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MagazineOctober 1998 (Vol. 9 Issue 7)Bricanyl

Who reads drug warnings? Not doctors, it seems

Who reads drug warnings? Not doctors, it seems. Doctors and obstetricians in particular have been giving pregnant women injections of Bricanyl (terbutaline sulphate) to help them go to full term. Along the way, at least one woman has died, and many others have suffered complications such as chest pains, tachycardia (rapid heart rate), dyspnea (breathlessness) and pulmonary oedema (water on the lungs).

So serious has the problem become that, in the United States, the Food and Drug Administration (FDA) has issued a warning, telling physicians to stop prescribing the drug for preterm labour.

As the drug is solely intended for treating asthma, the warning sounds reasonable. Apparently manufacturer Hoechst Marion Roussel has made this clear in information sheets in the American Physicians' Desk Reference. But doctors who wish to continue this dangerous practice need look no further than the UK's Compendium of Data Sheets, where the drug is still recommended for the management of premature labour.

Nonetheless, for US doctors, the practice represents a serious misuse of a drug, and one that is indefensible. Read the small print? These doctors are missing the capital letters!

Bricanyl is a beta agonist drug, designed to relieve acute and chronic obstructive lung disease and to improve lung flow rates. Within five minutes, a 0.25 mg dose has been shown to produce a measurable improvement in flow rates.

But even when it is prescribed appropriately, Bricanyl still offers a range of side effects for the unsuspecting patient. The most frequent, and typical for a drug in its class, are tremour and nervousness; these are particularly common in doses above the normal 0.25 mg. Other reported reactions include: increased heart rate, palpitations and dizziness, headache, drowsiness, vomiting, nausea, sweating and muscle cramps.

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