Can terbutaline be used in pregnant patients with asthma?

From the Guidelines

Terbutaline can be used in pregnant patients with asthma, but it is generally considered a second-line treatment option due to its potential cardiovascular effects on both mother and fetus 1. The preferred inhaled short-acting beta-agonists during pregnancy are albuterol (salbutamol) and levalbuterol, which have more established safety profiles 1. If terbutaline is needed, it should be used at the lowest effective dose for the shortest duration necessary to control symptoms. For acute asthma symptoms, the typical adult dose is 0.25 mg subcutaneously, which may be repeated in 15-30 minutes if needed, or 2-3 inhalations of the aerosol form every 4-6 hours 1. Some key points to consider when using terbutaline in pregnant patients with asthma include:

• Maintaining good asthma control is crucial for ensuring adequate oxygen supply to the developing fetus 1
• The benefits of treating asthma generally outweigh the potential risks of medication use 1
• Continuous use of terbutaline, especially in oral form, should be avoided during pregnancy due to potential cardiovascular effects on both mother and fetus 1
• The safety of asthma medications during pregnancy must be balanced against the risks of uncontrolled asthma, which can lead to serious complications including preeclampsia, preterm birth, and low birth weight 1. It is essential to monitor the level of asthma control and lung function during prenatal visits and adjust treatment as needed to ensure the best possible outcomes for both the mother and the fetus 1.

From the FDA Drug Label

Pregnancy -Teratogenic Effects Pregnancy Category C There are no adequate and well-controlled studies of terbutaline sulfate in pregnant women Terbutaline sulfate should be used during pregnancy only if the potential benefits justify the potential risk to the fetus. Use In Labor and Delivery Because of the potential for beta-agonist interference with uterine contractility, use of terbutaline sulfate injection for relief of bronchospasm during labor should be restricted to those patients in whom the benefits clearly outweigh the risk

Terbutaline can be used in pregnant patients with asthma, but caution is advised. The decision to use terbutaline in pregnant patients should be made on a case-by-case basis, considering the potential benefits and risks to the fetus. Key considerations include:

• Potential benefits: Relief of bronchospasm in asthma patients
• Potential risks: Increased heart rate, transient hyperglycemia, hypokalemia, cardiac arrhythmias, pulmonary edema, and myocardial ischemia in the mother, as well as increased fetal heart rate and neonatal hypoglycemia 2

From the Research

Terbutaline Use in Pregnant Patients with Asthma

• Terbutaline is a beta2-adrenergic agonist medication that can be prescribed during pregnancy to treat conditions such as asthma 3.
• The use of terbutaline in pregnant women has been studied, and it has been found that the plasma concentration of terbutaline is lowered and clearance is increased in pregnant women 4.
• There is no direct evidence to suggest that terbutaline is harmful to pregnant patients with asthma, but it is essential to weigh the risks and benefits of treatment versus non-treatment of asthma during pregnancy 3.

Pharmacokinetics of Terbutaline in Humans

• A systematic review of the pharmacokinetics of terbutaline in humans found that the oral route of administration depicted a linear relationship between plasma concentration and the administered dose 4.
• The review also found that the intravenous route of administration demonstrated multi-exponential behavior for disposition and renal clearance, and that higher systemic availability was observed with the inhaled route compared to the oral route 4.

Efficacy and Safety of Terbutaline in Asthma Treatment

• A retrospective study found that continuous terbutaline infusion could be a treatment option for severe unstable asthma and may reduce hospital admissions, but it is associated with significant side effects 5.
• Another study found that terbutaline administration in pediatric patients with severe asthma exacerbations was not associated with decreased PICU or general hospital floor admission 6.
• A comparison study found that an inhaled corticosteroid, budesonide, was more effective than terbutaline in improving peak expiratory flow and reducing symptoms of asthma in newly detected asthma patients 7.