Chemical formula: C₁₂H₁₉NO₃ Molecular mass: 225.284 g/mol PubChem compound: 5403
Terbutaline interacts in the following cases:
Owing to the hypokalaemic effect of beta-agonists, concurrent administration with terbutaline of serum potassium depleting agents known to exacerbate the risk of hypokalaemia, such as diuretics, methyl xanthines and corticosteroids, should be administered cautiously after careful evaluation of the benefits and risks with special regard to the increased risk of cardiac arrhythmias arising as a result of hypokalaemia. Hypokalaemia also predisposes to digoxin toxicity.
Systemic corticosteroids are frequently given during premature labour to enhance foetal lung development. There have been reports of pulmonary oedema in women concomitantly administered with beta-agonists and corticosteroids.
Corticosteroids are known to increase blood glucose and can deplete serum potassium, therefore concomitant administration should be undertaken with caution with continuous patient monitoring owing to the increased risk of hyperglycaemia and hypokalaemia.
Patients with underlying severe heart disease (e.g. ischaemic heart disease, arrhythmia or severe heart failure) who are receiving terbutaline should be warned to seek medical advice if they experience chest pain or other symptoms of worsening heart disease.
Due to the hyperglycaemic effects of beta2-agonists, additional blood glucose controls are recommended initially in diabetic patients.
As for all beta2-agonists caution should be observed in patients with thyrotoxicosis.
Although no teratogenic effects have been observed in animals or in patients, terbutaline should only be administered with caution during the first trimester of pregnancy.
Maintenance treatment with oral beta2-agonists for asthma and other pulmonary diseases should be used with caution at the end of pregnancy because of the potential tocolytic effect.
Terbutaline solution for injection is contraindicated for the treatment of premature labour before the gestational age of week 22.
Terbutaline is secreted into breast milk, but any effects on the infant are unlikely at therapeutic doses.
Transient hypoglycaemia has been reported in newborn preterm infants after maternal beta2-agonist treatment.
Terbutaline solution for injection is contraindicated for the treatment of premature labour before the gestational age of week 22.
Terbutaline has no or negligible influence on the ability to drive and use machines.
The intensity of the adverse reactions depends on dosage and route of administration. An initial dose titration will often reduce the adverse reactions. Most of the adverse reactions are characteristic of sympathomimetic amines. The majority of these effects have reversed spontaneously within the first 1-2 weeks of treatment.
The frequency of side effects is low at the recommended doses.
Adverse events are listed below by system organ class and frequency. Frequencies are defined as: very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000), very rare (<1/10,000) and not known (cannot be estimated from the available data).
| System Organ Class (SOC) | Frequency Classification | Adverse Drug Reaction Preferred Term |
|---|---|---|
| Immune System Disorders | Not Known^ | Hypersensitivity reactions including angioedema, bronchospasm, hypotension and collapse |
| Metabolism and Nutritional Disorders | Common | Hypokalaemia |
| Rare | Lactic acidosis | |
| Psychiatric Disorders | Not Known^ | Sleep disorder and Behavioural disturbances, such as agitation and restlessness |
| Nervous System Disorders | Very Common | Tremor Headache |
| Cardiac Disorders | Common | Tachycardia Palpitations |
| Not Known^ | Arrhythmias, e.g. atrial fibrillation, supraventricular tachycardia and extrasystoles Myocardial ischaemia | |
| Vascular Disorders | Not Known^ | Peripheral vasodilation |
| Respiratory, Thoracic and Mediastinal Disorders | Not Known^ | Paradoxical bronchospasm* |
| Gastrointestinal Disorders | Not Known^ | Nausea Mouth and throat irritation |
| Skin and Subcutaneous Tissue Disorders | Not Known^ | Urticaria Rash |
| Musculoskeletal and Connective Tissue Disorders# | Common | Muscle spasms |
^ Reported spontaneously in post-marketing data and therefore frequency regarded as unknown
* In rare cases, through unspecified mechanisms, paradoxical bronchospasm may occur, with wheezing immediately after inhalation. This should be immediately treated with a rapid-onset bronchodilator. Terbutaline therapy should be discontinued and after assessment, an alternative therapy initiated.
# A few patients feel tense; this is also due to the effects on skeletal muscle and not to direct CNS stimulation.
The most common undesirable effects of terbutaline are correlated with the betamimetic pharmacological activity and may be limited or avoided by a close monitoring of haemodynamic parameters, such as blood pressure and heart rate, and an appropriate adjustment of the dose. They normally recede upon therapy discontinuation.
| System Organ Class (SOC) | Frequency Classification | Adverse Drug Reaction Preferred Term |
|---|---|---|
| Blood and Lymphatic System Disorders | Not Known^ | An increased tendency to bleeding in connection with caesarean section |
| Immune System Disorders | Not Known^ | Hypersensitivity reactions including angioedema, bronchospasm, hypotension and collapse |
| Metabolism and Nutritional Disorders | Common | Hypokalaemia° |
| Rare | Hyperglycaemia° | |
| Rare | Lactic acidosis | |
| Psychiatric Disorders | Not Known^ | Sleep disorder and Behavioural disturbances, such as agitation and restlessness Hyperactivity |
| Nervous System Disorders | Very Common | Tremor Headache |
| Cardiac Disorders | Very Common | Tachycardia° |
| Common | Palpitations° Decrease in diastolic pressure° | |
| Rare | Cardiac arrhythmias, e.g. atrial fibrillation, supraventricular tachycardia and extrasystoles° Myocardial ischaemia° | |
| Vascular Disorder | Common | Hypotension° |
| Rare | Peripheral vasodilatation° | |
| Respiratory, Thoracic and Mediastinal Disorders | Uncommon | Pulmonary oedema° |
| Not Known^ | Paradoxical bronchospasm* | |
| Gastrointestinal Disorders | Very Common | Nausea |
| Not Known^ | Mouth and throat irritation | |
| Skin and Subcutaneous Tissue Disorders | Not Known^ | Urticaria Rash |
| Musculoskeletal and Connective Tissue Disorders# | Not Known^ | Muscle spasms |
^ Reported spontaneously in post-marketing data and therefore frequency regarded as unknown
° These reactions have been reported in association with the use of short acting beta-agonists in obstetric indications and are considered class effects.
* In rare cases, through unspecified mechanisms, paradoxical bronchospasm may occur, with wheezing immediately after inhalation. This should be immediately treated with a rapid-onset bronchodilator. Terbutaline therapy should be discontinued and after assessment, an alternative therapy initiated.
# A few patients feel tense; this is also due to the effects on skeletal muscle and not to direct CNS stimulation.
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