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Uses

Bronchospasm in Asthma

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

Current asthma management guidelines suggest use of oral β₂-adrenergic agonist therapy principally in patients unable to use inhaled bronchodilators (e.g., young children). Oral administration associated with slower onset of action and increased incidence of adverse effects.

Sub-Q terbutaline generally used for relief of acute exacerbations of asthma in hospitalized patients. No proven advantage of sub-Q administration compared with oral inhalation (no longer commercially available in US).

Bronchospasm in COPD

Symptomatic management of reversible bronchospasm associated with chronic bronchitis and emphysema.

Inhaled β₂-adrenergic agonists preferred over oral β₂-adrenergic agonist therapy for treatment of COPD; long-acting inhaled bronchodilators more effective and convenient than short-acting agents. Oral β₂-adrenergic agonist use associated with slower onset of action and increased incidence of adverse effects compared with inhaled therapy.

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

Antenatal Use in Preterm Labor

Acute IV† and sub-Q therapy in selected women to inhibit uterine contractions in preterm labor† (tocolysis) and prolong gestation when beneficial.

Manufacturers state that terbutaline should not be used for tocolysis. However, available data suggest that acute sub-Q β-adrenergic agonist treatment may forestall labor for 48 hours, providing time for patients to be transferred to other (e.g., tertiary-care) facilities and/or receive other agents (e.g., corticosteroids) to increase fetal maturation (e.g., lung maturation). Any other potential benefits of such drugs in prolonging pregnancy are unclear.

American College of Obstetricians and Gynecologists (ACOG) states that because of limited comparative studies, there is no clear first-line tocolytic agent.

Maintenance therapy with sub-Q infusion or oral β-adrenergic agonists, including terbutaline, in women with arrested preterm labor not shown to decrease risk of preterm birth. Current evidence considered inadequate to support use of sub-Q infusion or oral maintenance therapy. FDA states that safety and efficacy of sub-Q infusion maintenance therapy not adequately demonstrated and that such therapy is potentially dangerous. (See Preterm Labor under Cautions.)

Tocolytic therapy in general may be contraindicated by certain maternal or fetal conditions (e.g., advanced cervical dilation, acute fetal distress other than intrauterine resuscitation, placental insufficiency, chorioamnionitis, eclampsia or severe preeclampsia, fetal demise [singleton], lethal congenital or chromosomal abnormalities, fetal maturity, maternal hemodynamic instability, placental abruption, intrauterine infection), and specifically, β-adrenergic agonist therapy may be contraindicated by other conditions (e.g., maternal cardiac rhythm disturbances or certain other cardiac diseases, poorly controlled diabetes mellitus, thyrotoxicosis, hypertension).