Terbutaline parenteral
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Solution for injection or infusion containing terbutaline sulfate.
Drugs List
Therapeutic Indications
Uses
Bronchial asthma
Premature labour : prevention
Reversible airways obstruction
Dosage
Dosages should be individualised.
Adults
Treatment of severe forms of bronchospasm
Subcutaneous, intramuscular or slow intravenous injection
250 micrograms to 500 micrograms up to four times a day.
The subcutaneous and intramuscular routes are usually preferred.
Continuous intravenous infusion
Terbutaline sulfate may also be given as a solution containing 3 to 5 micrograms/ml by continuous intravenous infusion at a rate of 1.5 to 5 micrograms/minute for 8 to 10 hours.
Premature labour
The use of SABAs for tocolysis in premature labour is restricted to 48 hours maximum parenteral use under specialist supervision.
Administer as early as possible after the onset of premature labour, and after evaluation of the patient to exclude any contraindications to the use of terbutaline.
Initial dosage
5 micrograms/minute infused during the first 20 minutes. Increase by 2.5 micrograms/minute at 20 minute intervals until contractions cease. It is unlikely that more than 10 micrograms/minute will be required. 20 micrograms/minute must not be exceeded.
Discontinue treatment if labour progresses despite maximum dose of terbutaline sulfate.
If successful in halting labour continue infusion for 1 hour at the chosen rate then decrease by 2.5 micrograms/minute every 20 minutes until the lowest dose capable of suppressing contractions has been reached.
The infusion dose must be carefully titrated with reference to suppression of contractions, increase in pulse rate and changes in blood pressure. Avoid maternal heart rate of over 120 beats/minute.
Ensure maternal hydration level is carefully monitored to avoid pulmonary oedema. Keep volume of infusion fluid to a minimum. A controlled infusion device, preferably a syringe pump should be used.
Children
Treatment of severe forms of bronchospasm
Subcutaneous, intramuscular or slow intravenous injection
Children aged 15 to 18 years: 250 micrograms to 500 micrograms up to four times a day.
Children aged 2 to 15 years: 10 micrograms/kg body weight (maximum dose 300 micrograms total)
The subcutaneous and intramuscular routes are usually preferred.
The following alternative dosing schedule for continuous intravenous infusion may be suitable:
Children aged 2 to 18 years: Initially 2 to 4 micrograms/kg as a loading dose, then 1 to 10 micrograms/kg/hour according to response and heart rate (doses above 10 micrograms/kg/hour with close monitoring).
Children aged under 2 years (unlicensed): Initially 2 to 4 micrograms/kg as a loading dose, then 1 to 10 micrograms/kg/hour according to response and heart rate (doses above 10 micrograms/kg/hour with close monitoring).
Contraindications
Antepartum haemorrhage - if treating premature labour
Hypertrophic cardiomyopathy
Intra-uterine infection - if treating premature labour
Ischaemic heart disease - if treating premature labour
Placenta abruptio - if treating premature labour
Placenta praevia - if treating premature labour
Pre-eclampsia or eclampsia - if treating premature labour
Threatened abortion in first trimester
Threatened abortion in second trimester
Umbilical cord compression - if treating premature labour
Precautions and Warnings
Children under 2 years
Predisposition to hypokalaemia
Predisposition to long QT syndrome
Breastfeeding
Cardiac arrhythmias
Cardiac failure
Diabetes mellitus
First trimester of pregnancy
Hypertension
Hyperthyroidism
Hypoxia
Ischaemic heart disease
Lactic acidosis
Thyrotoxicosis
May decrease glucose tolerance in patients with diabetes mellitus
Premature labour: Treatment to be supervised by an obstetrics specialist
Premature labour: during infusion keep patient in lateral position
Monitor antidiabetic drug treatment
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
Neonate exposed in utero: Risk of hypoglycaemia in preterm neonate
Premature labour - monitor cardiorespiratory function
Advise patient to report any chest pain
Increased bleeding after Caesarean section may occur
May reduce serum potassium levels
Premature labour - maximum duration of treatment is 48 hours
Pregnancy and Lactation
Pregnancy
Administer terbutaline with caution in pregnant patients during the first trimester. 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 to the foetus.
With intravenous application there are some serious potential maternal side effects with terbutaline, however incidence is low. They include pulmonary oedema, myocardial ischaemia, cardiac arrhythmias, cerebral vasospasm, hypotension and miscellaneous metabolic alterations (hypokalaemia, increased serum lactate, and a decrease in measured haemoglobin concentration).
Transient maternal hyperglycaemia has been reported with terbutaline followed by an increase in serum insulin levels.
Transient hypoglycaemia has been reported in newborn preterm infants after maternal beta2- agonist treatment.
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
This medication should be used with caution during breastfeeding.
Terbutaline is secreted in breast milk but is unlikely to affect the infant at therapeutic levels. Although no toxic effects have been observed with the use of terbutaline, its use can 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
Hyperactivity
Hyperglycaemia
Hypersensitivity reactions
Hypokalaemia
Hypotension
Lactic acidosis
Maternal pulmonary oedema
Mouth irritation
Muscular cramps
Myocardial ischaemia
Nausea
Pain on intramuscular injection
Palpitations
Peripheral vasodilatation
Rash
Restlessness
Sleep disturbances
Supraventricular tachycardia
Tachycardia
Tendency to uterine bleeding
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: January 2014
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 Injection, 0.5 mg/ml, solution for injection or infusion. Astrazeneca UK Ltd. Revised April 2017.
MHRA Drug Safety Update November 2013
Available at: https://www.mhra.gov.uk
Last accessed: December 13, 2013
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 31 August 2017
UK Drugs in Lactation Advisory Service.
Available at: https://www.ukmicentral.nhs.uk/drugpreg/guide.htm
Last accessed: January 22, 2013
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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