Terbutaline (Monograph)

Drug class: Selective beta-2-Adrenergic Agonists

Medically reviewed by Drugs.com on Jun 10, 2024. Written by ASHP.

Warning

Injection is not FDA labeled for and is contraindicated for prolonged tocolysis (beyond 48–72 hours).¹⁹⁸ ²¹⁰ Oral tablets are not FDA labeled for and are contraindicated for acute or maintenance tocolysis.¹⁹⁹ ²¹⁰ Do not use terbutaline sulfate (injection or oral tablets) for maintenance tocolysis, particularly in the outpatient or home setting.¹⁹⁸ ¹⁹⁹ ²¹⁰ (See Preterm Labor under Cautions and Preterm Labor under Uses.)
Serious, sometimes fatal adverse effects, including increased heart rate, transient hyperglycemia, hypokalemia, cardiac arrhythmias, pulmonary edema, and myocardial ischemia,¹²⁴ ¹³⁰ ¹⁹⁷ ¹⁹⁸ ¹⁹⁹ ²⁰¹ ²¹⁰ reported after administration in pregnant women.¹⁶¹ ¹⁹⁸ ¹⁹⁹ ²¹⁰ Increased fetal heart rate and neonatal hypoglycemia may occur as a result of maternal administration.¹³⁰ ¹⁹⁸ ¹⁹⁹ ¹⁹⁷ (See Preterm Labor under Cautions.)

Introduction

Bronchodilator; relatively selective, short-acting β₂-adrenergic agonist.¹⁹⁸ ¹⁹⁹ ^c

Uses for Terbutaline

Bronchospasm in Asthma

Symptomatic management or prevention of bronchospasm in patients with reversible, obstructive airway disease (e.g., asthma).¹⁹⁸ ¹⁹⁹

The Global Initiative for Asthma (GINA) guidelines provide evidence-based recommendations for the management of asthma.¹² A stepwise approach to treatment is recommended where specific drugs are added or adjusted through a series of steps (1 through 5) to achieve symptom control while keeping the patient on the lowest effective treatment.¹²

The GINA guidelines state that IV terbutaline^{† [off-label]} (administered as an initial IV bolus dose followed by continuous IV infusion) may be used as an alternative to inhaled short-acting β₂-adrenergic agonist for the initial emergency department management of asthma exacerbations in children ≤5 years of age^{† [off-label]}.¹²

Some experts have suggested use of oral β₂-adrenergic agonist therapy principally in patients unable to use inhaled bronchodilators (e.g., young children).¹⁸³ However, oral administration is associated with slower onset of action and increased incidence of adverse effects.¹⁶⁷ ¹⁸³

Sub-Q terbutaline reserved for prehospital management of severe asthma exacerbations when inhaled β₂-selective agents are not readily available.¹⁷⁵ ²⁰⁹ Sub-Q terbutaline not used routinely for treatment of severe exacerbations of asthma in hospitalized patients.²⁰⁹

Bronchospasm in COPD

Symptomatic management of reversible bronchospasm associated with chronic bronchitis and emphysema.¹⁹⁸ ¹⁹⁹ ^c

Role of oral β₂-adrenergic agonists in treatment of COPD limited.¹⁹¹ ¹⁹²

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) publishes an annual guideline on the comprehensive management of COPD. ²⁵ Terbutaline is not mentioned in the most recent (2023) guidelines.²⁵

Preterm Labor

Has been used for acute IV^{† [off-label]} or sub-Q therapy in selected women to inhibit uterine contractions in preterm labor^{† [off-label]} (tocolysis) and prolong gestation when beneficial.¹⁰⁸ ¹⁰⁹ ¹¹⁰ ¹¹¹ ¹¹⁵ ¹¹⁶ ¹¹⁷ ¹¹⁸ ¹¹⁹ ¹²⁰ ¹²¹ ¹²² ¹²³ ¹²⁴ ¹²⁵ ¹²⁶ ¹⁸⁸ ¹⁹⁷

Manufacturers and FDA warn that injection is not FDA labeled for and is contraindicated for prolonged tocolysis (beyond 48–72 hours), because of the potential for serious maternal cardiac effects and death.¹⁹⁸ ²¹⁰ (See Preterm Labor under Cautions.)

Manufacturers and FDA also warn that oral tablets are not FDA labeled for and are contraindicated for acute or maintenance tocolysis, because efficacy not proven and safety concerns similar to injection.¹⁹⁹ ²⁰¹ ²¹⁰ (See Preterm Labor under Cautions.)

Do not use terbutaline sulfate (injection or oral tablets) for maintenance tocolysis, particularly in the outpatient or home setting.¹⁹⁸ ¹⁹⁹ ²⁰⁰ ²⁰¹ ²¹⁰ (See Preterm Labor under Cautions.)

However, available data suggest that acute β-adrenergic agonist treatment may forestall labor for 48 hours,¹⁰⁸ ¹¹¹ ¹¹⁹ ¹²⁰ ¹²¹ ¹²² ¹²³ ¹²⁴ ¹²⁶ ¹⁸⁸ ¹⁹⁷ providing time for patients to be transferred to other (e.g., tertiary-care) facilities and/or receive corticosteroids to increase fetal lung maturation.¹²⁴ ¹²⁵ ¹²⁶ ¹⁸⁸ ¹⁸⁹ ¹⁹⁷ ²¹¹ ²¹³ Any other potential benefits of such drugs in prolonging pregnancy are unclear.¹²⁴ ¹²⁵ ¹²⁶ ¹⁸⁸

ACOG states that because of conflicting results, there is no clear first-line tocolytic agent.¹⁸⁸

Terbutaline Dosage and Administration

Administration

Administer orally or sub-Q.¹⁹⁸ ¹⁹⁹

Has been administered IV^{† [off-label]} to inhibit uterine contractions in preterm labor^† (tocolysis).¹⁰⁹ ¹¹⁷ ¹²⁴ ¹⁹⁷ Administration of sub-Q injection preparation by other routes (e.g., IV) or methods not recommended by manufacturer.¹⁹⁸ (See Preterm Labor under Cautions.)

Oral Administration

Administer orally 3 times daily during waking hours, at approximately 6-hour intervals.¹⁹⁹

Sub-Q Administration

Inject into lateral deltoid area.¹⁹⁸

IV Administration†

Standardize 4 Safety

Standardized concentrations for IV terbutaline have been established through Standardize 4 Safety (S4S), a national patient safety initiative to reduce medication errors, especially during transitions of care.²⁴⁹ Because recommendations from the S4S panels may differ from the manufacturer’s prescribing information, caution is advised when using concentrations that differ from labeling, particularly when using rate information from the label.²⁴⁹ For additional information on S4S (including updates that may be available), see [Web]. ²⁴⁹

dosing units differ from concentration units

Table 1: Standardize 4 Safety Continuous IV Infusion Standard Concentrations for IV Terbutaline†249
Patient Population	Concentration Standards	Dosing Units
Pediatric patients (<50 kg)	1 mg/mL	mcg/kg/min

Dosage

Available as terbutaline sulfate; dosage expressed in terms of sulfate salt.¹⁹⁸ ¹⁹⁹

Pediatric Patients

Bronchospasm

Asthma

Oral

Children or adolescents 12–15 years of age: 2.5 mg 3 times daily.¹⁹⁹ Do not exceed total dosage of 7.5 mg within a 24-hour period.¹⁹⁹

Sub-Q

Hospitalized children ≤12 years of age^† with acute asthma exacerbation: 0.01 mg/kg has been given every 20 minutes for a total of 3 doses, then every 2–6 hours as needed.²⁰⁹

Children or adolescents ≥12 years of age: 0.25 mg recommended by manufacturer.¹⁹⁸ Repeat dose (0.25 mg) if substantial clinical improvement does not occur within 15–30 minutes.¹⁹⁸ If no response within another 15–30 minutes, consider other therapeutic measures.¹⁹⁸ Manufacturer states total dosage should not exceed 0.5 mg within a 4-hour period.¹⁹⁸

Hospitalized children or adolescents >12 years of age with asthma exacerbation: 0.25 mg every 20 minutes for a total of 3 doses suggested by some clinicians.²⁰⁹

For initial emergency department management of asthma exacerbations in children ≤5 years of age^†, terbutaline has been given as an IV bolus dose of 2 mcg/kg over 5 minutes, followed by continuous IV infusion^† of 5 mcg/kg/hour.¹² Closely monitor the child and adjust dosage according to response.¹²

Adults

Bronchospasm

Asthma

Oral

5 mg 3 times daily, given approximately every 6 hours during waking hours.¹⁹⁹ If disturbing adverse effects occur, reduce dosage to 2.5 mg 3 times daily.¹⁹⁹ Do not exceed total dosage of 15 mg within a 24-hour period.¹⁹⁹

Sub-Q

0.25 mg recommended by manufacturer.¹⁹⁸ Repeat dose (0.25 mg) if substantial clinical improvement does not occur within 15–30 minutes.¹⁹⁸ If no response within another 15–30 minutes, consider other therapeutic measures.¹⁹⁸ Manufacturer states total dosage should not exceed 0.5 mg within a 4-hour period.¹⁹⁸

Hospitalized adults with asthma exacerbation: 0.25 mg every 20 minutes for a total of 3 doses suggested by some clinicians.²⁰⁹

COPD

Oral

Sub-Q

Preterm Labor†

IV†

Carefully adjust rate and duration of infusion according to patient’s response as indicated by uterine response, maternal BP, and maternal and fetal heart rates.¹⁰⁸ ¹⁰⁹ ¹¹⁰ ¹¹¹ ¹¹⁴ ¹¹⁵ ¹¹⁷ ¹¹⁸ ¹²⁴ ¹²⁶

For acute tocolytic therapy, has been initiated at a dosage of 2.5–20 mcg/minute.¹⁰⁸ ¹¹⁰ ¹¹¹ ¹¹⁴ ¹¹⁵ ¹¹⁷ ¹¹⁸ ¹²⁶ Dosage may be increased gradually as tolerated at 10- to 20-minute intervals until desired effects achieved.¹⁰⁸ ¹⁰⁹ ¹¹⁰ ¹¹¹ ¹¹⁴ ¹¹⁵ ¹¹⁷ ¹¹⁸ ¹²⁶ Effective maximum dosages have ranged from 17.5–30 mcg/minute, although higher maximum dosages (e.g., 70–80 mcg/minute) used cautiously in some patients.¹⁰⁸ ¹⁰⁹ ¹¹⁰ ¹¹¹ ¹¹⁴ ¹¹⁵ ¹¹⁷ ¹¹⁸ ¹²⁶

Injection is contraindicated for prolonged tocolysis (beyond 48–72 hours).¹⁹⁸ ²¹⁰ (See Preterm Labor under Cautions and Preterm Labor under Uses.)

Sub-Q

0.25 mg every 0.3–3 hours has been recommended.¹⁸⁸

Temporarily discontinue if pulse rate is >120 bpm.¹⁸⁸

Injection is contraindicated for prolonged tocolysis^† (beyond 48–72 hours).¹⁹⁸ ²¹⁰ (See Preterm Labor under Cautions and Preterm Labor under Uses.)

Prescribing Limits

Pediatric Patients

Bronchospasm

Asthma

Oral

Children 12–15 years of age: Maximum 7.5 mg within a 24-hour period.¹⁹⁹

Sub-Q

Children ≥12 years of age: Maximum: 0.5 mg within a 4-hour period.¹⁹⁸

Adults

Bronchospasm

Asthma

Oral

Maximum 15 mg within a 24-hour period.¹⁹⁹

Sub-Q

Maximum 0.5 mg within a 4-hour period.¹⁹⁸

COPD

Oral

Maximum 15 mg within a 24-hour period.¹⁹⁹

Sub-Q

Maximum 0.5 mg within a 4-hour period.¹⁹⁸

Preterm Labor†

IV^†

Effective maximum dosages have ranged from 17.5–30 mcg/minute; higher maximum dosages (e.g., 70–80 mcg/minute) used cautiously in some patients.¹⁰⁸ ¹⁰⁹ ¹¹⁰ ¹¹¹ ¹¹⁴ ¹¹⁵ ¹¹⁷ ¹¹⁸ ¹²⁶

Injection is contraindicated for prolonged tocolysis (beyond 48–72 hours).¹⁹⁸ ²¹⁰ (See Preterm Labor under Cautions and Preterm Labor under Uses.)

Sub-Q

Injection is contraindicated for prolonged tocolysis (beyond 48–72 hours).¹⁹⁸ ²¹⁰ (See Preterm Labor under Cautions and Preterm Labor under Uses.)

Special Populations

Geriatric Patients

Select dosage with caution because of age-related decreases in hepatic, renal, and/or cardiac function and potential for concomitant disease and drug therapy.¹⁹⁸

Cautions for Terbutaline

Contraindications

Injection: Prolonged tocolysis^† (beyond 48–72 hours); do not use for maintenance tocolysis, particularly in the outpatient or home setting.¹⁹⁸ ²¹⁰ (See Preterm Labor under Cautions and Preterm Labor under Uses.)
Oral: Acute or maintenance tocolysis; do not use for maintenance tocolysis^†, particularly in the outpatient or home setting.¹⁹⁹ ²¹⁰ (See Preterm Labor under Cautions and Preterm Labor under Uses.)
Known hypersensitivity to sympathomimetic agents or any ingredient in formulation.¹⁹⁸ ¹⁹⁹

Warnings/Precautions

Warnings

Preterm Labor

Serious and sometimes fatal adverse effects, including increased heart rate, transient hyperglycemia, hypokalemia, cardiac arrhythmias, pulmonary edema, and myocardial ischemia,¹²⁴ ¹³⁰ ¹⁹⁷ ¹⁹⁸ ¹⁹⁹ ²⁰¹ ²¹⁰ reported after administration in pregnant women.¹⁶¹ ¹⁹⁸ ¹⁹⁹ ²¹⁰ Increased fetal heart rate and neonatal hypoglycemia also may occur following maternal administration.¹³⁰ ¹⁹⁷ ¹⁹⁸ ¹⁹⁹

FDA has received postmarketing reports of maternal death and serious cardiovascular events associated with obstetric use.¹⁶¹ ²¹⁰ FDA has concluded that risk of serious adverse events outweighs any potential benefit to pregnant women receiving prolonged tocolysis with terbutaline injection (beyond 48–72 hours) or receiving acute or prolonged tocolysis with oral terbutaline.¹⁹⁸ ¹⁹⁹ ²¹⁰

Injection is not FDA labeled for and is contraindicated for prolonged tocolysis (beyond 48–72 hours).¹⁹⁸ ²¹⁰ Oral tablets are not FDA labeled for and are contraindicated for acute or maintenance tocolysis.¹⁹⁹ ²⁰¹ ²¹⁰ Do not use terbutaline sulfate (injection or oral tablets) for maintenance tocolysis, particularly in the outpatient or home setting.¹⁹⁸ ¹⁹⁹ ²⁰⁰ ²⁰¹ ²¹⁰ (See Preterm Labor under Uses.)

Report adverse events involving terbutaline to the FDA MedWatch program.²¹⁰

Acute or Worsening Asthma

Failure to respond to a previously effective dosage of terbutaline may indicate seriously worsening asthma.¹⁸³ ¹⁹⁸ ¹⁹⁹ Reevaluate asthma therapy, giving special consideration to possible need for anti-inflammatory treatment (e.g., corticosteroids).¹⁸³ ¹⁹⁸ ¹⁹⁹ Use of β-adrenergic agents alone not adequate to control mild to severe persistent asthma symptoms.¹⁸³ ²⁰⁹

Cardiovascular Effects

Possible clinically important cardiovascular effects, including changes in BP, heart rate, and ECG (e.g., flattening of the T wave, prolongation of the QT_c interval, ST-segment depression).¹⁹⁸ ¹⁹⁹

Cautious use recommended in patients with cardiovascular disorders, including ischemic heart disease, coronary insufficiency, cardiac arrhythmias, and hypertension.¹⁹⁸ ¹⁹⁹ May require drug discontinuance.¹⁹⁸ ¹⁹⁹

Nervous System Effects

Possible CNS stimulation (e.g., nervousness, tremor).¹⁸³ ¹⁹⁸ ¹⁹⁹ ^c Seizures reported rarely; did not recur following drug discontinuance.¹⁹⁸ ¹⁹⁹

Cautious use recommended in patients with seizure disorders and those unusually responsive to sympathomimetic amines¹⁹⁸ ¹⁹⁹

Sensitivity Reactions

Immediate hypersensitivity reactions and exacerbations of bronchospasm reported.¹⁹⁸ ¹⁹⁹

General Precautions

Endocrine and Metabolic Effects

Large IV^† doses may aggravate preexisting diabetes and ketoacidosis.¹⁹⁸ ¹⁹⁹

Use with caution in patients with diabetes mellitus or hyperthyroidism.¹⁹⁸ ¹⁹⁹

Possible hypokalemia;¹⁹⁸ ¹⁹⁹ may increase risk of cardiovascular effects.¹⁹⁸ ¹⁹⁹ Hypokalemia usually transient, not requiring supplementation.¹⁹⁸ ¹⁹⁹

Specific Populations

Pregnancy

Category C.¹⁹⁸ ¹⁹⁹ Restrict use for relief of bronchospasm during labor to women in whom benefits clearly outweigh risks.¹⁹⁸ ¹⁹⁹ (See Preterm Labor under Cautions.)

Lactation

Distributed into milk, but in amounts generally considered insufficient to affect nursing infants.^c Administer to nursing women only if potential benefits to woman outweigh possible risk to infant.¹⁹⁸ ¹⁹⁹

Pediatric Use

Safety and efficacy not established in children <12 years of age.¹⁹⁸ ¹⁹⁹

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.¹⁹⁸ (See Geriatric Patients under Dosage and Administration.)

Common Adverse Effects

Oral: Nervousness,¹⁹⁹ tremor,¹⁹⁹ headache,¹⁹⁹ somnolence,¹⁹⁹ palpitations,¹⁹⁹ dizziness,¹⁹⁹ tachycardia,¹⁹⁹ nausea.¹⁹⁹

Sub-Q: Nervousness,¹⁹⁸ drowsiness,¹⁹⁸ tremor,¹⁹⁸ headache,¹⁹⁸ palpitations.¹⁹⁸

Drug Interactions

Specific Drugs

Drug	Interaction	Comments
Antidepressants, tricyclic	Potentiation of vascular effects¹⁹⁸ ¹⁹⁹	Extreme caution recommended with concomitant therapy or in patients receiving terbutaline ≤2 weeks after discontinuance of tricyclic antidepressants¹⁹⁸ ¹⁹⁹
β-Adrenergic blocking agents	Potential antagonism of pulmonary effects resulting in severe bronchospasm in asthmatic patients¹⁹⁸ ¹⁹⁹	If concomitant therapy required, consider cautious use of cardioselective β-adrenergic blocking agents without intrinsic sympathomimetic activity (e.g., metoprolol, atenolol, esmolol); ¹⁹⁸ ¹⁹⁹ ²⁰² use low dosages initially²⁰²
Diuretics, potassium depleting	Potential for decreased serum potassium concentrations and/or ECG changes, especially when recommended β-adrenergic agonist dosage exceeded¹⁹⁸ ¹⁹⁹	Use concomitantly with caution¹⁹⁸ ¹⁹⁹
MAO inhibitors	Potentiation of vascular effects¹⁹⁸ ¹⁹⁹	Extreme caution recommended with concomitant therapy or in patients receiving terbutaline ≤2 weeks after discontinuance of MAO inhibitors¹⁹⁸ ¹⁹⁹
Sympathomimetic agents	Potential for additive adverse cardiovascular effects¹⁹⁸ ¹⁹⁹ ^c	Concomitant use not recommended¹⁹⁸ ¹⁹⁹ Does not preclude use of an inhaled adrenergic agonist bronchodilator to relieve acute bronchospasm during long-term oral terbutaline therapy¹⁹⁹

Terbutaline Pharmacokinetics

Absorption

Bioavailability

Oral: About 30-50%.

Sub-Q: Well absorbed.^c

Onset

Sub-Q: Measurable changes in expiratory flow rate occur within 5 minutes.¹⁹⁸ Clinically important increases in FEV₁ occur within 15 minutes.¹⁹⁸ Maximum effects occur within 30–60 minutes.¹⁹⁸

Oral: Measurable changes in pulmonary flow rate usually occur within 30 minutes.¹⁹⁹ Substantial clinical improvement in pulmonary function occurs within 1–2 hours.¹⁹⁹ Maximum effects occur within 2–3 hours.¹⁹⁹

Duration

Sub-Q: Clinically important bronchodilator activity may continue for 1.5–4 hours.¹⁹⁸ Duration of clinical improvement similar to equivalent doses (mg for mg) of epinephrine.¹⁹⁸

Oral: Clinically important decreases in airway and pulmonary resistance may persist for ≥4 hours.¹⁹⁹

Distribution

Extent

Crosses placenta¹⁹⁷ ¹⁹⁸ ¹⁹⁹ ²⁰¹ and distributes into milk.^c (See Preterm Labor under Cautions.)

Elimination

Metabolism

Partially metabolized in liver, principally to inactive sulfate conjugate.¹⁹⁸ ¹⁹⁹ ^c

Elimination Route

Following sub-Q administration, excreted principally as unchanged drug (60%) in urine.¹⁹⁸ ¹⁹⁹

Half-life

Sub-Q administration: Mean 5.7 hours.¹⁹⁸

Oral single-dose administration in patients with asthma: Approximately 3.4 hours.¹⁹⁹

Stability

Storage

Oral

Tablets

Tight, light-resistant containers at 15–30°C.¹⁹⁹

Parenteral

Solution for Injection

20–25°C.¹⁹⁸ Protect from light by storing in original carton until use.¹⁹⁸

Actions

Stimulates β-adrenergic receptors of sympathetic nervous system with little or no effect on α-adrenergic receptors.¹⁹⁸ ¹⁹⁹ ^c
Less selective than relatively selective β₂-agonists (e.g., albuterol).^c
No apparent preferential β₂-adrenergic effect following sub-Q administration in controlled clinical studies.¹⁹⁸
Stimulates the production of cyclic adenosine-3′,5′-monophosphate (cAMP), which mediates numerous cellular responses, including bronchial smooth muscle relaxation and inhibition of release of mediators from mast cells in airways.¹⁹⁸ ¹⁹⁹
Decreases resistance of airways.¹⁹⁸ ¹⁹⁹ ^c
Relaxes uterine smooth muscle and inhibits uterine contractions.¹⁰⁸ ¹⁰⁹ ¹¹⁰ ¹¹¹ ¹¹⁵ ¹¹⁶ ¹¹⁷ ¹¹⁸ ¹¹⁹ ¹²⁰ ¹²¹ ¹²² ¹²³ ¹²⁴ ¹²⁵ ¹²⁶ ¹⁸⁸ ¹⁹⁸ ²⁰¹ ^c

Advice to Patients

Importance of understanding proper storage and administration techniques.¹⁹⁹
Importance of adherence to dosing schedules, including not exceeding the recommended dose or frequency of use unless otherwise instructed by clinician.¹⁹⁹
If decreased effectiveness occurs and/or symptoms become worse, contact clinician immediately; do not increase dose or frequency of administration.¹⁹⁹
Importance of using inhaled or other anti-asthma agents only as directed by clinician.¹⁹⁹
Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.¹⁹⁸ ¹⁹⁹ ²¹⁰
Importance of informing patients that serious adverse effects (e.g., maternal cardiac effects, death) reported after prolonged use to manage preterm labor^†.²¹⁰ Importance of informing patients of serious situations where short-term use of the injection in the hospital setting may benefit a pregnant woman.²¹⁰
Importance of informing patients that oral tablets should not be used either to treat preterm labor^† or prevent recurrent preterm labor^†.²¹⁰
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription (e.g., inhaled drugs, other antiasthma agents) and OTC drugs, as well as any concomitant illnesses.¹⁹⁸ ¹⁹⁹
Importance of informing patients of other important precautionary information.¹⁹⁸ ¹⁹⁹ (See Cautions.)

Additional Information

The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer’s labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Terbutaline Sulfate
Routes	Dosage Forms	Strengths	Brand Names
Oral	Tablets	2.5 mg*	Terbutaline Sulfate Tablets
		5 mg*	Terbutaline Sulfate Tablets
Parenteral	Injection, for subcutaneous use only	1 mg/mL*	Terbutaline Sulfate Injection

† Off-label: Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

12. Global Initiative for Asthma (GINA). GINA Report, Global Strategy for Asthma Management and Prevention. GINA. Updated 2022. Accessed Jan 23, 2023. https://ginasthma.org/gina-reports/

25. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2023 report. Accessed Feb 2, 2023. https://goldcopd.org/2023-gold-report-2/

26. Drugs for COPD. Med Lett Drugs Ther. 2020 Sep 7;62(1606):137-144. PMID: 32960872. https://pubmed.ncbi.nlm.nih.gov/32960872

100. Geigy. Brethaire (terbutaline sulfate) inhalation aerosol prescribing information. Summit, NJ; 1995 Nov.

101. Joseph X, Whitehurst VE, Bloom S et al. Enhancement of cardiotoxic effects of beta-adrenergic bronchodilators by aminophylline in experimental animals. Fundam Appl Toxicol. 1981; 1:443-7. https://pubmed.ncbi.nlm.nih.gov/6136445

102. Anon. Interactions between methyl xanthines and beta adrenergic agonists. FDA Drug Bull. 1981; 11:19-20. https://pubmed.ncbi.nlm.nih.gov/6119269

103. Kelly HW. Controversies in asthma therapy with theophylline and the β₂-adrenergic agonists. Clin Pharm. 1984; 3:386-95. https://pubmed.ncbi.nlm.nih.gov/6147224

104. Walker SB, Kradjan WA, Bierman CW. Bitolterol mesylate. A beta-adrenergic agent: chemistry, pharmacokinetics, pharmacodynamics, adverse effects and clinical efficacy in asthma. Pharmacotherapy. 1985; 5:127-37. https://pubmed.ncbi.nlm.nih.gov/3895171

105. Hampson NB, Mueller MP. Cooling of metered-dose inhalers decreases pressure output from canisters. N Engl J Med. 1989; 320:321. https://pubmed.ncbi.nlm.nih.gov/2563147

106. Lourenco RV, Cotromones E. Clinical aerosols: I. Characterization of aerosols and their diagnostic uses. Arch Intern Med. 1982; 142:2163-92. https://pubmed.ncbi.nlm.nih.gov/6753780

107. Geigy. Brethine (terbutaline sulfate) injection prescribing information. Summit, NJ; 1995 Dec.

108. Beall MH, Edgar BW, Paul RH et al. A comparison of ritodrine, terbutaline, and magnesium sulfate for the suppression of preterm labor. Am J Obstet Gynecol. 1985; 153:854-9. https://pubmed.ncbi.nlm.nih.gov/4073155

109. Kosasa TS, Busse R, Wahl N et al. Long-term tocolysis with combined intravenous terbutaline and magnesium sulfate: a 10-year study of 1000 patients. Obstet Gynecol. 1994; 84:369-73. https://pubmed.ncbi.nlm.nih.gov/8058233

110. Caritis SN, Toig G, Heddinger LA et al. A double-blind study comparing ritodrine and terbutaline in the treatment of preterm labor. Am J Obstet Gynecol. 1984; 150:7-14. https://pubmed.ncbi.nlm.nih.gov/6383045

111. Travis BE, McCullough JM. Pharmacotherapy of preterm labor. Pharmacotherapy. 1993; 13:28-36. https://pubmed.ncbi.nlm.nih.gov/8437965

112. Angel JL, O’Brien WF, Knuppel RA et al. Carbohydrate intolerance in patients receiving oral tocolytics. Am J Obstet Gynecol. 1988; 159:726-6.

113. Schreyer P, Caspi E, Snir E et al. Metabolic effects of intramuscular and oral administration of ritodrine in pregnancy. Obstet Gynecol. 1981; 57:730-3. https://pubmed.ncbi.nlm.nih.gov/7231825

114. Finley J, Katz M, Rojas-Perez M et al. Cardiovascular consequences of β-agonist tocolysis: an echocardiographic study. Obstet Gynecol. 1984; 64:787-91. https://pubmed.ncbi.nlm.nih.gov/6150456

115. Ingemarsson I, Bengtsson B. A five-year experience with terbutaline for preterm labor: low rate of severe side effects. Obstet Gynecol. 1985; 66:176-80. https://pubmed.ncbi.nlm.nih.gov/4022480

116. Main EK, Main DM, Gabbe SG. Chronic oral terbutaline tocolytic therapy is associated with maternal glucose intolerance. Am J Obstet Gynecol. 1987; 157:644-7. https://pubmed.ncbi.nlm.nih.gov/3631165

117. Parilla BV, Dooley SL, Minogue JP et al. The efficacy of oral terbutaline after intravenous tocolysis. Am J Obstet Gynecol. 1993; 169:965-9. https://pubmed.ncbi.nlm.nih.gov/8238158

118. How HY, Hughes SA, Vogel RL et al. Oral terbutaline in the outpatient management of preterm labor. Am J Obstet Gynecol. 1995; 173:1518-22. https://pubmed.ncbi.nlm.nih.gov/7503194

119. Adkins RT, Van Hooydonk JE, Bressman PL et al. Prevention of preterm birth: early detection and aggressive treatment with terbutaline. South Med J. 1993; 86:157-64. https://pubmed.ncbi.nlm.nih.gov/8240475

120. Allbert JR, Johnson C, Roberts WE et al. Tocolysis for recurrent preterm labor using a continuous subcutaneous infusion pump. J Reprod Med. 1994; 39:614-8. https://pubmed.ncbi.nlm.nih.gov/7996525

121. Fischer JR, Kaatz BL. Continuous subcutaneous infusion of terbutaline for suppression of preterm labor. Clin Pharm. 1991; 10:292-6. https://pubmed.ncbi.nlm.nih.gov/2032446

122. Lam F, Gill P, Smith M et al. Use of the subcutaneous terbutaline pump for long-term tocolysis. Obstet Gynecol. 1988; 72:810-3. https://pubmed.ncbi.nlm.nih.gov/3173932

123. Perry KG Jr, Morrison JC, Rust OA et al. Incidence of adverse cardiopulmonary effects with low-dose continuous terbutaline infusion. Am J Obstet Gynecol. 1995; 173:1273-7. https://pubmed.ncbi.nlm.nih.gov/7485336

124. American College of Obstetricians and Gynecologists (ACOG) Committee on Technical Bulletins. Preterm labor. Technical Bulletin No. 206. Washington, DC: American College of Obstetricians and Gynecologists; 1995 Jun.

125. Macones GA, Berlin M, Berlin JA. Efficacy of oral beta-agonist maintenance therapy in preterm labor: a meta-analysis. Obstet Gynecol. 1995; 85:313-7. https://pubmed.ncbi.nlm.nih.gov/7824252

126. King JF, Grant A, Keirse MJ et al. Beta-mimetics in preterm labour: an overview of the randomized controlled trials. Br J Obstet Gynaecol. 1988; 95:211-22. https://pubmed.ncbi.nlm.nih.gov/2897207

127. Canadian Preterm Labor Investigators Group. Treatment of preterm labor the beta-adrenergic agonist ritodrine. N Engl J Med. 1992; 327:308-12. https://pubmed.ncbi.nlm.nih.gov/1620169

128. Wilkins IA, Lynch L, Mehalek KE et al. Efficacy and side effects of magnesium sulfate and ritodrine as tocolytic agents. Am J Obstet Gynecol. 1988; 159:685-9. https://pubmed.ncbi.nlm.nih.gov/3048103

129. Astra USA, Inc. Yutopar (ritodrine hydrochloride) injection prescribing information dated April 1995. In: Physicians’ desk reference. 51st ed. Montvale, NJ; Medical Economics Company Inc; 1997:566-7.

130. CibaGeneva. Brethine (terbutaline sulfate) tablets prescribing information. In: Physicians’ desk reference. 50th ed. Montvale, NJ: Medical Economics Company Inc; 1997:831.2.

131. Meyer JM, Wenzel CL, Kradjan WA. Salmeterol: a novel, long-acting beta 2-agonist. Ann Pharmacother. 1993; 27:1478-87. https://pubmed.ncbi.nlm.nih.gov/7905757

132. Brogden RN, Faulds D. Salmeterol xinafoate: a review of its pharmacological properties and therapeutic potential in reversible obstructive airways disease. Drugs. 1991; 42:895-912. https://pubmed.ncbi.nlm.nih.gov/1723379

133. Kelly HW. Issues and advances in the pharmacotherapy of asthma. J Clin Pharm Ther. 1992; 17:271-81. https://pubmed.ncbi.nlm.nih.gov/1361192

134. Lipworth BJ. Risks versus benefits of inhaled β₂-agonists in the management of asthma. Drug Safety. 1992; 7:54-70. https://pubmed.ncbi.nlm.nih.gov/1346963

135. Sears MR, Taylor DR, Print CG et al. Regular inhaled beta-agonist treatment in bronchial asthma. Lancet. 1990; 336:1391-6. https://pubmed.ncbi.nlm.nih.gov/1978871

136. Anon. Warnings from the CSM. Int Pharm J. 1991; 5:247-8.

137. Spitzer WO, Sussa S, Ernst P et al. The use of β-agonists and the risk of death and near death from asthma. N Engl J Med. 1992; 326:501-6. https://pubmed.ncbi.nlm.nih.gov/1346340

138. Palmer JBD, Jenkins MM. β₂-agonists in asthma. Lancet. 1991; 337:43. https://pubmed.ncbi.nlm.nih.gov/1670660

139. Dahl R. β₂-agonists in asthma. Lancet. 1991; 337:43. https://pubmed.ncbi.nlm.nih.gov/1670660

140. Löfdahl CG, Svedmyr N. Beta agonists—friends or foes? Eur Respir J. 1991; 4:1161-5. Editorial.

141. Kamada AK, Spahn JD, Blake KV. Salmeterol: its place in asthma management. Ann Pharmacother. 1994; 28:1100-2. https://pubmed.ncbi.nlm.nih.gov/7803888

142. Wanner A. Is the routine use of inhaled β-adrenergic agonists appropriate in asthma treatment? Yes. Am J Respir Crit Care Med. 1995; 151:597-9. https://pubmed.ncbi.nlm.nih.gov/7881643

143. Sears MR. Is the routine use of inhaled β-adrenergic agonists appropriate in asthma treatment? No. Am J Respir Crit Care Med. 1995; 151:600-1. https://pubmed.ncbi.nlm.nih.gov/7881644

144. Lai CKW, Twentyman OP, Holgate ST. The effect of an increase in inhaled allergen dose after rimiterol hydrobromide on the occurrence and magnitude of the late asthmatic response and the asssociated change in nonspecific bronchial responsiveness. Am Rev Respir Dis. 1989; 140:917-23. https://pubmed.ncbi.nlm.nih.gov/2572192

145. Suissa S, Ernst P, Boivin JF et al. A cohort analysis of excess mortality in asthma and the use of inhaled beta-agonists. Am J Respir Crit Care Med. 1994; 149(3 Part 1):604-10. https://pubmed.ncbi.nlm.nih.gov/8118625

146. O’Connor BJ, Aikman SL, Barnes PJ. Tolerance to the nonbronchodilator effects of inhaled beta 2-agonists in asthma. N Engl J Med. 1992; 327:1204-8. https://pubmed.ncbi.nlm.nih.gov/1357551

147. Cockcroft DW, McParland CP, Britto SA et al. Regular inhaled salbutamol and airway responsiveness to allergen. Lancet. 1993; 342:833-7. https://pubmed.ncbi.nlm.nih.gov/8104272

148. Mullen ML, Mullen B, Carey M. The association between β-agonist use and death from asthma: a meta-analytic integration of case-control studies. JAMA. 1993; 270:1842-5. https://pubmed.ncbi.nlm.nih.gov/8105113

149. Reviewers’ comments (personal observations) on Salmeterol Xinafoate 12:12.

150. National Institutes of Health, National Heart, Lung, and Blood Institute. Global Initiative for asthma: global strategy for asthma management and prevention NHLBI/WHO Workshop Report. Bethesda, MD: National Institutes of Health. 1995 Jan:77-100. NIH/NHLBI Publication No. 95-3659.

151. Devoy MAB, Fuller RW, Palmer JBD. Are there any detrimental effects of the use of inhaled long-acting β₂-agonists in the treatment of asthma? Chest. 1995; 107:1116-24.

152. McFadden ER Jr. Perspectives in β₂-agonist therapy: vox clamantis in deserto vel lux in tenebris? J Allergy Clin Immunol. 1995; 95:641-51.

153. Crane J, Burgess C, Pearce N et al. Asthma deaths in New Zealand. BMJ. 1992; 304:1307. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1881872/ https://pubmed.ncbi.nlm.nih.gov/1606438

154. Crane J, Pearce N, Flatt A et al. Prescribed fenoterol and death from asthma in New Zealand, 1981-83: case-control study. Lancet. 1989; 1:917-22. https://pubmed.ncbi.nlm.nih.gov/2565417

155. Löfdahl CG, Svedmyr N. Beta agonists—friends or foes? Eur Respir J. 1991; 4:1161-5. Editorial.

156. Sisson MC. Preventing preterm labor. Is trebutaline our best option? AWHONN Lifelines. 1997; 1:42-6.

157. Allbert JR, Johnson C, Roberts WE et al. Tocolysis for recurrent preterm labor using a continuous subcutaneous infusion pump. J Reprod Med. 1994; 39:614-8. https://pubmed.ncbi.nlm.nih.gov/7996525

158. Moise KJ, Sala DJ, Zurawin RK et al. Continuous subcutaneous terbutaline pump therapy for premature labor: safety and efficacy. South Med J. 1992; 85:255-60. https://pubmed.ncbi.nlm.nih.gov/1546349

159. Wenstrom KD, Weiner CP, Merrill D et al. A placebo-controlled randomized trial of the terbutaline pump for prevention of preterm delivery. Am J Perinatol. 1997;14:87-91.

160. Perry KG, Morrison JC, Rust OA et al. Incidence of adverse cardiopulmonary effects with low dose continuous terbutaline infusion. Am J Obset Gynecol. 1995;173:1273-7.

161. Nightingale SL. Dear healthcare provider letter concerning proper use of terbutaline. Rockville, MD: US Food and Drug Administration; 1997 Nov 13.

162. Hudgens DR, Conradi SE. Sudden death associated with terbutaline sulfate Am J Obstet Gynecol. 1993;169:120-1.

163. Lindenbaum C, Ludmir J, Teplick FB et al. Maternal glucose intolerance and the subcutaneous terbutaline pump. Am J Obstet Gynecol. 1992: 166: 925-8. (IDIS 293989)

164. Adkins RT. Terbutaline pump treatment of premature labor. South Med J. 1993; 86: 1076. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493388/ https://pubmed.ncbi.nlm.nih.gov/8240475

165. National Asthma Education and Prevention Program. Expert panel report II: guidelines for the diagnosis and management of asthma. 1997 Feb.

166. National Asthma Education Program. Executive summary: guidelines for the diagnosis and management of asthma. NIH Publ. No.94-3042A. Washington, DC: US Government Printing Office; 1994 Jul.

167. National Institutes of Health, National Heart, Lung, and Blood Institute. Global Initiative for asthma: global strategy for asthma management and prevention NHLBI/WHO Workshop Report. Bethesda, MD: National Institutes of Health. 1995 Jan:77-100. NIH/NHLBI Publication No. 95-3659.

168. British Thoracic Society. Guidelines on the management of asthma. Thorax. 1993; 48(2 Suppl):S1-24.

169. Allen & Hanburys. Serevent (salmeterol xinafoate) inhalation aerosol prescribing information. Research Triangle Park, NC; 1994 Dec.

170. Allen & Hanburys. Serevent (salmeterol xinafoate) inhalation aerosol patient instructions. Research Triangle Park, NC; 1994 Feb.

171. Bone RC. Another word of caution regarding a new long-acting bronchodilator. JAMA. 1995; 273:967-8. https://pubmed.ncbi.nlm.nih.gov/7884959

172. Reviewers’ comments (personal observations) on salmeterol.

173. Anon. Warnings from the CSM. Int Pharm J. 1991; 5:247-8.

174. American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1995; 152: s77-120.

175. Siafakas NM, Vermeire P, Pride NB et al. Optimal assessment and management of chronic obstructive pulmonary disease (COPD). Eur Respir J. 1995: 8; 1398-1420.

176. Boehringer Ingelheim. Atrovent (ipratropium bromide) inhalation aerosol prescribing information. Ridgefield, CT; 1993 June.

177. Pearlman DS, Chervinsky P, LaForce C et al. A comparison of salmeterol with albuterol in the treatment of mild-to-moderate asthma. N Engl J Med. 1992; 327:1420-5.

178. D’Alonzo GE, Nathan RA, Henochowicz S et al. Salmeterol xinafoate as maintenance therapy compared with albuterol in patients with asthma. JAMA. 1994; 271:1412-6.

179. Drazen JM, Israel E, Boushey HA et al. Comparison of regularly scheduled with as- needed use of albuterol in mild asthma. N Engl J Med. 1996; 335:841-7.

180. National Asthma Education and Prevention Program. Expert panel report: guidelines for the diagnosis and management of asthma-update on selected topics 2002. Bethesda, Md: National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program Coordinating Committee; 2003 Jun. Available from National Heart, Lung, and Blood Institute Information Center, NIH Publication No. 02-5074. Also available from website. Accessed 2004 Sep. 15. http://www.nhlbi.nih.gov

181. Papageorgiou AN, Doray JL, Ardila R et al. Reduction of mortality, morbidity, and respiratory distress syndrome in infants weighing less than 1,000 grams by treatment with betamethasone and ritodrine. Pediatrics. 1989; 83:493-7. https://pubmed.ncbi.nlm.nih.gov/2927987

182. Veterans’ Health Administration Department of Veteran Affairs. The pharmacologic management of chronic obstructive pulmonary disease. Washington, DC: Veterans’ Health Administration; 1999 June. Pharmacy Benefits Management No. 99-0012. Available from website. Accessed Sep. 30, 2002. http://www.pbm.va.gov

183. National Institutes of Health, National Heart, Lung, and Blood Institute. Global Initiative for asthma: global strategy for asthma management and prevention. Bethesda, MD: National Institutes of Health. 2009 Dec. Available from website. Accessed 2010 Sep 23. http://www.ginasthma.com

184. National Heart, Lung, and Blood Institute/World Health Organization. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Bethesda, MD: National Heart, Lung, and Blood Institute, Global Initiative for Chronic Obstructive Lung Disease, World Health Organization; 2001. Available from website. Accessed Sep. 26, 2002. http://www.goldcopd.com

185. Boehringer Ingelheim. Atrovent (ipratropium bromide) inhalation aerosol prescribing information. Ridgefield, CT; 1999 Mar.

186. Snow V, Lascher S, Mottur-Pilson C for the Joint Expert Panel of Chronic Obstructive Pulmonary Disease of the American College of Chest Physicians and the American College of Physicians-American Society of Internal Medicine. Evidence base for management of acute exacerbations of chronic obstructive pulmonary disease. Clinical Practice Guideline, pt.1. Ann Intern Med. 2001; 134:595-9. https://pubmed.ncbi.nlm.nih.gov/11281744

187. Veterans’ Health Administration, Department of Veterans’ Affairs. VHA/DOD clinical practice guideline for the management of chronic obstructive pulmonary disease: complete summary. Washington, DC: Veterans’ Health Administration; 1999 Aug.

188. American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins. Management of preterm labor. Washington, DC; American College of Obstetricians and Gynecologists: 2003 May. Practice Bulletin No. 43.

189. Roberts D, Dalziel S. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev. 2006; 3:CD004454.

191. American Thoracic Society / European Respiratory Society Task Force. Standards for the diagnosis and management of patients with COPD. Version 1.2, for health professionals. New York, NY: American Thoracic Society, European Respiratory Society; 2005 Sep 8. Available from website. Accessed Aug 10, 2007. http://www.thoracic.org/clinical/copd-guidelines

192. National Heart, Lung, and Blood Institute/World Health Organization. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Bethesda, MD: National Heart, Lung, and Blood Institute, Global Initiative for Chronic Obstructive Lung Disease, World Health Organization; 2006 Nov. Available from website. Accessed Jun. 13, 2007. http://www.goldcopd.com

193. O’Donnell DE, Aaron S, Bourbeau J et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease-2003. Can Respir J. 2003; 10(Suppl. A):11A-65A. https://pubmed.ncbi.nlm.nih.gov/12861361

194. Celli BR, Macnee W. Standard for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004; 23:932-46. https://pubmed.ncbi.nlm.nih.gov/15219010

195. American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1995; 152: s77-120.

196. Siafakas NM, Vermeire P, Pride NB et al. Optimal assessment and management of chronic obstructive pulmonary disease (COPD). Eur Respir J. 1995: 8; 1398-1420.

197. Anotayanonth S, Subhedar NV, Garner P et al. Betamimetics for inhibiting preterm labour. Cochrane Database Syst Rev. 2004; :CD004352.

198. Bedford Laboratories. Terbutaline sulfate injection prescribing information. Bedford, OH; 2011 Apr.

199. Global Pharmaceuticals. Terbutaline sulfate tablets prescribing information. Philadelphia, PA; 2011 Feb.

200. Nanda K, Cook LA, Gallo MF et al. Terbutaline pump maintenance therapy after threatened preterm labor for preventing preterm birth. Cochrane Database Syst Rev. 2002; :CD003933. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171455/

201. Dodd JM, Crowther CA, Dare MR et al. Oral betamimetics for maintenance therapy after threatened preterm labour. Cochrane Database Syst Rev. 2006; :CD003927.

202. Tafreshi MJ, Weinacker AB. Beta-adrenergic-blocking agents in bronchospastic diseases: a therapeutic dilemma. Pharmacotherapy. 1999; 19(8):974-8. https://pubmed.ncbi.nlm.nih.gov/10453968

205. American Thoracic Society/European Respiratory Society. Standards for the diagnosis and management of patients with COPD: patient version. New York, NY: American Thoracic Society, European Respiratory Society; 2004. Available from website. Accessed Aug 20, 2007. http://www.thoracic.org/clinical/copd-guidelines

209. National Asthma Education and Prevention Program. Expert panel report III: guidelines for the diagnosis and management of asthma. 2007 Jul. Bethesda, MD: U.S. Department of Health and Human Services; National Institutes of Health; National Heart, Lung, and Blood Institute. Available from website. Accessed Jul 27, 2008. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm

210. US Food and Drug Administration. FDA drug safety communication: New warnings against use of terbutaline to treat preterm labor. Rockville, MD; 2011 Feb 17. From FDA website. Accessed 2011 Jul 6. http://www.fda.gov/Drugs/DrugSafety/ucm243539.htm

211. Simhan HN, Caritis SN. Prevention of preterm delivery. N Engl J Med. 2007; 357:477-87. https://pubmed.ncbi.nlm.nih.gov/17671256

212. Berkman ND, Thorp JM, Lohr KN et al. Tocolytic treatment for the management of preterm labor: a review of the evidence. Am J Obstet Gynecol. 2003; 188:1648-59. https://pubmed.ncbi.nlm.nih.gov/12825006

213. Sayres WG. Preterm labor. Am Fam Physician. 2010; 81:477-84. https://pubmed.ncbi.nlm.nih.gov/20148502

249. ASHP. Standardize 4 Safety: pediatric continuous infusion standard. Updated 2024 Mar. From ASHP website. Updates may be available at ASHP website. https://www.ashp.org/standardize4safety

HID. Trissel LA. Handbook on injectable drugs. 14th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2007:1533-4.

c. AHFS Drug Information 2007. McEvoy GK, ed. Terbutaline. Bethesda, MD: American Society of Health-System Pharmacists; 2007:1333-6.