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.

>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

Decreased effect with beta-blockers

Increased toxicity with MAO inhibitors, TCAs

Y-site administration: Compatible: Insulin (regular)

Compatibility in syringe: Compatible: Doxapram

Compatibility when admixed: Compatible: Aminophylline. Incompatible: Bleomycin

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

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

I.V.: Use infusion pump.

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

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

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

Tablet, as sulfate: 2.5 mg, 5 mg

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Bohn D, Kalloghlian A, Jenkins J, et al, "Intravenous Salbutamol in the Treatment of Status Asthmaticus in Children,"Crit Care Med, 1984, 12(10):892-6.

Canny GJ and Levison H, "Aerosols - Therapeutic Use and Delivery in Childhood Asthma,"Ann Allergy, 1988, 60(1):11-9.

Fuglsang G, Pedersen S, and Borgstrom L, "Dose-Response Relationships of I.V. Administered Terbutaline in Children With Asthma,"J Pediatr, 1989, 114(2):315-20.

Goldenhersh N and Rachelefsky GS, "Childhood Asthma: Management,"Pediatr Rev, 1989, 10(9):259-67.

Kelly HW, McWilliams BC, Katz R, et al, "Safety of Frequent High Dose Nebulized Terbutaline in Children With Acute Severe Asthma,"Ann Allergy, 1990, 64(2 Pt 2):229-33.

Lee DC, "Terbutaline Sulfate Overdose,"Ann Emerg Med, 1995, 26(1):107-8.

National Asthma Education and Prevention Program, "Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma - Update on Selected Topics 2002," Bethesda, MD: National Institutes of Health, National Heart, Lung, and Blood Intitute; 2003. NIH publication 02-5074. Available at: http://www.nhlbi.nih.gov/guidelines/asthma/asthmafullrpt.pdf. Accessed February 4, 2004.

National Asthma Education and Prevention Program, "Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma," Bethesda, MD: National Institutes of Health; 1997. NIH publication 97-4051.

Rachelefsky GS and Siegel SC, "Asthma in Infants and Children - Treatment of Childhood Asthma: Part II,"J Allergy Clin Immunol, 1985, 76(3):409-25.

Tipton WR and Nelson HS, "Frequent Parenteral Terbutaline in the Treatment of Status Asthmaticus in Children,"Ann Allergy, 1987, 58(4):252-6.

Zehner WJ Jr, Scott JM, Iannolo PM, et al, "Terbutaline vs Albuterol for Out-of-Hospital Respiratory Distress: Randomized Double-Blind Trial,"Acad Emerg Med, 1995, 2(8):686-91.