholinesterase.

Clinical pearls

Oral LABA — useful niche when patients cannot manage inhaler technique (frail, severe arthritis) and reversibility-confirmed asthma needs maintenance bronchodilation.
Prodrug — slow hydrolysis by plasma cholinesterase gives ~20-hour duration, hence ON dosing.
Caution in patients on neostigmine/pyridostigmine — competitive substrate for cholinesterase.
Should still be used WITH inhaled corticosteroid in asthma — never as monotherapy.

Contraindications

Hypersensitivity to bambuterol or terbutaline
Severe hepatic impairment
Pregnancy 1st trimester (relative)

Side effects

Tremor (very common)
Tachycardia, palpitations
Headache, restlessness
Hypokalaemia (esp. with diuretics, theophylline, steroids)
Muscle cramps
Lactic acidosis (high-dose IV/oral β2 — rare)
Paradoxical bronchospasm (rare)

Interactions

Beta-blockers: antagonise bronchodilator effect — avoid
Diuretics, theophylline, corticosteroids: additive hypokalaemia
MAOIs / TCAs: ↑ cardiovascular effects
Volatile anaesthetics: ↑ arrhythmia risk

Monitoring

K+ baseline if combined with diuretics/steroids
PEFR / symptom score

Reference: BNF 90; SmPC Bambec; BTS/SIGN Asthma Guideline 158 (2019); NICE NG80. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways