Terbutaline Side Effects

It is possible that some side effects of terbutaline may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

For the Consumer

Applies to terbutaline: oral elixir, oral tablet

Other dosage forms:

As well as its needed effects, terbutaline may cause unwanted side effects that require medical attention.

If any of the following side effects occur while taking terbutaline, check with your doctor immediately:

More common
  • Shakiness in the legs, arms, hands, or feet
  • trembling or shaking of the hands or feet
Less common
  • Extra heartbeat
  • feeling faint, dizzy, or lightheadedness
  • feeling of warmth or heat
  • flushing or redness of the skin, especially on the face and neck
  • headache
  • sweating
Rare
  • Burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • excessive muscle tone
  • muscle stiffness
  • muscle tension or tightness

If any of the following symptoms of overdose occur while taking terbutaline, get emergency help immediately:

Symptoms of overdose
  • Arm, back, or jaw pain
  • blurred vision
  • chest pain or discomfort
  • chest tightness or heaviness
  • confusion
  • convulsions
  • decreased urine
  • dizziness
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • dry mouth
  • fainting
  • fast, pounding, or irregular heartbeat or pulse
  • general feeling of discomfort or illness
  • increased thirst
  • loss of appetite
  • mood changes
  • muscle pain or cramps
  • nausea or vomiting
  • nervousness
  • numbness or tingling in the hands, feet, or lips
  • pounding in the ears
  • seizures
  • shortness of breath
  • sleeplessness
  • slow or fast heartbeat
  • trouble sleeping
  • unable to sleep
  • unusual tiredness or weakness

Some terbutaline side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

More common
  • Sleepiness or unusual drowsiness
Less common
  • Anxiety
  • lack or loss of strength
Rare
  • Fever
  • rash
  • redness, soreness, or itching skin
  • seeing, hearing, or feeling things that are not there
  • sores, welting, or blisters

For Healthcare Professionals

Applies to terbutaline: compounding powder, inhalation aerosol, inhalation aerosol with adapter, injectable solution, oral tablet

General

Terbutaline has usually been well tolerated and adverse effects seen have been consistent with its pharmacological action. In general, the severity of these adverse effects have been dependent on dose and the route of administration. Administration by metered dose inhaler (MDI) has been associated with less systemic effects than administration of higher doses by nebulizer or orally. Tolerance to the adverse effects of terbutaline has occurred.[Ref]

Cardiovascular

Changes in heart rate of approximately 30% may be observed following 5 mg of terbutaline given orally. Aggravation of angina may be due to the tachycardia induced by terbutaline. Prolongation of the QT interval occurred in ten healthy males given a bolus injection of 0.25 mg terbutaline followed by an infusion of 5 mcg/min. Supraventricular ectopic beats and ventricular tachycardia have also been reported. Higher dosages of terbutaline should be used with caution in patients with cardiac disease, arrhythmias, or hypertension. All of these effects are dose-related and lower doses may be tolerated.

In one case-control study a positive association was found between the use of oral terbutaline for longer than 9 days and peripartum cardiomyopathy. Further study is needed to determine if a causative relationship exists.[Ref]

Cardiovascular side effects have included palpitations and peripheral vasodilation, commonly resulting in reflex tachycardia. Changes in blood pressure, both increases and decreases, have been reported. Higher dosages have rarely aggravated angina and myocardial ischemia or caused atrial or ventricular arrhythmias. Rarely, peripartum cardiomyopathy has been reported with oral therapy. Pulmonary edema has occurred in pregnant patients receiving intravenous terbutaline.[Ref]

Musculoskeletal

Musculoskeletal side effects have included tremors, especially at higher doses. Tolerance has developed to the tremorogenic effects. Severe muscle cramping has been rarely reported.[Ref]

Metabolic

Metabolic side effects have included hypokalemia, hypomagnesemia, and less commonly hyperglycemia.[Ref]

Infusions of terbutaline, 25 mcg/min, in women in premature labor has caused decreases in serum potassium of up to 1.6 to 2 mEq/L. Another study in ten healthy males produced a mean decrease in serum potassium of 0.9 mEq/L following a bolus injection of 0.25 mg terbutaline, followed by an infusion of 5 mcg/min. A decrease in magnesium of 0.08 mmol/L was produced in these same patients.

This fall in potassium is presumably due to an intracellular shift of potassium secondary to hyperglycemia and hyperinsulinemia.[Ref]

Nervous system

Nervous system side effects have included headache, restlessness, anxiety, nervousness, irritability, and insomnia.[Ref]

Other

Other side effects have included the development of tachyphylaxis to the bronchodilating effects of terbutaline. Although conflicting data exist, the development of complete tolerance has not been reported.[Ref]

References

1. Larsson S, Svedmyr N "Bronchodilating effect and side effects of beta2- adrenoceptor stimulants by different modes of administration (tablets, metered aerosol, and combinations thereof). A study with salbutamol inasthmatics." Am Rev Respir Dis 116 (1977): 861-9

2. "Adverse effects and complications of treatment with beta-adrenergic agonist drugs. Committee on drugs, the American Academy of Allergy and Immunology." J Allergy Clin Immunol 75 (1985): 443-9

3. Hudgens DR, Conradi SE "Sudden death associated with terbutaline sulfate administration." Am J Obstet Gynecol 169 (1993): 120-1

4. Tveskov C, Djurhuus MS, Klitgaard NAH, Egstrup K "Potassium and magnesium distribution, ECG changes, and ventricular ectopic beats during beta(2)-adrenergic stimulation with terbutaline in healthy subjects." Chest 106 (1994): 1654-9

5. Kinney EL, Trautlein JJ, Harbaugh CV, Lambert D, Zelis RF "Ventricular tachycardia after terbutaline." JAMA 240 (1978): 2247

6. Al-Hillawi AH, Hayward R, Johnson NM "Incidence of cardiac arrhythmias in patients taking slow release salbutamol and slow release terbutaline for asthma." Br Med J (Clin Res Ed) 288 (1984): 367

7. Trautlein J, Allegra J, Gillin M "Aerosolized terbutaline sulfate--an evalution of efficacy and side effects in patients with reversible airway disease." J Clin Pharmacol 17 (1977): 76-80

8. Wagner JM, Morton MJ, Johnson KA, O'Grady JP, Speroff L "Terbutaline and maternal cardiac function." JAMA 246 (1981): 2697-701

9. Brogden RN, Speight TM, Avery GS "Terbutaline: a preliminary report of its pharmacological properties and therapeutic efficacy in asthma." Drugs 6 (1973): 324-32

10. Braden GL, Germain MJ, Mulhern JG, Hafer JG, Bria WF "Hemodynamic, cardiac, and electrolyte effects of low-dose aerosolized terbutaline sulfate in asthmatic patients." Chest 114 (1998): 380-7

11. Whitsett TL, Manion CV, Wilson MF "Cardiac, pulmonary and neuromuscular effects of clenbuterol and terbutaline compared with placebo." Br J Clin Pharmacol 12 (1981): 195-200

12. Lampert MB, Hibbard J, Weinert L, Briller J, Lindheimer M, Lang RM "Peripartum heart failure associated with prolonged tocolytic therapy." Am J Obstet Gynecol 168 (1993): 493-5

13. Bengtsson B, Fagerstrom PO "Extrapulmonary effects of terbutaline during prolonged administration." Clin Pharmacol Ther 31 (1982): 726-32

14. Hibbard JU "Chronic terbutaline therapy and peripartum cardiomyopathy: a case-control study." Hypertens Pregnancy 15 (1996): 183-91

15. Braden GL, vonOeyen PT, Germain MJ, Watson DJ, Haag BL "Ritodrine- and terbutaline-induced hypokalemia in preterm labor: Mechanisms and consequences." Kidney Int 51 (1997): 1867-75

16. Katz M, Robertson PA, Creasy RK "Cardiovascular complications associated with terbutaline treatment for preterm labor." Am J Obstet Gynecol 139 (1981): 605-8

17. Zelman S "Terbutaline and muscular symptoms." JAMA 239 (1978): 930

18. Hurlbert BJ, Edelman JD, David K "Serum potassium levels during and after terbutaline." Anesth Analg 60 (1981): 723-5

19. Gross TL, Sokol RJ "Severe hypokalemia and acidosis: a potential complication of beta- adrenergic treatment." Am J Obstet Gynecol 138 (1980): 1225-6

20. Herskowitz A, Herskowitz B "Acute paraparesis due to terbutaline sulfate." South Med J 95 (2002): 275-6

21. Drazen JM, Israel E, Boushey HA, et al. "Comparisons of regularly scheduled with as-needed use of albuterol in mild asthma." N Engl J Med 335 (1996): 841-7

22. Cockcroft DW, Swystun VA "Functional antagonism: tolerance produced by inhaled beta(2) agonists." Thorax 51 (1996): 1051-6

23. van Schayck CP, Dompeling E, van Herwaarden CL, et al. "Bronchodilator treatment in moderate asthma or chronic bronchitis: continuous or on demand? A randomised controlled study." BMJ 303 (1991): 1426-31

24. Lipworth BJ, Struthers AD, McDevitt DG "Tachyphylaxis to systemic but not to airway responses during prolonged therapy with high dose inhaled salbutamol in asthmatics." Am Rev Respir Dis 140 (1989): 586-92

25. Sears MR, Taylor DR, Print CG, et al. "Regular inhaled beta-agonist treatment in bronchial asthma." Lancet 336 (1990): 1391-5

26. Svedmyr N, Lofdahl CG "The use of beta(2)-adrenoceptor agonists in the treatment of bronchial asthma." Pharmacol Toxicol 78 (1996): 3-11

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