Terbutaline (Dosing, Interaction, Side Effect, Administration, Etc..)

DRUG CLASS:
Beta-2 Adrenergic Agonist
Bronchodilator
Sympathomimetic

DOSING:

Adult Dose

:
General information:
Maximum 15 mg/24 hours (

FDA dosage

)

Maximum dose

0.5 mg within 4 hours (FDA

dosage

)

Asthma - Bronchospasm; Treatment and Prophylaxis:
(Tablets) 5 mg orally 3 times daily at approximately 6-hour intervals while patient is awake; may decrease to 2.5 mg 3 times daily for adverse effects
(Injection) 0.25 mg subQ once; may repeat once in 15 to 30 minutes
(Injection) Severe exacerbation if aerosol therapy not available: 0.25 mg (0.25 mL of 1 mg/mL injection solution) subQ every 20 minutes for 3

doses

(

guideline dosage

)

Bronchospasm; Reversible; associated with bronchitis and emphysema; Treatment and Prophylaxis:
Tablets; 2.5 to 5 mg ORALLY every 6 hr 3 times a day
Injectable; 0.25 mg SUBQ once; may repeat in 15 to 30 min

Pediatric Dose

:
General Dosage Information:
Not FDA-approved in children less than 12 years of age
Maximum 7.5 mg/24 hours (FDA

dosage

)
Maximum

dose 0.5 mg

within 4 hours (

FDA dosage

)

Asthma - Bronchospasm; Treatment and Prophylaxis:
(Tablets; 12 to 15 years)
2.5 mg orally 3 times daily

(Injection; 12 years or older)
0.25 mg subQ once; may repeat in 15 to 30 minutes

(Injection; older than 12 years)
Severe exacerbation if aerosol therapy not available, 0.25 mg (0.25 mL of 1 mg/mL injection solution) subQ every 20 minutes for 3 doses (guideline dosage)

(Injection; 12 years or younger)
Severe exacerbation if aerosol therapy not available: 0.01 mg/kg (0.01 mL/kg of 1 mg/mL injection solution) subQ every 20 minutes for 3 doses then every 2 to 6 hours as needed (guideline dosage)

Bronchospasm; Reversible; associated with bronchitis and emphysema; Treatment and Prophylaxis:
Tablets:
12 to 15 years; 2.5 mg ORALLY 3 times per day

Injectable:
12 years and older; 0.25 mg SUBQ once; may repeat in 15 to 30 min

INDICATIONS:
FDA LABELED INDICATIONS:
Asthma - Bronchospasm; Treatment and Prophylaxis
Bronchospasm; Reversible; associated with bronchitis and emphysema; Treatment and Prophylaxis

NON FDA-LABELED INDICATIONS:
Exercise-induced asthma; Prophylaxis

MECHANISM OF ACTION

:

Terbutaline sulfate

is a beta-adrenergic agonist with preferential effects on beta(2)-adrenergic receptors exerting bronchodilating and smooth muscle relaxation effects. Its

pharmacologic mechanism

is due to the stimulation of adenyl cyclase resulting in increased intracellular level of cyclic AMP. Elevated cAMP triggers relaxation of bronchial smooth muscle and inhibition of release of inflammatory mediators

ADVERSE EFFECT:
Common:
Cardiovascular:
Palpitations
Tachyarrhythmia

Neurologic:
Headache
Seizure
Tremor

Psychiatric:
Feeling nervous

Serious:
Cardiovascular:
Cardiac dysrhythmia

Respiratory:
Paradoxical bronchospasm
Pulmonary edema

CONTRAINDICATION:
Acute or maintenance tocolysis (unapproved indication)
Prolonged tocolysis lasting greater than 48-72 hours (unapproved indication); especially for maintenance in the outpatient setting
Hypersensitivity to sympathomimetic amines or any component of

terbutaline sulfate

products

DRUG INTERACTION:
Major:
Iobenguane I 123 (theoretical)

PHARMACOKINETICS:
Absorption:
Time for Maximum Plasma Concentration (Tmax) Oral:
Solution: time to peak concentration; 1.5 h (0.5 h to 3 h)
Tablet: 2 h (1 h to 3 h)
51mcg/kg to 62mcg/kg body weight: 1 h to 3 h

Time for Maximum Plasma Concentration (Tmax) Subcutaneous:
0.25 mg: About 20 min
0.5 mg: 0.5 h (0.08 h to 1 h)
Bioavailability:
(Tablet): 103% relative to the solution

Metabolism:
Metabolite:
sulfate conjugate

Excretion:
Fecal

Renal:
Oral: 30% to 50%
Subcutaneous: About 90%; about 60% unchanged
Dialyzable: unknown

Elimination:
(Oral):
Approximately 3.4 h

(Subcutaneous):
Approximately 2.9 h to 14 h

PRECAUTION:
Cardiovascular:
ECG changes such as flattening of the T wave; QTc prolongation; and ST segment depression; have been reported.

Use

cautiously in patients with known cardiovascular disorders; particularly coronary insufficiency; ischemic heart disease; cardiac arrhythmias and hypertension
May cause clinically significant changes in pulse rate; blood pressure or other cardiovascular symptoms; discontinuation may be required Endocrine and Metabolic: Significant hypokalemia may occur; which may cause adverse cardiovascular effects

Endocrine and Metabolic:

Use

with caution in patients with hyperthyroidism or diabetes mellitus. IV

terbutaline sulfate

may worsen pre-existing diabetes and ketoacidosis when

used in

large doses

.

Immunologic:
Immediate hypersensitivity reactions and worsening of bronchospasms may occur.

Neurologic:
Seizures have been reported with the

use of terbutaline

Use with

caution in patients with a history of convulsive disorders

Respiratory:
Asthma may be worsened acutely or chronically; medical management (e.g. corticosteroids) may be required
Beta-adrenergic agonist bronchodilators may not effectively manage asthma symptoms alone; additional management with anti-inflammatory agents (e.g. corticosteroids) may be required.

PREGNANCY CATEGORY:
B (FDA)
A (AUS)

BREAST FEEDING:
AAP: Maternal medication usually compatible with breastfeeding.
WHO: Compatible with breastfeeding.

MONITORING:
Reduced asthma symptoms
Pulmonary function tests
ECG; blood pressure; heart rate (patients with cardiac history)

HOW TO TAKE OR ADMINISTRATION:
General Information:
Do not administer as IV infusion

Subcutaneous:
Administer into the lateral deltoid area

DOSAGE FORM:
Subcutaneous Solution:
1 MG/1 ML

TREATMENT:
MANAGEMENT OF MILD TO MODERATE TOXICITY:
Simple symptomatic care is all that is required in the vast majority of

overdoses

. Hydration and benzodiazepines may be

used as

needed for agitation and mild vital sign abnormalities

MANAGEMENT OF SEVERE TOXICITY:
VITAL SIGNS:
Fluid resuscitation should be the first-line treatment for hypotension. Hyperthermia should be treated with benzodiazepines; cooled fluids; and external cooling measures if mild; however; for temperatures over 40 degrees Celsius; intubation and paralysis is recommended

CARDIOVASCULAR:
Antihypertensives can be

used for

severely elevated blood pressure associated with end organ effects such as myocardial ischemia or cerebrovascular ischemia. In the hypertensive tachycardic patient; one should avoid using beta-blockers in isolation due to the possibility of unopposed alpha effects worsening vasospastic ischemia. Nicardipine or labetalol are good antihypertensive choices because they have effects on both heart rate and blood pressure. Treat ventricular dysrhythmias with lidocaine or amiodarone; and cardioversion if hemodynamically unstable

NEUROLOGIC:

Large doses of

benzodiazepines may be needed to control profound agitation and seizures. If benzodiazepines are ineffective; propofol or phenobarbital can be

used to

control the symptoms. Management of cerebrovascular hemorrhage should focus on blood pressure control and airway management as appropriate.

RENAL:
Fluid resuscitation is the key to maintaining urine output. Acidosis can be treated with normal saline (and sedation to control agitation) until euvolemia is achieved; followed by bicarbonate for persistent severe acidosis

MUSCULOSKELETAL:
Sedation to control agitation; fluid resuscitation and maintenance of urine output will limit progression of rhabdomyolysis

TOXICOLOGY:
SYMPATHOMIMETICS; ORAL:
TOXICITY: Varies by agent. Twice the

therapeutic dose

may lead to adverse effects.

SYMPATHOMIMETICS-PARENTERAL:
TOXICITY: Varies depending on the agent. Toxic effects may occur at

therapeutic doses

while large doses have also resulted in no ill effects. Also depends on comorbid conditions as myocardial infarction has occurred with doses as little as 0.6mg Sub epinephrine. Fatalities have been reported at doses of 3 to 4 mg IV epinephrine.

PATIENT COUNSELING OR CLINICAL TEACHING:

Oral terbutaline

is contraindicated for

use in the treatment

or prevention of preterm labor
Advise patient to inform healthcare professional if she is pregnant or becomes pregnant while receiving

terbutaline treatment

This drug may cause palpitations; headache; seizures; tremors; and nervousness
This drug may also cause serious cardiovascular adverse effects (eg; palpitations tachycardia). Advise patient to inform healthcare professional if these occur
Instruct patient to report needing increased frequency or amounts of drug to provide symptomatic relief
Advise patient there are multiple significant drug-drug interactions for this drug. Consult healthcare professional prior to new drug

use

(including over-the-counter and herbal drugs)


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For the Registered Medical Practitioner Only. We are not recommended for self medication. self medication is may harmful for health. We are only Provide information about medicine.