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Terbutaline: Pediatric drug information

Terbutaline: Pediatric drug information
(For additional information see "Terbutaline: Drug information" and see "Terbutaline: Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
ALERT: US Boxed Warning
Prolonged tocolysis:

Terbutaline has not been approved and should not be used for prolonged tocolysis (beyond 48 to 72 hours). In particular, terbutaline should not be used for maintenance tocolysis in the outpatient or home setting. Serious adverse reactions, including death, have been reported after administration of terbutaline to pregnant women. In the mother, these adverse reactions include increased heart rate, transient hyperglycemia, hypokalemia, cardiac arrhythmias, pulmonary edema, and myocardial ischemia. Increased fetal heart rate and neonatal hypoglycemia may occur as a result of maternal administration.

Brand Names: Canada
  • Bricanyl Turbuhaler
Therapeutic Category
  • Adrenergic Agonist Agent;
  • Antiasthmatic;
  • Beta2-Adrenergic Agonist;
  • Bronchodilator;
  • Sympathomimetic;
  • Tocolytic Agent
Dosing: Pediatric
Asthma, acute exacerbation

Asthma, acute exacerbation:

Continuous infusion: Limited data available, optimal dose not defined, efficacy results variable: Children and Adolescents: Initial: IV bolus dose: 4 to 10 mcg/kg followed by continuous infusion of 0.2 to 0.4 mcg/kg/minute, titrate by 0.1 to 0.2 mcg/kg/minute increments as frequently as every 30 minutes based on patient response or toxicity. Usual maximum dose is 5 mcg/kg/minute; however, doses as high as 10 mcg/kg/minute have been described; monitor closely for adverse reactions (Ref).

Oral:

Children ≥12 and Adolescents <15 years: 2.5 mg three times daily; maximum daily dose: 7.5 mg/24 hours

Adolescents ≥15 years: 5 mg three times daily (approximately every 6 hours); reduce dose to 2.5 mg three times daily if side effects occur; maximum daily dose: 15 mg/24 hours

SubQ:

Children: Limited data available: SubQ: 0.01 mg/kg/dose every 20 minutes for 3 doses; may repeat every 2 to 6 hours as needed (Ref)

Adolescents: SubQ: 0.25 mg/dose; may repeat every 20 minutes for up to 3 doses (Ref)

Oral inhalation: Canadian labeling: Bricanyl Turbuhaler [Canadian product]: Children ≥6 years and Adolescents: 1 inhalation (0.5 mg) as needed; if not effective after 5 minutes may repeat dose. If second dose is not effective, consult health care provider immediately. Maximum daily dose: 6 inhalations/24 hours.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Adult

(For additional information see "Terbutaline: Drug information")

Asthma, refractory or severe exacerbation

Asthma, refractory or severe exacerbation (alternative agent):

Note: Rarely used and based on limited data; may use in patients whose symptoms are refractory to standard therapy and who are in impending respiratory arrest. May also consider in patients with severe exacerbations who are unable to use inhaled bronchodilators (Ref). Do not use in combination with parenteral epinephrine (Ref).

SUBQ: Initial: 0.25 mg once; if severe symptoms persist after initial dose, may repeat every 20 minutes for a total of 3 doses (Ref).

Asthma, intermittent symptom relief

Asthma, intermittent symptom relief (alternative agent):

Note: An alternative short-acting inhaled beta agonist or rapid-onset long-acting beta agonist/inhaled steroid combination is preferred. Use on an as-needed basis (reliever therapy) rather than regularly scheduled (Ref).

Dry powder inhaler (0.5 mg/actuation) (Canadian product): Oral inhalation: One inhalation with spacer every 4 hours as needed; if dose is not effective after 5 minutes, may repeat. If second dose is not effective, consult health care provider immediately (maximum dose: 6 inhalations/day). Note: If adequate relief is not obtained with previously effective dose or duration of effect is <3 hours, patient should be reassessed promptly; may indicate worsening asthma (Ref).

Oral: 5 mg 3 times daily (~6-hour intervals); if side effects occur, reduce dose to 2.5 mg 3 times daily; maximum daily dose: 15 mg/day. Note: Clinical practice guidelines do not recommend oral short-acting beta-agonists or nonselective beta-agonists (including oral terbutaline) for routine management and treatment of asthma due to slower onset of action and higher risk of adverse effects (Ref).

Extravasation management, sympathomimetic vasoconstrictors

Extravasation management, sympathomimetic vasoconstrictors (off-label use):

Large extravasations: SUBQ: Infiltrate affected extravasation area with terbutaline 1 mg using a solution of terbutaline 1 mg diluted in 10 mL NS (administration volume varied from 3 to 10 mL); may repeat dose after 15 minutes (Ref).

Small/distal extravasations: SUBQ: Infiltrate affected extravasation area with terbutaline 0.5 mg using a solution of terbutaline 1 mg diluted in 1 mL NS; may repeat dose after 15 minutes (Ref).

Tocolysis

Tocolysis (off-label use):

Note: Only for acute, short-term use (≤72 hours).

IV: 2.5 to 5 mcg/minute; increase gradually every 20 to 30 minutes by 2.5 to 5 mcg/minute up to a maximum of 25 mcg/minute; decrease to the lowest effective dose once contractions are controlled (Ref).

SUBQ: 0.25 mg every 20 minutes to 3 hours; hold for pulse >120 beats per minute. Terbutaline has not been approved for and should not be used for prolonged tocolysis (beyond 48 to 72 hours) (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%:

Central nervous system: Nervousness, restlessness

Endocrine & metabolic: Decreased serum potassium, increased serum glucose

Neuromuscular & skeletal: Tremor

1% to 10%:

Cardiovascular: Hypertension, tachycardia

Central nervous system: Dizziness, drowsiness, headache, insomnia

Dermatologic: Diaphoresis

Gastrointestinal: Dysgeusia, nausea, vomiting, xerostomia

Neuromuscular & skeletal: Muscle cramps, weakness

<1%, postmarketing, and/or case reports: Cardiac arrhythmia, chest pain, hyperglycemia (preterm labor), hypokalemia (preterm labor), hypotension (preterm labor), ischemic heart disease (preterm labor), lactic acidosis (Smith 2019), myocardial infarction (preterm labor), paradoxical bronchospasm, pulmonary edema (preterm labor)

Contraindications

Hypersensitivity to terbutaline, sympathomimetic amines, or any component of the formulation.

Injection: Additional contraindications: Prolonged tocolysis (>48 to 72 hours), especially for maintenance in the outpatient setting.

Oral: Additional contraindications: Acute or maintenance tocolysis.

Canadian labeling: Additional contraindications (not in the US labeling): Hypersensitivity to lactose; history of tachyarrhythmias; as tocolytic in patients at risk of premature labor or threatened abortion.

Warnings/Precautions

Concerns related to adverse effects:

• Bronchospasm: Paradoxical bronchospasm that may be life-threatening may rarely occur with use of inhaled bronchodilating agents; this reaction should be distinguished from inadequate response. Discontinue immediately if paradoxical bronchospasm occurs and institute alternative therapy.

• Hypersensitivity reactions: Immediate hypersensitivity reactions (urticaria, angioedema, rash, bronchospasm) have been reported.

• Serious effects/fatalities: Do not exceed recommended dose or frequency; serious adverse events, including fatalities, have been associated with excessive use of inhaled sympathomimetics.

Disease-related concerns:

• Asthma: Appropriate use: When used as a bronchodilator, optimize anti-inflammatory treatment before initiating maintenance treatment with terbutaline. Do not use as a component of chronic therapy without an anti-inflammatory agent.

• Cardiovascular disease: Use with caution in patients with cardiovascular disease (arrhythmia, coronary insufficiency, hypertension, heart failure); beta-agonists may cause elevation in blood pressure, heart rate and result in CNS stimulation/excitation. Beta2-agonists have been reported to produce ECG changes, such as flattening of the T wave, prolongation of the QTc interval, and ST segment depression.

• Diabetes: Use with caution in patients with diabetes mellitus; beta2-agonists may increase serum glucose and aggravate preexisting diabetes and ketoacidosis.

• Glaucoma: Use with caution in patients with glaucoma; may elevate intraocular pressure.

• Hyperthyroidism: Use with caution in hyperthyroidism; may stimulate thyroid activity.

• Hypokalemia: Use with caution in patients with hypokalemia; beta2-agonists may transiently decrease serum potassium.

• Seizures: Use with caution in patients with seizure disorders; beta-agonists may result in CNS stimulation/excitation.

Dosage form specific issues:

• Lactose; Bricanyl Turbuhaler [Canadian product]: Dry powder inhalers may contain lactose; hypersensitivity reactions have been reported in patients with milk protein allergy.

Other warnings/precautions:

• Patient information: Patients must be instructed to seek medical attention in cases where acute symptoms are not relieved or a previous level of response is diminished. The need to increase frequency of use may indicate deterioration of asthma, and treatment must not be delayed.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Injection, as sulfate:

Generic: 1 mg/mL (1 mL)

Solution, Injection, as sulfate [preservative free]:

Generic: 1 mg/mL (1 mL [DSC])

Tablet, Oral, as sulfate:

Generic: 2.5 mg, 5 mg

Generic Equivalent Available: US

Yes

Pricing: US

Solution (Terbutaline Sulfate Injection)

1 mg/mL (per mL): $1.56 - $23.64

Tablets (Terbutaline Sulfate Oral)

2.5 mg (per each): $5.44 - $13.73

5 mg (per each): $6.65 - $16.77

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Aerosol Powder Breath Activated, Inhalation:

Bricanyl Turbuhaler: 0.5 mg/actuation (1 ea)

Extemporaneous Preparations

A 1 mg/mL oral suspension may be made with tablets. Crush twenty-four 5 mg tablets in a mortar and reduce to a fine powder. Add 5 mL purified water USP and mix to a uniform paste; mix while adding simple syrup, NF in incremental proportions to almost 120 mL; transfer to a calibrated bottle, rinse mortar with vehicle, and add quantity of simple syrup, NF sufficient to make 120 mL. Label "shake well" and "refrigerate". Stable for 30 days.

Nahata MC, Pai VB, and Hipple TF, Pediatric Drug Formulations, 5th ed, Cincinnati, OH: Harvey Whitney Books Co, 2004.
Administration: Pediatric

Oral: May administer without regard to food; administer around-the-clock to promote less variation in peak and trough serum levels.

Parenteral:

Direct IV injection: Administer undiluted over 5 to 10 minutes

Continuous IV infusion: Administer via an infusion pump at a concentration ≤1 mg/mL (Ref).

Inhalation: Bricanyl Turbuhaler [Canadian product]: To prepare inhaler prior to use, load dose by holding inhaler in upright position and turn blue grip as far as it will go in one direction and then turn it as far as it will go in the other direction. Prior to first use, this procedure should be done twice; with subsequent dosing, perform this procedure once. Clicking sound means inhaler is loaded with dose and ready for use. Place mouthpiece between teeth and close lips over mouthpiece. Inhale deeply and forcefully. Do not exhale through inhaler. If the Turbuhaler is dropped, shaken, or breathed into after it is loaded, the dose will be lost and a new dose will need to be loaded. When a red mark appears in the dose indicator window, 20 doses are left. When the red mark reaches the bottom of the window, the inhaler should be discarded.

Administration: Adult

Oral inhalation: Dry powder inhaler: Bricanyl Turbuhaler [Canadian product]: When ready to use, remove lid and hold inhaler upright. Turn blue grip as far as it will go in one direction, then turn blue grip in the opposite direction until you hear a click; repeat this step a second time and then inhaler is ready to use. Exhale fully (not into inhaler) and place lips around mouthpiece and inhale deeply; remove inhaler from mouth prior to exhaling. Rinse mouth with water after use (do not swallow). If inhaler is dropped or shaken, or if patient exhales into the inhaler after a dose is loaded, the dose will be lost and a new dose should be loaded and inhaled. Clean mouthpiece once weekly with a dry tissue; do not use water or any other fluid to clean and keep inhaler dry. First appearance of red mark in dose indicator indicates that 10 doses remain; discard inhaler when the dose indicator reaches "0".

SUBQ: Administer injections into the lateral deltoid area.

Extravasation management, sympathomimetic vasopressors (off-label use): Stop vesicant infusion immediately and disconnect IV line (leave needle/cannula in place); gently aspirate extravasated solution from the IV line (do NOT flush the line); remove needle/cannula; elevate extremity (Ref).

Large extravasations: SUBQ: Infiltrate affected extravasation area with terbutaline 1 mg using a solution of terbutaline 1 mg diluted in 10 mL NS (administration volume varied from 3 to 10 mL); may repeat dose after 15 minutes (Ref).

Small/distal extravasations: SUBQ: Infiltrate affected extravasation area with terbutaline 0.5 mg using a solution of terbutaline 1 mg diluted in 1 mL NS; may repeat dose after 15 minutes (Ref).

Storage/Stability

Injection: Store vial at 20°C to 25°C (68°F to 77°F); protect from light by storing in original carton until use.

Dry powder inhaler (Bricanyl Turbuhaler [Canadian availability]): Store at 15°C to 30°C (59°F to 86°F).

Use

Bronchodilator for relief of reversible bronchospasm in patients with asthma, bronchitis, and emphysema (Tablets, Injection: FDA approved in ages ≥12 years and adults)

Medication Safety Issues
Sound-alike/look-alike issues:

Brethine may be confused with Methergine

Terbutaline may be confused with terbinafine, TOLBUTamide

Terbutaline and methylergonovine parenteral dosage forms look similar. Due to their contrasting indications, use care when administering these agents.

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Amisulpride (Oral): May enhance the QTc-prolonging effect of QT-prolonging Agents (Moderate Risk). Risk C: Monitor therapy

Antidiabetic Agents: Hyperglycemia-Associated Agents may diminish the therapeutic effect of Antidiabetic Agents. Risk C: Monitor therapy

Atomoxetine: May enhance the tachycardic effect of Beta2-Agonists. Risk C: Monitor therapy

Atomoxetine: May enhance the hypertensive effect of Sympathomimetics. Atomoxetine may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Atosiban: Beta2-Agonists may enhance the adverse/toxic effect of Atosiban. Specifically, there may be an increased risk for pulmonary edema and/or dyspnea. Risk C: Monitor therapy

Azithromycin (Systemic): QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of Azithromycin (Systemic). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Beta-Blockers (Beta1 Selective): May diminish the bronchodilatory effect of Beta2-Agonists. Of particular concern with nonselective beta-blockers or higher doses of the beta1 selective beta-blockers. Risk C: Monitor therapy

Beta-Blockers (Nonselective): May diminish the bronchodilatory effect of Beta2-Agonists. Risk X: Avoid combination

Cannabinoid-Containing Products: May enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Carbetocin: QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of Carbetocin. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Chloroquine: QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of Chloroquine. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Clofazimine: QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of Clofazimine. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Cocaine (Topical): May enhance the hypertensive effect of Sympathomimetics. Management: Consider alternatives to use of this combination when possible. Monitor closely for substantially increased blood pressure or heart rate and for any evidence of myocardial ischemia with concurrent use. Risk D: Consider therapy modification

Dabrafenib: QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of Dabrafenib. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Domperidone: QT-prolonging Agents (Moderate Risk) may enhance the QTc-prolonging effect of Domperidone. Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider therapy modification

Doxofylline: Sympathomimetics may enhance the adverse/toxic effect of Doxofylline. Risk C: Monitor therapy

Encorafenib: May enhance the QTc-prolonging effect of QT-prolonging Miscellaneous Agents (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Etelcalcetide: QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of Etelcalcetide. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Fexinidazole: May enhance the QTc-prolonging effect of QT-prolonging Miscellaneous Agents (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Fluorouracil Products: QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of Fluorouracil Products. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Gadobenate Dimeglumine: QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of Gadobenate Dimeglumine. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Guanethidine: May enhance the arrhythmogenic effect of Sympathomimetics. Guanethidine may enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy

Halofantrine: QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of Halofantrine. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Haloperidol: QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of Haloperidol. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Inotuzumab Ozogamicin: QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of Inotuzumab Ozogamicin. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Kratom: May enhance the adverse/toxic effect of Sympathomimetics. Risk X: Avoid combination

Levoketoconazole: QT-prolonging Agents (Moderate Risk) may enhance the QTc-prolonging effect of Levoketoconazole. Risk X: Avoid combination

Levothyroxine: May enhance the adverse/toxic effect of Sympathomimetics. Specifically, the risk of coronary insufficiency may be increased in patients with coronary artery disease. Levothyroxine may enhance the therapeutic effect of Sympathomimetics. Sympathomimetics may enhance the therapeutic effect of Levothyroxine. Risk C: Monitor therapy

Linezolid: May enhance the hypertensive effect of Sympathomimetics. Management: Consider initial dose reductions of sympathomimetic agents, and closely monitor for enhanced blood pressure elevations, in patients receiving linezolid. Risk D: Consider therapy modification

Lofexidine: QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of Lofexidine. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Loop Diuretics: Beta2-Agonists may enhance the hypokalemic effect of Loop Diuretics. Risk C: Monitor therapy

Loxapine: Agents to Treat Airway Disease may enhance the adverse/toxic effect of Loxapine. More specifically, the use of Agents to Treat Airway Disease is likely a marker of patients who are likely at a greater risk for experiencing significant bronchospasm from use of inhaled loxapine. Management: This is specific to the Adasuve brand of loxapine, which is an inhaled formulation. This does not apply to non-inhaled formulations of loxapine. Risk X: Avoid combination

Meglumine Antimoniate: May enhance the QTc-prolonging effect of QT-prolonging Miscellaneous Agents (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Methacholine: Beta2-Agonists (Short-Acting) may diminish the therapeutic effect of Methacholine. Management: Hold short-acting beta2 agonists for 6 hours before methacholine use. Risk D: Consider therapy modification

Midostaurin: QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of Midostaurin. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Monoamine Oxidase Inhibitors: May enhance the adverse/toxic effect of Beta2-Agonists. Risk C: Monitor therapy

Ondansetron: QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of Ondansetron. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Oxytocin: QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of Oxytocin. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Ozanimod: May enhance the hypertensive effect of Sympathomimetics. Risk C: Monitor therapy

Pentamidine (Systemic): QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of Pentamidine (Systemic). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Pimozide: May enhance the QTc-prolonging effect of QT-prolonging Agents (Moderate Risk). Risk X: Avoid combination

Piperaquine: QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of Piperaquine. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Probucol: QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of Probucol. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

QT-prolonging Agents (Highest Risk): Terbutaline may enhance the QTc-prolonging effect of QT-prolonging Agents (Highest Risk). Management: Consider alternatives to this combination. Patients with other risk factors (eg, older age, female sex, bradycardia, hypokalemia, hypomagnesemia, heart disease, and higher drug concentrations) are likely at greater risk for these toxicities. Risk D: Consider therapy modification

QT-prolonging Antidepressants (Moderate Risk): May enhance the QTc-prolonging effect of QT-prolonging Miscellaneous Agents (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

QT-prolonging Antipsychotics (Moderate Risk): QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of QT-prolonging Antipsychotics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

QT-prolonging Class IC Antiarrhythmics (Moderate Risk): QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of QT-prolonging Class IC Antiarrhythmics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

QT-Prolonging Inhalational Anesthetics (Moderate Risk): QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of QT-Prolonging Inhalational Anesthetics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

QT-prolonging Kinase Inhibitors (Moderate Risk): May enhance the QTc-prolonging effect of QT-prolonging Miscellaneous Agents (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk): May enhance the QTc-prolonging effect of QT-prolonging Miscellaneous Agents (Moderate Risk). QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase the serum concentration of QT-prolonging Miscellaneous Agents (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

QT-prolonging Quinolone Antibiotics (Moderate Risk): QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of QT-prolonging Quinolone Antibiotics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

QT-prolonging Strong CYP3A4 Inhibitors (Moderate Risk): May enhance the QTc-prolonging effect of QT-prolonging Miscellaneous Agents (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Sertindole: May enhance the QTc-prolonging effect of QT-prolonging Agents (Moderate Risk). Risk X: Avoid combination

Solriamfetol: Sympathomimetics may enhance the hypertensive effect of Solriamfetol. Sympathomimetics may enhance the tachycardic effect of Solriamfetol. Risk C: Monitor therapy

Sotalol: Terbutaline may enhance the QTc-prolonging effect of Sotalol. Sotalol may diminish the therapeutic effect of Terbutaline. Risk X: Avoid combination

Succinylcholine: Terbutaline may enhance the neuromuscular-blocking effect of Succinylcholine. Risk C: Monitor therapy

Sympathomimetics: May enhance the adverse/toxic effect of other Sympathomimetics. Risk C: Monitor therapy

Tedizolid: May enhance the hypertensive effect of Sympathomimetics. Tedizolid may enhance the tachycardic effect of Sympathomimetics. Risk C: Monitor therapy

Theophylline Derivatives: Beta2-Agonists may enhance the adverse/toxic effect of Theophylline Derivatives. Specifically, sympathomimetic effects may be increased. Theophylline Derivatives may enhance the hypokalemic effect of Beta2-Agonists. Risk C: Monitor therapy

Thiazide and Thiazide-Like Diuretics: Beta2-Agonists may enhance the hypokalemic effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy

Toremifene: QT-prolonging Miscellaneous Agents (Moderate Risk) may enhance the QTc-prolonging effect of Toremifene. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor therapy

Tricyclic Antidepressants: May enhance the adverse/toxic effect of Beta2-Agonists. Risk C: Monitor therapy

Pregnancy Considerations

Terbutaline crosses the placenta; umbilical cord concentrations are ~11% to 48% of maternal blood levels.

Terbutaline may affect uterine contractility; use caution if needed to control bronchospasm in pregnant patients.

Uncontrolled asthma is associated with adverse events in pregnancy (increased risk of perinatal mortality, preeclampsia, preterm birth, low-birth-weight infants, cesarean delivery, and the development of gestational diabetes). Poorly controlled asthma or asthma exacerbations may have a greater fetal/maternal risk than what is associated with appropriately used asthma medications. Maternal treatment improves pregnancy outcomes by reducing the risk of some adverse events (eg, preterm birth, gestational diabetes). Although short acting beta-2 agonists should be used to treat acute asthma exacerbations in pregnant patients, agents other than terbutaline are preferred (ERS/TSANZ [Middleton 2020]; GINA 2023).

Terbutaline injection has not been approved for and should not be used for prolonged tocolysis (beyond 48 to 72 hours). Oral terbutaline sulfate has not been approved and should not be used for acute or maintenance tocolysis. Terbutaline should not be used for maintenance tocolysis in the outpatient or home setting. Serious adverse reactions, including death, have been reported after administration of terbutaline to pregnant patients. Maternal adverse reactions include increased heart rate, transient hyperglycemia, hypokalemia, cardiac arrhythmias, pulmonary edema, and myocardial ischemia. Increased fetal heart rate and neonatal hypoglycemia may also occur. Terbutaline has been used in the management of preterm labor. Tocolytics may be used for the short-term prolongation of pregnancy to allow for the administration of antenatal steroids and should not be used prior to fetal viability or when the risks of use to the fetus or mother are greater than the risk of preterm birth (ACOG 2016).

Monitoring Parameters

Heart rate, heart rhythm, blood pressure, respiratory rate, serum potassium, glucose, arterial or capillary blood gases (if applicable), pulmonary function tests (eg, FEV1, peak flow)

Mechanism of Action

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

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: Oral: 30 to 45 minutes; SubQ: 6 to 15 minute; Inhalation: 5 minutes (maximum effect: 15 to 60 minutes).

Duration: Oral: 4 to 8 hours; Oral inhalation: 3 to 6 hours; SubQ: 1.5 to 4 hours.

Absorption: 33% to 50%.

Protein binding: 25%.

Metabolism: Hepatic to inactive sulfate conjugates.

Bioavailability: SubQ doses are more bioavailable than oral.

Half-life elimination: 5.7 hours (range: 2.9 to 14 hours).

Time to peak, serum: SubQ: 0.5 hours.

Excretion: Urine (~60% as unchanged drug); feces.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Bricanyl;
  • (AT) Austria: Bricanyl | Bricanyl-duriles;
  • (AU) Australia: Bricanyl;
  • (BD) Bangladesh: Tervent;
  • (BE) Belgium: Bricanyl;
  • (BR) Brazil: Bricanyl | Greencanyl;
  • (CH) Switzerland: Bricanyl;
  • (CN) China: Bricanyl | Hui bang | Terbutaline | Terbutaline Sulphate;
  • (CO) Colombia: Bricanyl | Sulter | Terburop | Terbutalina;
  • (CZ) Czech Republic: Bricanyl;
  • (DE) Germany: Asthmoprotect | Bricanyl | Contimit | Terbul | Terbutalin al | Terbutalin ratiopharm;
  • (DO) Dominican Republic: Terburop;
  • (EC) Ecuador: Bricanyl | Terburop;
  • (EE) Estonia: Bricanyl;
  • (EG) Egypt: Aironyl | Bricanyl | Terbutaline | Terbutanyl;
  • (ES) Spain: Tedipulmo | Terbasmin | Terbasmin ern;
  • (FI) Finland: Bricanyl;
  • (FR) France: Bricanyl | Bricanyl lp;
  • (GB) United Kingdom: Bricanyl | Monovent;
  • (GR) Greece: Dracanyl;
  • (HK) Hong Kong: Apt Terbutaline | Ataline | Bricanyl | Britaline | Brothines | Butaline | Butylin | Dhatalin | Eurobutal | Terbron | Terbuline | Terbuta | Terbutaline | Tertal | Uni-Breth;
  • (HU) Hungary: Bricanyl;
  • (ID) Indonesia: Asmabet | Asthmoprotect | Bintasma | Brasmatic | Bricasma | Forasma | Lasmalin | Nairet | Neosma | Prosmalin | Pulmobron | Sedakter | Tabas | Terasma | Tismalin | Yarisma;
  • (IE) Ireland: Bricanyl;
  • (IL) Israel: Bricalin;
  • (IN) India: Bricanyl | Terbutaline Sulphate | Tetrasma;
  • (IT) Italy: Terbasmin;
  • (JO) Jordan: Bricanyl | Talin;
  • (JP) Japan: Bricanyl | Convon | Naropatin;
  • (KR) Korea, Republic of: Beta-2 | Bricanyl;
  • (KW) Kuwait: Bricanyl | Butaline;
  • (LB) Lebanon: Bricanyl;
  • (LT) Lithuania: Bricanyl;
  • (LU) Luxembourg: Bricanyl | Terbul;
  • (LV) Latvia: Bricanyl;
  • (MA) Morocco: Bricanyl;
  • (MX) Mexico: Bricanyl | Taziken;
  • (MY) Malaysia: Anvelin | Asmalin | Ataline | Bricanyl | Britaline | Bronkine | Brontaline | Bucanil | Butaline | Butanil | Butylin | Pritalin | Terbron | Terbuline | Terbutaline | Terbutaline Sulphate;
  • (NL) Netherlands: Bricanyl;
  • (NO) Norway: Bricanyl;
  • (NZ) New Zealand: Bricanyl | Terbutalin al;
  • (PH) Philippines: Astebron | Blucodil | Bricanyl | Bronchodam | Lungex | Pulmoxcel | Terbulin | Terbutaline | Terbutaline Am-Europharma | Terbutaline Scheele | Ventryl;
  • (PK) Pakistan: Asmanyl | Brethin | Bricanyl | Respair | Terbulin | Terbutascot | Terbutil | Tesmic | Ventair;
  • (PL) Poland: Bricanyl;
  • (PR) Puerto Rico: Brethine | Terbutaline;
  • (PT) Portugal: Bricanyl;
  • (QA) Qatar: Aironyl | Bricanyl | Bronclyn | Dilanyl | Neoterb | Talin | Terbu-Q;
  • (RO) Romania: Bricanyl;
  • (RU) Russian Federation: Aironyl | Bricanyl;
  • (SA) Saudi Arabia: Bricanyl;
  • (SE) Sweden: Bricanyl | Respirol;
  • (SG) Singapore: Anvelin | Asmalin | Ataline | Bricanyl | Bucanil | Butylin | Dhatalin | Terbutaline;
  • (SI) Slovenia: Bricanyl;
  • (SK) Slovakia: Bricanyl;
  • (TH) Thailand: Asmaline | Asmarin | Asmotab | Asthamsian | Asthermine | Asthmic | Asthmotab | B-lene | Baltic | Becasyl | Biterine | Bricanyl | Britaline | Broncho | Broncholine | Bronchonil | Bronchonyl | Bronco Asmo | Bronic | Bucanyl | Bucaril | Buline | Butalin | Butaline | Butanyl | Byterine | Cabrinyl | Cocolax | Fasma | Framagon | H ma | Manotaline | P-Canil | Piptanyl | Proasma-t | Terbaline | Terbron | Terbu | Terbulin | Terbuline | Terbumed | Terbuno | Terbusin | Terbutab | Terbutal | Terbutaline | Terbuton | Terlain | Tolbin | Unires;
  • (TN) Tunisia: Bricanyl | Talin;
  • (TR) Turkey: Bricanyl;
  • (TW) Taiwan: Berocol | Brandyl | Bricanyl | Bricardyl | Brothine | Glin | Soter | Terbeline | Terbuline | Tersultran | Tusoloc;
  • (UA) Ukraine: Bricanyl;
  • (VE) Venezuela, Bolivarian Republic of: Bricanyl | Nortol;
  • (ZA) South Africa: Bricanyl
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