No

Beta₂ Agonist

Bronchodilator in reversible airway obstruction and bronchial asthma

B

Hypersensitivity to terbutaline or any component, cardiac arrhythmias associated with tachycardia, tachycardia caused by digitalis intoxication

Excessive or prolonged use may lead to tolerance; paradoxical bronchoconstriction may occur with excessive use; if it occurs, discontinue terbutaline immediately

>10%:

Central nervous system: Nervousness, restlessness

Neuromuscular & skeletal: Trembling

1% to 10%:

Cardiovascular: Tachycardia, hypertension

Central nervous system: Dizziness, drowsiness, headache, insomnia

Gastrointestinal: Xerostomia, nausea, vomiting, bad taste in mouth

Neuromuscular & skeletal: Muscle cramps, weakness

Miscellaneous: Diaphoresis

<1%: Chest pain, arrhythmias, paradoxical bronchospasm

Symptoms of overdose include seizures, nausea, vomiting, tachycardia, cardiac dysrhythmias, hypokalemia

In cases of overdose, supportive therapy should be instituted; prudent use of a cardioselective beta-adrenergic blocker (eg, atenolol or metoprolol) should be considered, keeping in mind the potential for induction of bronchoconstriction in an asthmatic individual. Dialysis has not been shown to be of value in the treatment of an overdose with this agent.

Decreased effect with beta-blockers

Increased toxicity with MAO inhibitors, TCAs

Store injection at room temperature; protect from heat, light, and from freezing; use only clear solutions

Relaxes bronchial smooth muscle by action on beta₂-receptors with less effect on heart rate

Onset of action: Oral: 30-45 minutes; S.C.: Within 6-15 minutes

Protein binding: 25%

Metabolism: In the liver to inactive sulfate conjugates

Bioavailability: S.C. doses are more bioavailable than oral

Half-life: 11-16 hours

Elimination: In urine

Children <12 years:

Oral: Initial: 0.05 mg/kg/dose 3 times/day, increased gradually as required; maximum: 0.15 mg/kg/dose 3-4 times/day or a total of 5 mg/24 hours

S.C.: 0.005-0.01 mg/kg/dose to a maximum of 0.3 mg/dose every 15-20 minutes for 3 doses

Nebulization: 0.01-0.03 mg/kg/dose every 4-6 hours

Inhalation: 1-2 inhalations every 4-6 hours

Children >12 years and Adults:

Oral:

12-15 years: 2.5 mg every 6 hours 3 times/day; not to exceed 7.5 mg in 24 hours

>15 years: 5 mg/dose every 6 hours 3 times/day; if side effects occur, reduce dose to 2.5 mg every 6 hours; not to exceed 15 mg in 24 hours

S.C.: 0.25 mg/dose repeated in 15-30 minutes for one time only; a total dose of 0.5 mg should not be exceeded within a 4-hour period

Nebulization: 0.01-0.03 mg/kg/dose every 4-6 hours

Inhalation: 2 inhalations every 4-6 hours; wait 1 minute between inhalations

Dosing adjustment/comments in renal impairment:

Cl_cr 10-50 mL/minute: Administer at 50% of normal dose

Cl_cr <10 mL/minute: Avoid use

Serum potassium, heart rate, blood pressure, respiratory rate

Restlessness and nervousness are common; may cause dizziness, drowsiness, or insomnia

Concurrent use with TCAs or MAOIs may increase toxicity

No information available to require special precautions

No effects or complications reported

Use exactly as directed (see Administration below). Do not use more often than recommended (excessive use may result in tolerance, overdose may result in serious adverse effects) and do not discontinue without consulting prescriber. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). You may experience nervousness, dizziness, or fatigue (use caution when driving or engaging in tasks requiring alertness until response to drug is known); or dry mouth, stomach upset (frequent small meals, frequent mouth care, chewing gum, or sucking hard candy may help). Report unresolved GI upset; dizziness or fatigue; vision changes; chest pain, rapid heartbeat, or palpitations; insomnia, nervousness, or hyperactivity; muscle cramping, tremors, or pain; unusual cough; or rash (hypersensitivity).

Administration: Self-administered inhalation: Store canister upside down; do not freeze. Shake canister before using. Sit when using medication. Close eyes when administering terbutaline to avoid spray getting into eyes. Exhale slowly and completely through nose; inhale deeply through mouth while administering aerosol. Hold breath for 1-3 seconds after inhalation. Wait at least 1 full minute between inhalations. Wash mouthpiece between use. If more than one inhalation medication is used, use bronchodilator first and wait 5 minutes between medications.

Parenteral form is only for S.C. use. Before using, the inhaler must be shaken well; assess lung sounds, pulse, and blood pressure before administration and during peak of medication; observe patient for wheezing after administration, if this occurs, call physician

Aerosol, oral, as sulfate: 0.2 mg/actuation (10.5 g)

Injection, as sulfate: 1 mg/mL (1 mL)

Tablet, as sulfate: 2.5 mg, 5 mg

A 1 mg/mL suspension made from terbutaline tablets in simple syrup NF is stable 30 days when refrigerated

Bohn D, Kalloghlian A, Jenkins J, et al, "Intravenous Salbutamol in the Treatment of Status Asthmaticus in Children," Crit Care Med, 1984, 12(10):892-6.

Canny GJ and Levison H, "Aerosols - Therapeutic Use and Delivery in Childhood Asthma," Ann Allergy, 1988, 60(1):11-9.

Expert Panel Report 2, "Guidelines for the Diagnosis and Management of Asthma," Clinical Practice Guidelines, National Institutes of Health, National Heart, Lung, and Blood Institute, NIH Publication No. 94-4051, April, 1997.

Fuglsang G, Pedersen S, and Borgstrom L, "Dose-Response Relationships of I.V. Administered Terbutaline in Children With Asthma," J Pediatr, 1989, 114(2):315-20.

Goldenhersh N and Rachelefsky GS, "Childhood Asthma: Management," Pediatr Rev, 1989, 10(9):259-67.

Kelly HW, McWilliams BC, Katz R, et al, "Safety of Frequent High Dose Nebulized Terbutaline in Children With Acute Severe Asthma," Ann Allergy, 1990, 64(2 Pt 2):229-33.

Lee DC, "Terbutaline Sulfate Overdose," Ann Emerg Med, 1995, 26(1):107-8.

Rachelefsky GS and Siegel SC, "Asthma in Infants and Children - Treatment of Childhood Asthma: Part II," J Allergy Clin Immunol, 1985, 76(3):409-25.

Tipton WR and Nelson HS, "Frequent Parenteral Terbutaline in the Treatment of Status Asthmaticus in Children," Ann Allergy, 1987, 58(4):252-6.

Zehner WJ Jr, Scott JM, Iannolo PM, et al, "Terbutaline vs Albuterol for Out-of-Hospital Respiratory Distress: Randomized Double-Blind Trial," Acad Emerg Med, 1995, 2(8):686-91.