Terbutaline

Aka: Terbutaline, Brethine, Bricanyl

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II. Indications

  1. Preterm Labor
  2. Asthma

III. Contraindications

  1. Antepartum Hemorrhage
  2. Cardiovascular disease
  3. Hyperthyroidism
  4. Uncontrolled Diabetes Mellitus

IV. Mechanism

  1. Ethanolamine derivative with selective beta-2 adrenergic activity (bronchodilation, Tocolysis)
  2. Triggers intracellular adenyl cyclase activation with secondary increase in cAMP
    1. Bronchial Smooth Muscle relaxation
    2. Vascular Smooth Muscle relaxation
    3. Reduces Calcium movement across cell membranes resulting in Smooth Muscle relaxation
    4. Triggers glycogenolysis and Gluconeogenesis

V. 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 and not recommended)
    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

VI. Dosing: Asthma

  1. Status Asthmaticus
    1. Terbutaline may be used as an alternative to the preferred Epinephrine
    2. Adult
      1. Dose: 0.25 mg SQ lateral deltoid now (may repeat up to once within 15 to 30 min)
      2. Maximum: 0.5 mg per 4 hours
    3. Child (off-label)
      1. Dose: 0.01 mg/kg (up to 0.25 mg) SC every 20 min for up to 3 doses
      2. May be repeated up to every 2-6 hours as needed
  2. Asthma rescue Inhaler
    1. Terbutaline was previously available in U.S. as BrethaireInhaler
    2. Had been used as a Short-acting Beta Agonist rescue Inhaler similar to Albuterol

VII. Efficacy

  1. Effective at temporarily stopping contractions
    1. Results in shortest hospital triage stays
    2. Guinn (1997) Am J Obstet Gynecol 177:814-87 [PubMed]
  2. Oral Terbutaline is not effective in Preterm Labor
    1. Lewis (1996) Am J Obstet Gynecol 175:834-7 [PubMed]

VIII. Adverse Effects

  1. Maternal Tachycardia
  2. Fetal Tachycardia
  3. Tremor
  4. Palpitations
  5. Anxiety
  6. Shortness of Breath
  7. Pulmonary Edema
  8. Hypotension
  9. Hyperglycemia

IX. 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

X. Resources

  1. Terbutaline (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=613df3cb-4d55-4d12-ab08-a932481aaa0b

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Cost: Medications

terbutaline (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
TERBUTALINE SULFATE 2.5 MG TAB Generic $1.78 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

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