Terbutaline Pregnancy and Breastfeeding Warnings
Terbutaline Pregnancy Warnings
Terbutaline has been shown to cross the placenta, and the fetus may experience the general adverse effects reported in the mother. Pulmonary edema has been associated with the intravenous use of terbutaline in pregnant women. Myocardial necrosis in one infant was thought to be associated with terbutaline given at a rate of 0.5 mg/hr for 12 weeks by subcutaneous infusion. In one retrospective review of 8,709 patients receiving continuous low-dose subcutaneous infusion of terbutaline to arrest preterm labor, only 47 (0.54%) had one or more cardiopulmonary problems. Pulmonary edema was reported in 28 patients (0.32%), 17 of whom had been treated concurrently with large amounts of IV fluids or one to three tocolytic agents and four of whom had been diagnosed with pregnancy-induced hypertension and/or multiple gestation. Other cardiovascular effects occurred in 19 patients (0.22%), including electrocardiogram changes, irregular heart rate, chest pain, or shortness of breath. However, 7 of these patients had a history of cardiac problems. Use of terbutaline in pregnant women for the relief of bronchospasm may interfere with uterine contractility. For the treatment of asthma, administration by metered dose inhaler results in lower plasma concentrations and consequently fewer adverse effects for the mother and fetus. Hepatitis has been reported in at least two patients receiving terbutaline to control premature labor.
Terbutaline has been assigned to pregnancy category B by the FDA. Animal studies have failed to reveal evidence of teratogenicity. Terbutaline is only recommended for use during pregnancy when benefit outweighs risk.
Terbutaline Breastfeeding Warnings
Terbutaline is excreted in small amounts into human milk. In four mothers taking 2.5 to 5 mg per day of terbutaline, milk concentrations averaged 3 to 4 ng/mL. The calculated daily dose of terbutaline taken in by a nursing infant ranges from 0.2% to 0.7% of the mother's dose. Terbutaline is not detectable in the plasma of nursing infants and clinical signs of beta-adrenergic stimulation have not been reported. Terbutaline is considered be compatible with breast-feeding by the American Academy of Pediatrics.
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