Home Drug Guide Bitolterol Mesylate

Drug Guide

Generic Name

Bitolterol Mesylate

Brand Names Tornalate

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.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.