Terbutaline

Aka: Terbutaline, Brethine, Bricanyl

1. See Also
   1. Preterm Labor Management
   2. Tocolytic
2. Indications
   1. Preterm Labor
   2. Asthma
3. Contraindications
   1. Antepartum Hemorrhage
   2. Cardiovascular disease
   3. Hyperthyroidism
   4. Uncontrolled Diabetes Mellitus
4. Dosing: Preterm Labor
   1. Subcutaneous
      1. Dose: 0.25 mg SQ every 1-4 hours for 24 hours
      2. Maximum: 5 mg in 24 hours
   2. Intravenous
      1. Start: 10 mcg/minute
      2. Increase rate by 5 mcg per minute every 10 minutes
      3. Maximum: 25 mcg per minute
      4. Once controlled, decrease dose 5 mcg every 30 minutes
      5. Titrate dose down to lowest effective dose
   3. Oral (not effective)
      1. Dose: 2.5 to 7.5 mg PO every 1.5 to 4 hours
      2. Hold for maternal pulse >100 beats per minute
   4. Subcutaneous Pump
      1. Basal rate: 0.05 to 0.10 mg/hour
      2. Boluses: 0.25 mg
5. Efficacy
   1. Effective at temporarily stopping contractions
      1. Results in shortest hospital triage stays
      2. Guinn (1997) Am J Obstet Gynecol 177:814-87
   2. Oral Terbutaline is not effective in Preterm Labor
      1. Lewis (1996) Am J Obstet Gynecol 175:834-7
6. Adverse Effects
   1. Maternal Tachycardia
   2. Fetal Tachycardia
   3. Tremor
   4. Palpitations
   5. Anxiety
   6. Shortness of Breath
   7. Pulmonary edema
7. Monitoring
   1. Baseline testing to consider
      1. Electrocardiogram
      2. Serum Glucose
      3. Serum Potassium
      4. Complete Blood Count
      5. Type and screen
   2. Close monitoring
      1. Blood Pressure for Hypertension
      2. Pulse for maternal Tachycardia over 100
      3. Lung Exam for signs of pulmonary edema
      4. Follow Serum Glucose and Serum Potassium
      5. Consider fluid restriction <2400 cc per day