Nurses Compass
Drug Guide
Bitolterol Mesylate
Classification
Therapeutic: Bronchodilator
Pharmacological: Beta-adrenergic agonist
FDA Approved Indications
- Management of bronchospasm related to asthma or COPD
Mechanism of Action
Bitolterol Mesylate is a prodrug that is converted in the body to terbutaline, a beta-2 adrenergic receptor agonist, leading to relaxation of smooth muscle in the bronchi, resulting in bronchodilation.
Dosage and Administration
Adult: Inhalation via nebulizer, dosage individualized based on severity. Typically, 1-2 inhalations 3-4 times daily.
Pediatric: Use with caution; dosing based on age and weight, often similar to adult dosing. Consult specific pediatric guidelines.
Geriatric: Start at low end of dosing range due to increased sensitivity. Monitor respiratory status closely.
Renal Impairment: Use cautiously; no specific dose adjustment data available, monitor closely.
Hepatic Impairment: Use cautiously; no specific dose adjustment data available.
Pharmacokinetics
Absorption: Rapid absorption after inhalation.
Distribution: Widely distributed, crosses the placenta.
Metabolism: Converted to terbutaline, primarily metabolized in the liver.
Excretion: Excreted in urine mainly as metabolites.
Half Life: Approximately 3-4 hours for terbutaline.
Contraindications
- Hypersensitivity to beta-adrenergic agonists
- Tachyarrhythmias, especially with cardiac issues
Precautions
- Use with caution in patients with cardiovascular disorders, diabetes, hyperthyroidism, or seizure disorders.
- Monitor for paradoxical bronchospasm, which can be life-threatening.
Adverse Reactions - Common
- Tremor (Common)
- Nervousness (Common)
- Increased heart rate (tachycardia) (Common)
- Headache (Common)
Adverse Reactions - Serious
- Cardiac arrhythmias (Rare)
- Paradoxical bronchospasm (Rare)
Drug-Drug Interactions
- Other sympathetic drugs, MAO inhibitors, tricyclic antidepressants (may enhance effects)
Drug-Food Interactions
- Limited data—generally no significant food interactions
Drug-Herb Interactions
- Limited data—use caution with herbal sympathomimetics
Nursing Implications
Assessment: Monitor respiratory status, heart rate, blood pressure, and for adverse effects.
Diagnoses:
- Ineffective airway clearance
- Risk for tachycardia
Implementation: Administer using inhalation device as prescribed, educate patient on proper inhaler techniques.
Evaluation: Assess therapeutic response, monitor for adverse effects, and adjust dose accordingly.
Patient/Family Teaching
- Instruct on correct inhaler technique.
- Advise to monitor for side effects such as tremors, nervousness, or palpitations.
- Seek medical attention if paradoxical bronchospasm or severe side effects occur.
Special Considerations
Black Box Warnings:
- None specific to Bitolterol Mesylate, but caution with cardiac comorbidities.
Genetic Factors: No known genetic considerations affecting response.
Lab Test Interference: May cause false-positive results for urinary catecholamines or metanephrines.
Overdose Management
Signs/Symptoms: Severe tachycardia, hypertension, hypokalemia, and paradoxical bronchospasm.
Treatment: Discontinue drug, provide supportive care, administer beta-blockers cautiously if indicated, correct electrolyte imbalances.
Storage and Handling
Storage: Store in a dry place at room temperature, away from light and moisture.
Stability: Stable for recommended storage duration, check specific product insert.