Terbutaline use while Breastfeeding
Drugs containing Terbutaline: Brethine, Bricanyl, Brethaire
Terbutaline Levels and Effects while Breastfeeding
Summary of Use during Lactation
Maternal use of oral or inhaled terbutaline is unlikely to affect a breastfed infant. The authors of several reviews and an expert panel agree that use of inhaled bronchodilators is acceptable during breastfeeding because of the low bioavailability and maternal serum levels after use. Terbutaline use as a tocolytic agent might decrease the duration of breastfeeding.
Maternal Levels. With long-term maternal intake of 2.5 or 5 mg three times daily orally, milk terbutaline levels ranged from 2.5 to 4 mcg/L at various times during the dosing interval. There was little fluctuation of milk levels. The average dose that an exclusively breastfed infant would receive based on these patients is 1.4% (range 0.7 to 2.2%) of the maternal weight-adjusted dose.
Infant Levels. Serum levels were undetectable (<0.1 mcg/L) in one 8-week-old exclusively breastfed infant whose mother was taking oral terbutaline 5 mg three times daily.
Effects in Breastfed Infants
Two papers have reported a total of 4 infants aged 3 to 8 weeks who were breastfed during maternal use of oral terbutaline 2.5 or 5 mg three times daily. None of the infants had any signs of sympathetic stimulation and all were developing normally. These cases were also summarized in a third publication.
Effects on Lactation and Breastmilk
A small retrospective survey from Serbia found that mothers who received a beta agonist pharmacologically similar to terbutaline (fenoterol or hexoprenaline) as a tocolytic breastfed for a shorter period of time than those who received no tocolytic (4.5 vs 9.5 months). It is not known if terbutaline has a similar effect.
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5. National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program Asthma and Pregnancy Working Group. NAEPP expert panel report. Managing asthma during pregnancy: recommendations for pharmacologic treatment-2004 update. 2004;1-57. http://www.nhlbi.nih.gov/health/prof/lung/asthma/astpreg.htm
6. Boreus LO, de Chateau P, Lindberg C et al. Terbutaline in breast milk. Br J Clin Pharmacol. 1982;13:731-2. Letter. PMID: 7082542
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8. Lindberg C, Boreus LO, de Chateau P et al. Transfer of terbutaline into breast milk. Eur J Resp Dis. 1984;65 (Suppl 134):87-91. PMID: 6586490
9. Bjelakovic L, Trajkovic T, Kocic G et al. The association of prenatal tocolysis and breastfeeding duration. Breastfeed Med. 2016;11:561-3. PMID: 27704871
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Other brands: Brethine