II. Indications

III. Contraindications

  1. Antepartum Hemorrhage
  2. Cardiovascular disease
  3. Hyperthyroidism
  4. Uncontrolled Diabetes Mellitus

IV. Dosing: Preterm Labor

  1. Subcutaneous
    1. Dose: 0.25 mg SQ every 1-4 hours for 24 hours
    2. Maximum: 5 mg in 24 hours
  2. Intravenous
    1. Start: 10 mcg/minute
    2. Increase rate by 5 mcg per minute every 10 minutes
    3. Maximum: 25 mcg per minute
    4. Once controlled, decrease dose 5 mcg every 30 minutes
    5. Titrate dose down to lowest effective dose
  3. Oral (not effective)
    1. Dose: 2.5 to 7.5 mg PO every 1.5 to 4 hours
    2. Hold for maternal pulse >100 beats per minute
  4. Subcutaneous Pump
    1. Basal rate: 0.05 to 0.10 mg/hour
    2. Boluses: 0.25 mg

V. Efficacy

  1. Effective at temporarily stopping contractions
    1. Results in shortest hospital triage stays
    2. Guinn (1997) Am J Obstet Gynecol 177:814-87 [PubMed]
  2. Oral Terbutaline is not effective in Preterm Labor
    1. Lewis (1996) Am J Obstet Gynecol 175:834-7 [PubMed]

VI. Adverse Effects

VII. Monitoring

  1. Baseline testing to consider
    1. Electrocardiogram
    2. Serum Glucose
    3. Serum Potassium
    4. Complete Blood Count
    5. Type and screen
  2. Close monitoring
    1. Blood Pressure for Hypertension
    2. Pulse for maternal Tachycardia over 100
    3. Lung Exam for signs of pulmonary edema
    4. Follow Serum Glucose and Serum Potassium
    5. Consider fluid restriction <2400 cc per day

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Cost: Medications

terbutaline (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
TERBUTALINE SULFATE 2.5 MG TAB Generic $4.16 each

Ontology: Terbutaline (C0039542)

Definition (NCI) An ethanolamine derivative with bronchodilating and tocolytic activities. Terbutaline selectively binds to and activates beta-2 adrenergic receptors, leading to intracellular adenyl cyclase activation via a trimeric G protein and subsequent increase in cyclic AMP (cAMP) production. Increased cAMP levels result in relaxation of bronchial and vascular smooth muscle mediated through the activation of protein kinase A (PKA), which phosphorylates proteins in control of muscle tone. cAMP also inhibits calcium ion release from intracellular stores, reduces calcium entry into cells and induces the sequestration of intracellular calcium all of which aids in the relaxation of airway muscles. Terbutaline also increases mucociliary clearance and reduces release of inflammatory cell mediators.
Definition (MSH) A selective beta-2 adrenergic agonist used as a bronchodilator and tocolytic.
Definition (CSP) beta-adrenergic receptor agonist used as a bronchodilator and tocolytic.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D013726
SnomedCT 372745006, 45311002
LNC LP17982-7, MTHU013595
English Terbutaline, 1,3-Benzenediol, 5-(2-((1,1-dimethylethyl)amino)-1-hydroxyethyl)-, Terbutaline [Chemical/Ingredient], terbutaline, TERBUTALINE, Terbutaline (product), Terbutaline (substance)
Swedish Terbutalin
Czech terbutalin
Finnish Terbutaliini
Russian TERBUTALIN, ТЕРБУТАЛИН
Japanese ブリスチュリン, 硫酸テルブタリン, テルブタリン硫酸塩, ブリカニール, コンボン, テルブタリン
Croatian TERBUTALIN
Polish Terbutalina
Spanish terbutalina (producto), terbutalina (sustancia), terbutalina, Terbutalina
French Terbutaline
German Terbutalin
Italian Terbutalina
Portuguese Terbutalina

Ontology: Bricanyl (C0591192)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D013726
English bricanyl, Bricanyl, Bricanyl SA, AstraZeneca Brand of Terbutaline Sulfate, Hoechst Brand of Terbutaline Sulfate, Terbasmin, pharma-stern Brand of Terbutaline Sulfate

Ontology: Brethine (C0701014)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D013726
English brethine, Brethine, Novartis Brand of Terbutaline Sulfate