Terbutaline should be used with caution in:
- People with diabetes
- People with an overactive thyroid gland (hyperthyroidism)
- People with cardiovascular disease
- People with an abnormal heart rhythm
- People taking diuretics (water tablets) for high blood pressure or heart failure
- People taking xanthines for breathing problems such as theophylline or aminophylline
- People taking steroids
- People taking beta blockers normally used to treat high blood pressure or heart problems such as propranolol, sotalol or atenolol, including eye drops for glaucoma (e.g. timolol)
It should not be used in:
- People with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption (terbutaline tablets as they contain lactose)
Terbutaline should not be used to manage premature labour in:
- Women with reduced blood supply to the heart muscle (ischaemic heart disease or significant risk factors for ischaemic heart disease)
- Complicated premature labour where prolonging the pregnancy could be hazardous for the mother or foetus.
Also see list of precautions and interactions
Do not store above 30°C.
Terbutaline tablets: Do not store above 25°C.
What is it used for?
- Terbutaline is used to treat people with breathing difficulties due to asthma or other lung conditions where bronchospasm (contraction of the lung smooth muscle and airways of the lung) is a complicating factor such as in chronic obstructive pulmonary disease (COPD). It is also used to treat women with uncomplicated premature labour.
- It is a short-acting, selective beta-2 (ß2) agonist (SABA), sometimes known as a bronchodilator.
- It is used to widen the airways in the lung making it easier to breathe. Terbutaline taken by inhalation has a fast onset of action and is used as a ‘reliever’ medicine (fast-acting bronchodilator) to give immediate relief of breathing difficulties when required. It can also be taken orally or by injection to treat breathing difficulties and to relax the muscles in the uterus and prevent premature delivery of the baby.
- In general this drug is used to treat asthma. Terbutaline is used to provide immediate relief of symptoms and to manage asthma attacks.
- Benefits of being on this drug can include relief from symptoms such as chest tightness, breathlessness, wheezing and cough. Terbutaline also effectively prolongs pregnancy.
Listed below are the typical uses of terbutaline.
- Relief of acute asthma symptoms
- Relief of symptoms of chronic bronchitis, emphysema, and other respiratory diseases where bronchospasm is a complicating factor, such as chronic obstructive pulmonary disease (COPD).
- Management of uncomplicated premature labour (terbutaline given orally or by injection)
On occasion your doctor may prescribe this medicine to treat a condition not on the above list. Such conditions are listed below.
HOW TO USE/TAKE
Terbutaline is available as a breath actuated inhaler (Turbuhaler), oral syrup and tablets, a solution for injection or infusion and as Respules (containers which have liquid medicine inside), which are used with a machine called a nebuliser. This converts the medicine inside the Respules into a fine mist which can then be inhaled.
How often do I take it?
- Terbutaline Turbuhaler: Take this medication by inhalation usually 1 puff for the relief of acute breathing difficulties, as required. Detailed advice on how to take terbutaline can be found in the Patient Information Leaflet. Do not take more than 4 puffs in any 24 hour period.
- Terbutaline Respules: Take this medication by inhalation usually two to four times daily for the relief of acute breathing difficulties, as required. Detailed advice on how to take terbutaline Respules can be found in the Patient Information Leaflet.
- Terbutaline taken by inhalation starts to have an immediate effect within 1 to 3 minutes which usually lasts for up to 6 hours.
- Terbutaline syrup /tablets for breathing problems: Take this medication orally usually 3 times daily (adults) or 2 or 3 times daily (children), with or without food. The effect of an oral dose of terbutaline usually lasts for up to 7 to 8 hours.
- Terbutaline syrup /tablets for premature labour: Take this medication orally usually 3 times daily (adults) with or without food. The tablets or syrup are taken after the contractions have been controlled using terbutaline injections.The effect of an oral dose of terbutaline usually lasts for up to 7 to 8 hours.
- Terbutaline injection: It is also available as a solution for an injection which will be given to you by a doctor or nurse intravenously (IV), intramuscularly (IM) or subcutaneously (under skin).
- Certain medical conditions may require different dosage instructions as directed by your doctor.
- Dosage is based on your age, gender, medical condition, response to therapy, and use of certain interacting medicines.
Do I need to avoid anything?
- This medicine is unlikely to affect driving ability or the ability to operate machinery. Avoid driving or using machinery whilst using your inhaler. Consult your doctor or pharmacist for more details.
When can I stop?
- It is important to continue taking this medication even if you feel well, unless your doctor tells you to stop. Do not stop using terbutaline without talking to your doctor.
TERBUTALINE SIDE EFFECTS
- Tremor (shaking)
- Palpitations (fast and irregular heart beats)
- Faster heart rate
- Muscle cramps
- Low blood potassium levels (may cause symptoms of muscle weakness, tingling feeling 'pins and needles)
- Feeling restless or agitated
- Difficulty sleeping
- Abnormal heart rhythm such as atrial fibrillation
- Chest pain or tightness (due to lack of blood to the heart)
- Sore throat and mouth
- Allergic skin reactions including skin rash, itchiness, lumpy rash (hives) or blistering
- Breathing difficulty (due to narrowing of the airways on inhalation)
- Serious allergic reactions such as swelling of tongue, face, lips or throat, trouble breathing, feeling faint or anaphylaxis (very severe allergic reaction with collapse)- see below
If any of these persist or you consider them severe then inform your doctor or pharmacist.
Tell your doctor immediately if you develop any of the following symptoms:
- An increase in wheezing or other breathing difficulties immediately after using your inhaler. Stop using and seek immediate medical advice.
- Worsening of your asthma
- Less relief from your symptoms than usual or the relief is not lasting for as long,
- Your breathing is getting worse
- You start getting a tight chest
- You are waking up often during the night
- Your condition may be getting worse and you may need other medicines.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
The Yellow Card Scheme allows you to report suspected side effects from any type of medicine (which includes vaccines, herbals and over the counter medicines) that you are taking. It is run by the medicines safety watchdog called the Medicines and Healthcare products Regulatory agency (MHRA). Please report any suspected side effect on the Yellow Card Scheme website.
Before taking terbutaline, tell your doctor or pharmacist if you are allergic to it or to other beta agonists; or if you have any other allergies.
This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have:
- hypersensitivity (allergy) to terbutaline or to any of its ingredients
Before using this medication, tell your doctor or pharmacist your medical history, especially any of the following
- Overactive thyroid gland (hyperthyroidism)
- Severe cardiovascular disease including
- - Very high blood pressure
- - Severe heart failure
- - Fast and /or irregular heart beat
- - Reduced blood flow in the heart e.g. due to ischaemic heart disease or hypertrophic obstructive cardiomyopathy (thickening of the heart muscle with obstruction of the blood flow)
- Abnormal heart rhythm
Before having surgery, tell your doctor or dentist that you are taking this medication.
Does alcohol intake affect this drug?
- Alcohol is not known to affect terbutaline.
The elderly: terbutaline can be used in the elderly.
Pregnancy and breastfeeding - please ensure you read the detailed information below
The safety of terbutaline has not been established during pregnancy. Ask your doctor or pharmacist if you have any doubts or questions about this.
First trimester: avoid use
Low blood sugar has been reported in new born babies born prematurely after the mother has been treated with terbutaline to prolong pregnancy.
It is sensible to limit use of medication during pregnancy whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
Terbutaline passes into breast milk. Taking terbutaline whilst breastfeeding is unlikely to harm the infant.
It is sensible to limit use of medication during breastfeeding whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.
If you are currently using any of these medications, tell your doctor or pharmacist before starting Terbutaline.
Before using this medication, tell your doctor or pharmacist of all prescription and non-prescription/herbal products you may use, especially of:
- Beta blockers used to treat high blood pressure or other heart problems, such as propranolol, sotalol and atenolol
- Beta blocker eye drops for glaucoma e.g. timolol
- Xanthines used to treat breathing problems, such as aminophylline and theophylline
- Diuretics (water tablets) used to treat high blood pressure or heart failure, such as furosemide and hydrochlorothiazide
- Steroids used to treat inflammation such as prednisolone
This information does not contain all possible interactions. Therefore, before using terbutaline, tell your doctor or pharmacist of all the products you use.
If you use more terbutaline than you should, contact your doctor or pharmacist for advice immediately.
Possible symptoms and signs of overdose are headache, anxiety, tremor, nausea, muscle cramps, palpitations (fast and irregular heart beats), fast heart rate and abnormal heart rhythm (arrhythmia). A fall in blood pressure sometimes occurs, which may make you feel faint or dizzy.
If you think you, or someone you care for, might have accidentally taken more than the recommended dose of Terbutaline or intentional overdose is suspected, contact your local hospital, GP or if in England call 111. In Scotland call NHS 24. In Wales, call NHS Direct Wales. In the case of medical emergencies, always dial 999.
If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.