Adult: As metered-dose powd inhaler: 250-500 mcg as required. Max: 2,000 mcg daily.
Inhalation/Respiratory Severe bronchospasm
Adult: As 1% nebuliser soln: 2.5-10 mg 2-4 times daily. Child: <25 kg: 2-5 mg 2-4 times daily; ≥25 kg: 5 mg 2-4 times daily.
Intravenous Uncomplicated premature labour
Adult: To arrest labour between 22-37 wk of gestation: Initially, 5 mcg/min, w/ increments of 2.5 mcg/min at 20 min intervals until contractions stop. Max: 20 mcg/min. Continue for 1 hr after contractions have ceased, then decrease by 2.5 mcg/min every 20 min to lowest dose that maintains suppression. Max duration: 48 hr.
Oral Acute bronchospasm
Adult: Initially, 2.5 mg or 3 mg tid, up to 5 mg tid as necessary. As modified-release tab: 5 mg or 7.5 mg bid. Child: <12 yr Initially, 0.05 mg/kg/dose tid, increase gradually as required. Max: 5 mg/day; 12-15 yr 2.5 mg tid; >15 yr Same as adult dose.
Parenteral Severe bronchospasm
Adult: 250-500 mcg up to 4 times daily by SC, IM or IV inj, or by IV infusion as a soln containing 3-5 mcg/mL at a rate of 0.5-1 mL/min. Child: 2-15 yr 0.01 mg/kg. Max: 0.3 mg/dose.
What are the brands available for Terbutaline in Hong Kong?
Ataline
Bricanyl
Terbuta
Administration
Terbutaline May be taken with or without food.
Reconstitution
Add 10 mL of terbutaline soln for inj to 40 mL of dextrose 5% if using a syringe pump or to 490 mL of dextrose 5% if syringe pump is not available.
Contraindications
Parenteral: Prolonged (beyond 48-72 hr) or maintenance tocolysis, particularly in outpatient or home setting. PO: Acute or maintenance tocolysis.
Monitor cardiorespiratory function, serum K and glucose levels; signs/symptoms of pulmonary oedema (when used in premature labour).
Overdosage
Symptoms: Headache, anxiety, tremor, nausea, tonic cramps, palpitations, tachycardia, arrhythmia; hypotension, hypokalaemia, hyperglycaemia and lactic acidosis may occur. Management: Reduce dose in mild to moderate cases. In severe cases, perform necessary tests to determine acid-base balance, blood sugar and electrolyte levels. Monitor BP, heart rate and rhythm and correct metabolic changes. A cardioselective β-blocker (e.g. metoprolol) may be given for the treatment of arrhythmias but w/ caution.
Drug Interactions
Increased risk of haemorrhage and serious ventricular rhythm disorder w/ halogenated anaesth. May reduce the effect of anti-diabetic drugs. Increased risk of hypokalaemia w/ K-depleting agents (e.g. diuretics). Concomitant β-agonist and corticosteroid may result to pulmonary oedema. May partially or totally inhibit the effect of non-selective β-blockers.
Action
Description: Mechanism of Action: Terbutaline stimulates intracellular adenyl cyclase, the enzyme that catalyses the conversion of ATP to cyclic-3', 5'-adenosine monophosphate (cAMP) resulting in relaxation of bronchial smooth muscle and inhibition of release of mediators of immediate hypersensitivity from mast cells. Onset: W/in 5 min (inhalation); 30-45 min (oral); 6-15 min (SC). Duration: 6 hr (inhalation); 8 hr (oral). Pharmacokinetics: Absorption: Variably absorbed from the GI tract; absorbed from the airways (<10%). Bioavailability: Approx 14-15% (oral). Time to peak plasma concentration: 1-4 hr. Distribution: Crosses the placenta and enters breast milk (trace amounts). Plasma protein binding: 25%. Metabolism: Undergoes extensive first-pass metabolism via sulfate and some glucoronide conjugation in the liver and the gut wall. Excretion: Via urine and faeces as inactive sulfate conjugate and unchanged drug. Terminal half-life: 16-20 hr.
Chemical Structure
Terbutaline Source: National Center for Biotechnology Information. PubChem Database. Terbutaline, CID=5403, https://pubchem.ncbi.nlm.nih.gov/compound/Terbutaline (accessed on Jan. 23, 2020)
R03CC03 - terbutaline ; Belongs to the class of adrenergics for systemic use, selective beta-2-adrenoreceptor agonists. Used in the treatment of obstructive airway diseases. R03AC03 - terbutaline ; Belongs to the class of adrenergic inhalants, selective beta-2-adrenoreceptor agonists. Used in the treatment of obstructive airway diseases.
References
Anon. Terbutaline. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 15/07/2015.Buckingham R (ed). Terbutaline Sulfate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 15/07/2015.McEvoy GK, Snow EK, Miller J et al (eds). Terbutaline Sulfate. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 15/07/2015.Terbutaline Sulfate Tablet (Marlex Pharmaceuticals Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 15/07/2015.
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