Issues for surgery
Increased risk of exacerbation of asthma, bronchospasm and / or reversible airways obstruction if omitted.
Advice in the perioperative period
Elective and emergency surgery
Continue.
Post-operative advice
Restart post-operatively as soon as next dose is due.
For patients taking bambuterol tablets
Monitor renal function – dose reduction may be necessary if renal function is impaired post-operatively (consult current product literature).
If swallowing difficulties or unreliable oral absorption post-operatively consider inhaled administration of long-acting beta-2 adrenoceptor agonist, or rescue doses of short-acting beta-2 adrenoceptor agonist.
Interactions with common anaesthetic agents
Halogenated anaesthetics
Bambuterol may cause hypokalaemia. Concomitant use with medications that prolong the QT-interval (e.g. desflurane, isoflurane, sevoflurane and possibly thiopental) increases the risk of torsades de pointes. Monitor serum potassium and QT-interval with concomitant treatment.
Neuromuscular blocking drugs (NMBDs)
Bambuterol can prolong the recovery time from neuromuscular blockade with suxamethonium and mivacurium. The effect appears to be related to both the dose and the timing of bambuterol administration; the manufacturer suggests this interaction should be considered for other NMBDs metabolised by plasma cholinesterase. However, the interaction is thought to only be clinically significant in patients with abnormal plasma cholinesterase activity.
Interactions with other common medicines used in the perioperative period
Corticosteroids
Dexamethasone and hydrocortisone may cause hypokalaemia which would potentiate any bambuterol-mediated hypokalaemia. Hypokalaemia increases the risk of torsades de pointes with medications which prolong the QT-interval e.g. antiemetics (domperidone, droperidol, granisetron, haloperidol, ondansetron and possibly prochlorperazine), antimicrobials (ciprofloxacin, clarithromycin, erythromycin) and loperamide.
Further information
None relevant.
References
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://about.medicinescomplete.com [Accessed on 27th June 2021]
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://about.medicinescomplete.com [Accessed on 27th June 2021]
Summary of Product Characteristics – Bambec® (bambuterol) Tablets 10mg. AstraZeneca UK Limited. Accessed via www.medicines.org.uk 27/06/2021 [date of revision of the text January 2017]