Oral Terbutaline Dosing for Children ≥2 Months
The evidence provided does not contain specific oral terbutaline dosing recommendations for children aged ≥2 months or older. The available guidelines focus primarily on nebulized terbutaline for acute asthma management in pediatric patients, not oral formulations.
Available Evidence on Terbutaline in Children
Nebulized Dosing (Acute Asthma)
- For acute severe asthma in children, nebulized terbutaline is dosed at 10 mg (or half doses in very young children, meaning 5 mg) via oxygen-driven nebulizer 1
- This represents the standard acute care dosing, not maintenance oral therapy 1
Critical Gap in Evidence
- None of the provided guidelines specify oral terbutaline dosing for pediatric patients by weight, dosing interval, or maximum doses 1
- The British Thoracic Society guidelines mention subcutaneous terbutaline (2.5 mg) as an alternative route but do not address oral dosing in children 1
Adult Oral Dosing (For Reference Only)
- In adults, oral terbutaline has been studied at 5 mg three times daily for maintenance therapy 2
- Adult studies show oral terbutaline 5-10 mg produces bronchodilation with peak effects at 1-4 hours and duration up to 6 hours 3
- These adult doses cannot be safely extrapolated to pediatric patients without weight-based adjustments 2, 3
Important Safety Considerations
Adverse Effects Requiring Monitoring
- Tachycardia and tremor are dose-dependent side effects of terbutaline that occur with both oral and inhaled routes 3
- Sequential doses of parenteral terbutaline cause clinically significant hypokalemia (mean reduction -1.1 mEq/L) with associated QTc prolongation 4
- The hypokalemic effect is temporally related to bronchodilation and represents a significant safety concern 4
Monitoring Parameters
- Heart rate should be monitored, as terbutaline causes dose-dependent tachycardia 3
- Serum potassium monitoring is essential with repeated dosing due to risk of clinically significant hypokalemia 4
- ECG monitoring for QTc prolongation should be considered, particularly with frequent or high-dose administration 4
Tolerance Development
- Long-term oral terbutaline (5 mg three times daily for 12 months) does not cause bronchial beta-receptor resistance, though tolerance to tremor develops within one month 2
- Cardiac beta-receptor sensitivity is generally preserved in most patients during chronic therapy 2
Clinical Recommendation
Given the absence of pediatric oral terbutaline dosing guidelines in the provided evidence, and the clear preference in modern guidelines for inhaled beta-agonists over oral formulations, oral terbutaline should not be used in pediatric patients when inhaled alternatives are available. The British Thoracic Society and other guideline bodies consistently recommend nebulized or MDI-delivered beta-agonists as first-line therapy for children 1.
If oral terbutaline must be considered, consultation with a pediatric pulmonologist and reference to current manufacturer prescribing information is essential, as the provided evidence does not support safe weight-based dosing recommendations for children.