Does terbutaline cause side effects?

Terbutaline is a type of bronchodilator called a beta-adrenergic receptor agonist used to treat asthma and other diseases of the airways. 

Asthma is a breathing problem caused by narrowing of air passages (bronchial tubes) through which air moves in and out of the lungs. These airways can be narrowed due to the accumulation of mucus, spasm of the muscles that surround them (bronchospasm), or swelling of their linings due to the accumulation of fluid. Airway narrowing leads to shortness of breath, wheezing, and cough

Terbutaline dilates (expands) air passages in the lungs. It attaches to beta adrenergic receptors on muscles surrounding the air passages, causing the muscles to relax and dilate the air passages. Wider air passages allow more air to flow in and out of the lungs. Increased airflow reduces shortness of breath, wheezing, and cough

Terbutaline also is used for delaying premature labor by relaxing the muscles of the uterus that are responsible for expelling the fetus at the time of delivery. 

Common side effects of terbutaline include:

Serious side effects of terbutaline include:

Low blood potassium (hypokalemia) and high blood glucose have been associated with terbutaline.

Drug interactions of terbutaline include thioridazine, which may increase the occurrence of abnormal heart rhythms because both drugs can cause abnormal heart rhythms.

The effects of terbutaline are reversed by beta-blockers and terbutaline may reduce the effect of beta-blockers. Terbutaline reduces uterine contractions and may inhibit labor. There are no adequate studies of terbutaline in pregnant women.

Terbutaline is found in small amounts in the breast milk of nursing women. The American Academy of Pediatrics considers terbutaline to be compatible with breastfeeding.

What are the important side effects of terbutaline?

Terbutaline may cause side effects such as:

Vomiting, anxiety, restlessness, lethargy, excessive sweating, chest pain, and muscle cramping also may occur. Low blood potassium (hypokalemia) and high blood glucose have been associated with terbutaline.

Terbutaline side effects list for healthcare professionals

Adverse reactions observed with terbutaline are similar to those commonly seen with other sympathomimetic agents. All these reactions are transient in nature and usually do not require treatment.

The following table compares adverse reactions seen in patients treated with terbutaline sulfate injection (0.25 mg and 0.5 mg), with those seen in patients treated with epinephrine injection (0.25 mg and 0.5 mg), during eight double-blind crossover studies involving a total of 214 patients.

Incidence (%) of Adverse Reactions

  Terbutaline (%) Epinephrine (%)
0.25 mg 0.5 mg 0.25 mg 0.5 mg
N=77 N=205 N=153 N=61
Reaction  
Central Nervous System
  Tremor 7.8 38.0 16.3 18.0
  Nervousness 16.9 30.7 8.5 31.1
  Dizziness 1.3 10.2 7.8 3.3
  Headache 7.8 8.8 3.3 9.8
  Drowsiness 11.7 9.8 14.4 8.2
Cardiovascular
  Palpitations 7.8 22.9 7.8 29.5
  Tachycardia 1.3 1.5 2.6 0.0
Respiratory
  Dyspnea 0.0 2.0 2.0 0.0
  Chest discomfort 1.3 1.5 2.6 0.0
Gastrointestinal
  Nausea/vomiting 1.3 3.9 1.3 11.5
Systemic
  Weakness 1.3 0.5 2.6 1.6
  Flushed feeling 0.0 2.4 1.3 0.0
  Sweating 0.0 2.4 0.0 0.0
  Pain at injection site 2.6 0.5 2.6 1.6
Note: Some patients received more than one dosage strength of terbutaline sulfate and epinephrine. In addition, there were reports of anxiety, muscle cramps, and dry mouth ( < 0.5%). There have been rare reports of elevations in liver enzymes and of hypersensitivity vasculitis with terbutaline administration.

What drugs interact with terbutaline?

The concomitant use of terbutaline with other sympathomimetic agents is not recommended, since the combined effect on the cardiovascular system may be deleterious to the patient.

Monoamine Oxidase Inhibitors or Tricyclic Antidepressants

Terbutaline should be administered with extreme caution to patients being treated with monoamine oxidase inhibitors or tricyclic antidepressants, or within 2 weeks of discontinuation of such agents, since the action of terbutaline on the vascular system may be potentiated.

Beta-Blockers

Beta-adrenergic receptor blocking agents not only block the pulmonary effect of beta-agonists, such as terbutaline, but may produce severe bronchospasm in asthmatic patients. Therefore, patients with asthma should not normally be treated with beta-blockers. However, under certain circumstances, e.g., as prophylaxis after myocardial infarction, there may be no acceptable alternatives to the use of beta-adrenergic blocking agents in patients with asthma. In this setting, cardioselective beta-blockers could be considered, although they should be administered with caution.

Diuretics

The ECG changes and/or hypokalemia that may result from the administration of nonpotassium-sparing diuretics (such as loop or thiazide diuretics) can be acutely worsened by beta-agonists, especially when the recommended dose of the beta-agonist is exceeded. Although the clinical significance of these effects is not known, caution is advised in the coadministration of beta-agonists with nonpotassium-sparing diuretics.

Summary

Terbutaline is a type of bronchodilator called a beta-adrenergic receptor agonist used to treat asthma and other diseases of the airways. Common side effects of terbutaline include tremor, nausea, nervousness, dizziness, headache, drowsiness, heartburn, heart palpitations, fast heart rate, and elevated blood pressure. Terbutaline reduces uterine contractions and may inhibit labor. There are no adequate studies of terbutaline in pregnant women. Terbutaline is found in small amounts in the breast milk of nursing women. The American Academy of Pediatrics considers terbutaline to be compatible with breastfeeding.

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Medically Reviewed on 5/18/2020
References
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Professional side effects and drug interactions sections courtesy of the U.S. Food and Drug Administration.
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