Formulary
Terbutaline sulfate: Indications, Dosing, Side Effects and Interactions
Terbutaline sulfate clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 6 min read
Terbutaline sulfate: Indications, Dosing, Side Effects and Interactions
Terbutaline sulfate clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Asthma,Other conditions associated with reversible airways obstruction**
- **Adult** (By Mouth): Initially 2.5 mg 3 times a day for 1-2 weeks, then increased to up to 5 mg 3 times a day, use by inhalation preferred over by mouth.
- **Adult** (By Subcutaneous Injection, Or By Slow Intravenous Injection): 90-300 micrograms/hour for 8-10 hours, to be administered as a solution containing 3-5 micrograms/mL, high doses require close monitoring, reserve intravenous beta 2 agonists for those in whom inhaled therapy cannot be used reliably or there is no current effect.
- **Adult** (By Inhalation Of Powder): 500 micrograms up to 4 times a day, for persistent symptoms.
- **Adult** (By Inhalation Of Nebulised Solution): 5-10 mg 2-4 times a day, additional doses may be necessary in severe acute asthma.
**Acute asthma**
- **Child** (By Subcutaneous Injection, Or By Slow Intravenous Injection): Loading dose 2-4 micrograms/kg, then 1-10 micrograms/kg/hour, dose to be adjusted according to response and heart rate, close monitoring is required for doses above 10 micrograms/kg/hour, reserve intravenous beta 2 agonists for those in whom inhaled therapy cannot be used reliably or there is no current effect.
**Moderate, severe, or life-threatening acute asthma**
- **Child** (By Inhalation Of Nebulised Solution): 12-17 years 10 mg, repeat every 20-30 minutes or when required, give via oxygen-driven nebuliser if available.
- **Adult** (By Inhalation Of Nebulised Solution): 10 mg, repeat every 20-30 minutes or when required, give via oxygen-driven nebuliser if available.
**Exacerbation of reversible airways obstruction (including nocturnal asthma),Prevention of exercise-induced bronchospasm**
- **Child** (By Inhalation Of Powder): 5-17 years 500 micrograms up to 4 times a day, for occasional use only.
- **Child** (By Mouth): 15-17 years Initially 2.5 mg 3 times a day, then increased if necessary to 5 mg 3 times a day, administration by mouth is not recommended.
**Uncomplicated premature labour (between 22 and 37 weeks of gestation) (specialist supervision in hospital)**
- **Adult** (By Intravenous Infusion): Initially 5 micrograms/minute for 20 minutes, then increased in steps of 2.5 micrograms/minute every 20 minutes until contractions have ceased (more than 10 micrograms/minute should seldom be given-20 micrograms/minute should not be exceeded), continue for 1 hour, then reduced in steps of 2.5 micrograms/minute every 20 minutes to lowest dose that maintains suppression (maximum total duration 48 hours).
**Acute asthma for terbutaline sulfate**
- **Child 2-14 years** (By subcutaneous injection, or by slow intravenous injection): 10 micrograms/kg up to 4 times a day (max. per dose 300 micrograms), reserve intravenous beta2 agonists for those in whom inhaled therapy cannot be used reliably or there is no current effect.
- **Child 15-17 years** (By subcutaneous injection, or by slow intravenous injection): 250-500 micrograms up to 4 times a day, reserve intravenous beta2 agonists for those in whom inhaled therapy cannot be used reliably or there is no current effect.
- **Child** (By continuous intravenous infusion): Loading dose 2-4 micrograms/kg, then 1-10 micrograms/kg/hour, dose to be adjusted according to response and heart rate, close monitoring is required for doses above 10 micrograms/kg/hour, reserve intravenous beta2 agonists for those in whom inhaled therapy cannot be used reliably or there is no current effect.
**Moderate, severe, or life-threatening acute asthma for terbutaline sulfate**
- **Child 1 month-4 years** (By inhalation of nebulised solution): 5 mg, repeat every 20-30 minutes or when required, give via oxygen-driven nebuliser if available.
- **Child 5-11 years** (By inhalation of nebulised solution): 5-10 mg, repeat every 20-30 minutes or when required, give via oxygen-driven nebuliser if available.
- **Child 12-17 years** (By inhalation of nebulised solution): 10 mg, repeat every 20-30 minutes or when required, give via oxygen-driven nebuliser if available.
**Exacerbation of reversible airways obstruction (including nocturnal asthma), Prevention of exercise-induced bronchospasm for terbutaline sulfate**
- **Child 5-17 years** (By inhalation of powder): 500 micrograms up to 4 times a day, for occasional use only.
- **Child 1 month-6 years** (By mouth): 75 micrograms/kg 3 times a day (max. per dose 2.5 mg), administration by mouth is not recommended.
- **Child 7-14 years** (By mouth): 2.5 mg 2-3 times a day, administration by mouth is not recommended.
- **Child 15-17 years** (By mouth): Initially 2.5 mg 3 times a day, then increased if necessary to 5 mg 3 times a day, administration by mouth is not recommended.
Cautions
For all beta-2-adrenoceptor agonists, selective Arrhythmias; cardiovascular disease; diabetes (risk of hyperglycaemia and ketoacidosis, especially with intravenous use); hypertension; hyperthyroidism; hypokalaemia; susceptibility to QT-interval prolongation Cautions, further information Hypokalaemia Potentially serious hypokalaemia may result from beta 2 agonist therapy. Particular caution is required in severe asthma or COPD, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, diuretics, and by hypoxia. M Cautions For terbutaline sulfate Mild to moderate pre-eclampsia (when used for uncomplicated premature labour) (in adults); suspected cardiovascular disease (should be assessed by a cardiologist before initiating therapy for uncomplicated premature labour) (in adults)
Contraindications
When used for Uncomplicated premature labour Abruptio placenta (in adults); antepartum haemorrhage (in adults); cord compression (in adults); eclampsia (in adults); history of cardiac disease (in adults); intra-uterine fetal death (in adults); intra-uterine infection (in adults); placenta praevia (in adults); pulmonary hypertension (in adults); severe pre-eclampsia (in adults); significant risk factors for myocardial ischaemia (in adults); threatened miscarriage (in adults)
Side effects
For all beta-2-adrenoceptor agonists, selective Common or very common Arrhythmias; dizziness; headache; hyperglycaemia; palpitations; tremor Rare or very rare Bronchospasm paradoxical (sometimes severe) Side-effects For terbutaline sulfate General side-effects: Common or very common Hypokalaemia; hypotension; muscle spasms; nausea Rare or very rare Myocardial ischaemia; vasodilation Frequency not known Angioedema; anxiety; behaviour abnormal; bronchospasm; circulatory collapse; oral irritation; skin reactions; sleep disorder; throat irritation Specific side-effects: Uncommon With parenteral use Pulmonary oedema Rare or very rare With parenteral use Lactic acidosis Frequency not known When used by inhalation Lactic acidosis (with high doses) With parenteral use Akathisia; bleeding tendency
Interactions
**Other interactions (6):**
- Therefore, Bricanyl preparations and non-selective beta-blockers should not normally be administered concurrently.
- Corticosteroids Systemic corticosteroids are frequently given during premature labour to enhance foetal lung development.
- There have been reports of pulmonary oedema in women concomitantly administered with beta-agonists and corticosteroids.
- Corticosteroids are known to increase blood glucose and can deplete serum potassium, therefore concomitant administration should be undertaken with caution with continuous patient monitoring owing...
- Anti-diabetics The administration of beta-agonists is associated with a rise of blood glucose, which can be interpreted as an attenuation of anti-diabetic therapy; therefore individual anti-diabetic...
- Potassium depleting agents Owing to the hypokalaemic effect of beta-agonists, concurrent administration of serum potassium depleting agents known to exacerbate the risk of hypokalaemia, such as...
Pregnancy
For all beta-2-adrenoceptor agonists, selective Inhaled drugs for asthma can be taken as normal during pregnancy. Pregnancy For terbutaline sulfate Inhaled drugs for asthma can be taken as normal during pregnancy.
Breast feeding
Inhaled drugs for asthma can be taken as normal during breast-feeding.
Medicinal forms
Solution,Powder
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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