Beta-2 Agonist — Acute Tocolysis Pregnancy: Used intrapartum for acute tocolysis — fetal tachycardia expected but resolves as drug wears off

Terbutaline (Acute Tocolysis / Fetal Bradycardia)

Brand names: Bricanyl

Adult dose

Dose: Acute tocolysis: 250 micrograms SC single dose. Fetal bradycardia (CTG): 250 micrograms SC single dose

Route: Subcutaneous

Frequency: Single dose; may repeat once after 15 minutes if needed

Max: 500 micrograms total (two doses)

NOT for prolonged tocolysis (MHRA restriction) — only short-term (maximum 48 hours) to allow transfer or corticosteroid administration. Fetal bradycardia from uterine hyperstimulation: 250 micrograms SC — rapidly relaxes uterus

Paediatric dose

Dose: Not applicable N/A/kg

Route: N/A

Frequency: N/A

Max: N/A

Maternal medication

Dose adjustments

Renal

Use with caution in renal impairment

Hepatic

Use with caution

Paediatric weight-based calculator

Patient weight (kg)

Maternal medication

Clinical pearls

MHRA 2011 safety restriction: Subcutaneous terbutaline for tocolysis restricted to maximum 48-72 hours — prolonged oral or IV use associated with maternal pulmonary oedema deaths; oral terbutaline withdrawn for tocolysis
Acute intrapartum use: terbutaline 250 micrograms SC is RCOG and ALSO recommended treatment for uterine hyperstimulation causing fetal bradycardia — relieves tachysystole within 60-90 seconds; essential drug in obstetric emergencies
Hypokalaemia: beta-2 stimulation drives K into cells — monitor potassium especially if concurrent corticosteroids given (also cause hypokalaemia)
Pulmonary oedema risk: increased with IV use, multiple gestation, fluid overload, or concurrent steroids — restrict to SC route for acute use
Atosiban (oxytocin antagonist) is now preferred for sustained tocolysis — superior safety profile for longer-term use

Contraindications

Prolonged tocolysis beyond 48 hours (MHRA 2011)
Antepartum haemorrhage requiring immediate delivery
Eclampsia or severe pre-eclampsia
Intrauterine infection

Side effects

Maternal tachycardia
Palpitations
Tremor
Headache
Hypokalaemia (monitor potassium)
Pulmonary oedema (with IV use or prolonged treatment)
Fetal tachycardia

Interactions

Beta-blockers (antagonism)
Corticosteroids (hypokalaemia risk)
MAOIs (enhanced cardiovascular effects)
Digoxin (hypokalaemia increases toxicity)

Monitoring

Maternal heart rate and blood pressure
Fetal heart rate (CTG)
Potassium
Respiratory rate and oxygen saturation
Blood glucose (beta-2 stimulation raises glucose)

Reference: BNFc; BNF 90; MHRA Drug Safety Update 2011 (terbutaline tocolysis); RCOG Green-top 1b (Tocolysis); ALSO Advanced Life Support in Obstetrics. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators