Drugs List

Therapeutic Indications

Uses

Acute asthma
Reversible airways obstruction

Contraindications

Hypertrophic cardiomyopathy

Precautions and Warnings

Family history of long QT syndrome
Hypersensitivity to milk protein (contaminant of lactose excipient)
Predisposition to hypokalaemia
Breastfeeding
Cardiac arrhythmias
Cardiovascular disorder
Diabetes mellitus
First trimester of pregnancy
History of torsade de pointes
Hypertension
Hyperthyroidism
Hypocalcaemia
Hypokalaemia
Hypomagnesaemia
Hypoxia
Ischaemic heart disease
Long QT syndrome
Pregnancy at term
Thyrotoxicosis

May decrease glucose tolerance in patients with diabetes mellitus
Some formulations contain lactose
Check patient is using correct inhaler technique
Monitor blood glucose closely in patients with diabetes mellitus
Monitor for development of lactic acidosis
Monitor serum K+ in patients on high dose steroids/xanthines/diuretics
Monitor serum potassium in hypoxic patients
Monitor serum potassium regularly in patients with severe asthma
Advise patient to report any chest pain
Advise patient to seek medical advice if asthma seems to be worsening
May reduce serum potassium levels
Discontinue if paradoxical bronchospasm occurs

Pregnancy and Lactation

Pregnancy

Use terbutaline with caution in first trimester of pregnancy.

Terbutaline is used as a tocolytic and as a bronchodilator in asthma and such use has been considered low risk. However, new data has suggested an association exists between continuous use (greater than or equal to two weeks of terbutaline by any route) and autism spectrum disorders. Short-term use, such as 48 to 72 hours to allow for corticosteroid use to improve foetal lung maturation, is probably safe, but there may be a subpopulation of mothers and foetuses at increased risk secondary to genetic predisposition. In addition, there is a report of an association between first trimester terbutaline exposure for asthma and cardiac defects. The risk magnitude for these toxicities requires confirmation. Because of these reports, avoiding beta2-adrenergics early in gestation, except for quick relief of asthmatic symptoms with low inhaled doses, and the continuous use in the second/third trimesters appears to be warranted.

No reports linking the use of terbutaline with congenital defects have been located. Reproductive studies in mice, rats and rabbits have revealed no evidence of impaired fertility or foetal harm.

Terbutaline rapidly crosses the placenta. Adverse effects in the foetus and newborn (tremors, tachycardia, hypoglycaemia, and hypokalaemia) have been reported, especially when high doses of beta 2-agonists are used. The effects are less common when used by inhalation, and they are reversible.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use terbutaline with caution in breastfeeding.

Terbutaline is secreted in breastmilk but is unlikely to affect the infant at therapeutic levels. With inhalation, the passage of terbutaline into breastmilk is less than with oral treatment. Excessive overdosing, however, could lead to restlessness and tachycardia in the infant.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Agitation
Angioedema
Atrial fibrillation
Behavioural disturbances
Bronchospasm (paradoxical)
Cardiac arrhythmias
Collapse
Extrasystoles
Fine tremor (usually hands)
Headache
Hypersensitivity reactions
Hypokalaemia
Hypotension
Lactic acidosis
Mouth irritation
Muscular cramps
Myocardial ischaemia
Nausea
Palpitations
Peripheral vasodilatation
Rash
Sleep disturbances
Supraventricular tachycardia
Tachycardia
Throat irritation
Urticaria
Wheezing

Presentation

Inhalation and nebulised formulations of terbutaline sulfate.

Drugs List

Therapeutic Indications

Uses

Acute asthma
Reversible airways obstruction

Dosage

Adults

Children

Contraindications

Hypertrophic cardiomyopathy

Precautions and Warnings

Family history of long QT syndrome
Hypersensitivity to milk protein (contaminant of lactose excipient)
Predisposition to hypokalaemia
Breastfeeding
Cardiac arrhythmias
Cardiovascular disorder
Diabetes mellitus
First trimester of pregnancy
History of torsade de pointes
Hypertension
Hyperthyroidism
Hypocalcaemia
Hypokalaemia
Hypomagnesaemia
Hypoxia
Ischaemic heart disease
Long QT syndrome
Pregnancy at term
Thyrotoxicosis

May decrease glucose tolerance in patients with diabetes mellitus
Some formulations contain lactose
Check patient is using correct inhaler technique
Monitor blood glucose closely in patients with diabetes mellitus
Monitor for development of lactic acidosis
Monitor serum K+ in patients on high dose steroids/xanthines/diuretics
Monitor serum potassium in hypoxic patients
Monitor serum potassium regularly in patients with severe asthma
Advise patient to report any chest pain
Advise patient to seek medical advice if asthma seems to be worsening
May reduce serum potassium levels
Discontinue if paradoxical bronchospasm occurs

Pregnancy and Lactation

Pregnancy

Use terbutaline with caution in first trimester of pregnancy.

Terbutaline is used as a tocolytic and as a bronchodilator in asthma and such use has been considered low risk. However, new data has suggested an association exists between continuous use (greater than or equal to two weeks of terbutaline by any route) and autism spectrum disorders. Short-term use, such as 48 to 72 hours to allow for corticosteroid use to improve foetal lung maturation, is probably safe, but there may be a subpopulation of mothers and foetuses at increased risk secondary to genetic predisposition. In addition, there is a report of an association between first trimester terbutaline exposure for asthma and cardiac defects. The risk magnitude for these toxicities requires confirmation. Because of these reports, avoiding beta2-adrenergics early in gestation, except for quick relief of asthmatic symptoms with low inhaled doses, and the continuous use in the second/third trimesters appears to be warranted.

No reports linking the use of terbutaline with congenital defects have been located. Reproductive studies in mice, rats and rabbits have revealed no evidence of impaired fertility or foetal harm.

Terbutaline rapidly crosses the placenta. Adverse effects in the foetus and newborn (tremors, tachycardia, hypoglycaemia, and hypokalaemia) have been reported, especially when high doses of beta 2-agonists are used. The effects are less common when used by inhalation, and they are reversible.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use terbutaline with caution in breastfeeding.

Terbutaline is secreted in breastmilk but is unlikely to affect the infant at therapeutic levels. With inhalation, the passage of terbutaline into breastmilk is less than with oral treatment. Excessive overdosing, however, could lead to restlessness and tachycardia in the infant.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Agitation
Angioedema
Atrial fibrillation
Behavioural disturbances
Bronchospasm (paradoxical)
Cardiac arrhythmias
Collapse
Extrasystoles
Fine tremor (usually hands)
Headache
Hypersensitivity reactions
Hypokalaemia
Hypotension
Lactic acidosis
Mouth irritation
Muscular cramps
Myocardial ischaemia
Nausea
Palpitations
Peripheral vasodilatation
Rash
Sleep disturbances
Supraventricular tachycardia
Tachycardia
Throat irritation
Urticaria
Wheezing

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: July 2015

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Summary of Product Characteristics: Bricanyl Turbohaler, 0.5mg/dose, inhalation powder. Astrazeneca UK Ltd. Revised September 2018.

Summary of Product Characteristics: Bricanyl Respules 2.5mg/ml Nebuliser Solution. Astrazeneca UK Ltd. Revised April 2017.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 31 August 2017

UK Drugs in Lactation Advisory Service.
Available at: https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Last accessed: 13 July 2015