Terbutaline Sulfate

(ter-BYOO-tuh-leen SULL-fate)

Brethaire, Brethine, Bricanyl

Class: Bronchodilator/Sympathomimetic

 Action Produces bronchodilation by relaxing bronchial smooth muscle through beta₂-receptor stimulation.

 Indications Treatment of reversible bronchospasm associated with asthma, bronchitis and emphysema. unlabeled use (S): Inhibits premature labor.

 Contraindications Cardiac arrhythmias associated with tachycardia.

 Route/Dosage

ADULTS & CHILDREN ³ 12 YR: Inhalation 2 inhalations (separated by 60 sec interval) q 4–6 hr. Do not repeat more than q 4 hr. ADULTS & CHILDREN ³ 15 YR: PO 2.5–5 mg at 6 hr intervals, 3 times per day during waking hours. Do not exceed 15 mg in 24 hr. CHILDREN 12–15 YR: PO 2.5 mg tid. Do not exceed 7.5 mg in 24 hr. SC 0.25 mg given in lateral deltoid area. May repeat in 15–30 min. Do not exceed 0.5 mg in 4 hr.

Premature Labor Inhibition

ADULTS: IV 10–80 mcg/min for 4 hr has shown some success. Maintenance: PO 2.5 mg q 4–6 hr.

 Interactions

Beta-blockers: Block bronchodilator effect of terbutaline. MAO inhibitors: Hypertension may occur. Tricyclic antidepressants: Cardiovascular effects of terbutaline may be enhanced.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Palpitations; tachycardia; chest discomfort or pain; arrhythmias; blood pressure changes/hypertension. CNS: Stimulation; tremor; dizziness; nervousness; drowsiness; headache; weakness. GI: Nausea; vomiting; GI distress. HEPA: Elevated liver enzymes. META: Hypokalemia (with high doses). RESP: Dyspnea. OTHER: Flushing; sweating; muscle cramps; hypersensitivity vasculitis; ECG changes (eg, sinus pause, atrial premature beats, AV block, ventricular premature beats, ST-T-wave depression, T-wave inversion, sinus bradycardia, atrial escape beat with aberrant conduction); increased heart rate; muscle cramps; central stimulations; pain at injection site; elevations in liver enzymes; seizures; hypersensitivity vasculitis.

 Precautions

Pregnancy: Category B. Lactation: Excreted in breast milk. Labor and delivery: May inhibit uterine contractions and delay preterm labor. Children: Safety and efficacy in children < 12 years not established. Elderly: Lower doses may be required. Cardiovascular effects: Toxic symptoms in patients with cardiovascular disorders may occur. CNS effects: CNS stimulation may occur; use cautiously in patients with history of seizures or hyperthyroidism. Carcinogenesis: A significant increase in the incidence of leiomyomas of the mesovarium and ovarian cysts has been demonstrated. Diabetes: Dosage adjustment of insulin or oral hypoglycemic agent may be required. Excessive use: Paradoxical bronchospasm and cardiac arrest have been associated with excessive inhalant use. Hypersensitivity: Hypersensitivity (allergic) reactions can occur after administration. Hypokalemia: Decreases in potassium levels have occurred. Tolerance: If previously effective dose fails to provide relief, therapy may need to be reassessed.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

• For IV administration, obtain baseline potassium level prior to administration and place patient on cardiac monitor to assess for tachycardia or arrhythmias. Toxic symptoms have been documented in patients with cardiovascular disorders.
• Do not allow patient to use inhaler form of medication more than 6 times/day.
• Limit subcutaneous doses to no more than 0.5 mg in 4 hours.
• For patients who are also using steroid inhaler, make sure that terbutaline is used first and 5 min elapse before steroid inhaler is used.
• Do not use medication if discolored.
• Store at room temperature. Protect from light.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Be alert for drug tolerance, which may occur with long-term use.

OVERDOSAGE: SIGNS & SYMPTOMS   Tremor, palpitations, increased heart rate, decreased blood pressure, seizures, hypokalemia, muscle cramps, headache, hyperglycemia

 Patient/Family Education

• Instruct patient on proper technique for use of inhalers and evaluate return demonstration.
• Demonstrate use of spacer or peak flow meter if prescribed.
• Caution patient not to use inhaler form of medication more than 6 times/day.
• Advise patient to take tablets with food to avoid GI upset.
• Inform patient that the drug can stop working over time. If this is noted or if the inhalation makes breathing worse, the physician should be notified at once.
• Instruct patient to report these symptoms to physician: Chest pain, dizziness or headache or persisting symptoms of asthma.

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