Pronunciation:

(ter BYOO ta leen)

U.S. Brand Names:

Synonyms:

Generic Available:

Canadian Brand Names:

Use:

Use - Unlabeled/Investigational:

Pregnancy Risk Factor:

Lactation:

Contraindications:

Warnings/Precautions:

Use caution in patients with cardiovascular disease (arrhythmia or hypertension or CHF), convulsive disorders, diabetes, glaucoma, hyperthyroidism, or hypokalemia. Beta agonists may cause elevation in blood pressure, heart rate, and result in CNS stimulation/excitation. Beta2 agonists may increase risk of arrhythmia, increase serum glucose, or decrease serum potassium.

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. Only the mildest form of asthma (Step 1 and/or exercise-induced) would not require concurrent use based upon asthma guidelines. Patient 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.

Do not exceed recommended dose; serious adverse events including fatalities, have been associated with excessive use of inhaled sympathomimetics. Rarely, paradoxical bronchospasm may occur with use of inhaled bronchodilating agents; this should be distinguished from inadequate response.

Adverse Reactions:

>10%:

Central nervous system: Nervousness, restlessness

Endocrine & metabolic: Serum glucose increased, serum potassium decreased

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, arrhythmia, hypokalemia, paradoxical bronchospasm

Overdosage/Toxicology:

Drug Interactions:

Decreased effect with beta-blockers

Increased toxicity with MAO inhibitors, TCAs

Ethanol/Nutrition/Herb Interactions:

Stability:

Compatibility:

Y-site administration: Compatible: Insulin (regular)

Compatibility in syringe: Compatible: Doxapram

Compatibility when admixed: Compatible: Aminophylline. Incompatible: Bleomycin

Mechanism of Action:

Pharmacodynamics/Kinetics:

Onset of action: Oral: 30-45 minutes; SubQ: 6-15 minutes

Protein binding: 25%

Metabolism: Hepatic to inactive sulfate conjugates

Bioavailability: SubQ doses are more bioavailable than oral

Half-life elimination: 11-16 hours

Excretion: Urine

Dosage:

Children <12 years: Bronchoconstriction:

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

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

Children >12 years and Adults: Bronchoconstriction:

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

SubQ: 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 inhalations

Adults: Premature labor (tocolysis; unlabeled use):

Acute: I.V. 2.5-10 mcg/minute; increased gradually every 10-20 minutes; effective maximum dosages from 17.5-30 mcg/minute have been used with caution. Duration of infusion is at least 12 hours.

Maintenance: Oral: 2.5-10 mg every 4-6 hours for as long as necessary to prolong pregnancy depending on patient tolerance

Dosing adjustment/comments in renal impairment:

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

Clcr<10 mL/minute: Avoid use

Administration:

I.V.: Use infusion pump.

Oral: Administer around-the-clock to promote less variation in peak and trough serum levels

Monitoring Parameters:

Patient Education:

Preterm labor: Notify prescriber immediately if labor resumes or adverse side effects are noted.

Anesthesia and Critical Care Concerns/Other Considerations:

Cardiovascular Considerations:

Dental Health: Effects on Dental Treatment:

Dental Health: Vasoconstrictor/Local Anesthetic Precautions:

Mental Health: Effects on Mental Status:

Mental Health: Effects on Psychiatric Treatment:

Dosage Forms:

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

Tablet, as sulfate: 2.5 mg, 5 mg

Extemporaneously Prepared:

Horner RK and Johnson CE, "Stability of An Extemporaneously Compounded Terbutaline Sulfate Oral Liquid,"Am J Hosp Pharm, 1991, 48(2):293-5.

International Brand Names: