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.
References for pregnancy information
- Fletcher SE, Fyfe DA, Case CL, Wiles HB, Upshur JK, Newman RB "Myocardial necrosis in a newborn after long-term maternal subcutaneous terbutaline infusion for suppression of preterm labor." Am J Obstet Gynecol 165 (1991): 1401-4
- Ingemarsson I, Bengtsson B "A five-year experience with terbutaline for preterm labor: low rate of severe side effects." Obstet Gynecol 66 (1985): 176-80
- Ingemarsson I, Westgren M, Lindberg C, Ahren B, Lundquist I, Carlsson C "Single injection of terbutaline in term labor: placental transfer and effects on maternal and fetal carbohydrate metabolism." Am J Obstet Gynecol 139 (1981): 697-701
- Quinn PG, Sherman BW, Tavill AS, Gibas AL "Terbutaline hepatitis in pregnancy: report of two cases and literature review." Am J Gastroenterol 89 (1994): 781-4
- "Product Information. Brethaire (terbutaline)." Novartis Pharmaceuticals, East Hanover, NJ.
- Bergman B, Bokstrom H, Borga O, Enk L, Hedner T, Wangberg B "Transfer of terbutaline across the human placenta in late pregnancy." Eur J Respir Dis Suppl 134 (1984): 81-6
- Benedetti TJ, Hargrove JC, Rosene KA "Maternal pulmonary edema during premature labor inhibition." Obstet Gynecol 59 (1982): s33-7
References for breastfeeding information
- Roberts RJ, Blumer JL, Gorman RL, et al "American Academy of Pediatrics Committee on Drugs: Transfer of drugs and other chemicals into human milk." Pediatrics 84 (1989): 924-36
- Mcdonald CF, Burdon JGW "Asthma in pregnancy and lactation - a position paper for the thoracic society of australia and new zealand." Med J Aust 165 (1996): 485-8
- Lonnerholm G, Lindstrom B "Terbutaline excretion into breast milk." Br J Clin Pharmacol 13 (1982): 729-30
- Boreus LO, de Chateau PU "Terbutaline in breast milk." Br J Clin Pharmacol 13 (1982): 731-2
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