Terbutaline

Indications
 Oral
Acute bronchospasm
Adult: Initially, 2.5 or 3 mg tid increased to 5 mg tid if necessary; as modified-release tablet: 7.5 mg bid.
Child: 75 mcg/kg tid; usual dose for >7 yr: 2.5 mg bid-tid.
Inhalation
Acute bronchospasm
Adult: As metered dose inhaler: 250 mcg or 500 mcg every 4-6 hrs. Max: 2000 mcg/24hr. As nebuliser: 5-10 mg inhaled 2-4 times or 1-2mg/hr given as a 0.01% nebuliser solution in sodium chloride 0.9%.
Child: As metered dose inhaler: 250 mcg or 500 mcg every 4-6 hrs. Max: 2000 mcg/24hr. As nebuliser: 2-5 mg inhaled 2-4 times.
Parenteral
Severe bronchospasm
Adult: 250-500 mcg SC, IM or slow IV Inj up to 4 times daily, or by IV infusion 3-5 mcg/ml run at a infusion rate of 0.5-1 mL/min.
Child: >2 yrs: 10 mcg/kg by SC, IM or slow IV injection. Max total dose: 300mcg.
Intravenous
Uncomplicated premature labour
Adult: 5 mcg/min for 20 min, increased every 20 min in steps of 2.5 mcg/min until contractions have ceased (usually 10 mcg/min sufficient), continue for 1 hr then decrease every 20 min in steps of 2.5 mcg/min to lowest dose that maintains suppression, continue at this level for 12 hrs. Max: 20mcg/min. Switch to oral at 2.5-10mg every 4-6hr if indicated and tolerated. Continue as long as needed to prolong pregnancy.
Contraindications
 Hypersensitivity to sympathomimetics. Any condition of mother or foetus in which prolongation of pregnancy is dangerous.
Warnings / Precautions
 Arrhythmias, hyperthyroidism, hypertension, diabetes, myocardial insufficiency, history of seizures, heart disease.
Adverse Reactions
 Fine skeletal muscle tremor esp hands, dizziness, anxiety, flushes, sweating, nausea, vomiting, lethargy, tinnitus, tachycardia, palpitations, muscle cramps, headache, paradoxical bronchospasm. IV: Transient hyperglycemia, transient hypokaelemia.
Potentially Fatal: (IV): MI, pulmonary oedema, ketoacidosis.
Overdose Reactions
 Headache, anxiety, tremor, nausea, palpitations, hypotension, tachycardia and arrhythmia, hypokaelaemia, hyperglycaemia and lactic acidosis. Supportive and symptomatic treatment; use β-blockers (eg. metoprolol) cautiously for treatment of arrhythmias; IV loop diuretic for treatment of pulmonary oedema; IV propranolol 1 -2mg, if increased tendency to uterine bleed during Caesarean section.
Drug Interactions
 Antagonised effects of β-blockers. Increased risk of hypokaelemia with xanthine derivatives, corticosteriods and diuretics; increased risk of arrhythmias with inhaled anaesthetics, sympathomimetics.
See Below for More terbutaline Drug Interactions
Mechanism of Actions
 Terbutaline is a direct-acting sympathomimetic which relaxes bronchial smooth muscle by selective action on β2 receptors. It also decreases uterine contractility.
Onset: Inhalation: 5 min; Oral: 30 min.
Duration: Inhalation: 3-4 hr; Oral: 8 hr.
Absorption: Absorbed from the GI tract.
Distribution: Some amounts cross the placenta and appear in breast milk. Half-life: 3 to 4 hr.
Metabolism: 60% of absorbed dose undergoes first-pass metabolism by sulphate conjugation in the liver and gut wall.
Excretion: Via the urine partly as inactive conjugates and partly as unchanged drug.
Administration
 May be taken with or without food.
ATC Classification
 R03AC03 - terbutaline ; Belongs to the class of adrenergic inhalants, selective beta-2-adrenoreceptor agonists. Used in the treatment of obstructive airway diseases.
R03CC03 - terbutaline ; Belongs to the class of adrenergics for systemic use, selective beta-2-adrenoreceptor agonists. Used in the treatment of obstructive airway diseases.
Available As
  • Terbutaline Sulphate 0.05 mg
  • Terbutaline Sulphate 0.5 mg
  • Terbutaline 0.5 mg
  • Terbutaline 0.75 mg
  • Terbutaline Sulphate 0.75 mg
  • Terbutaline 1 mg
  • Terbutaline Sulphate 1.2 mg
  • Terbutaline 1.2 mg
  • Terbutaline Sulphate 1.25 mg
  • Terbutaline 1.25 mg
  • Terbutaline Sulphate 1.5 mg
  • Terbutaline 1.5 mg
  • Terbutaline Sulphate 10 mg
  • Terbutaline 12.5 mg
  • Terbutaline Sulphate 12.5 mg
  • Terbutaline Sulphate 125 mg
  • Terbutaline 125 mg
  • Terbutaline Sulphate 2 mg
  • Terbutaline 2 mg
  • Terbutaline 2.5 mg
  • Terbutaline Sulphate 2.5 mg
  • Terbutaline Sulphate 25 mg
  • Terbutaline 250 mcg
  • Terbutaline Sulphate 250 mcg
  • Terbutaline Sulphate 3 mg
  • Terbutaline 4 mg
  • Terbutaline Sulphate 5 mg
  • Terbutaline 5 mg
  • Terbutaline Sulphate 7.5 mg

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