Terbutaline

eMC §4.2 (Bricanyl Respules 2.5 mg/ml Nebuliser Solution, emc product 868): 'In most patients, the use of terbutaline sulfate, based on the doses below, given 2-4 times daily will be sufficient to relieve bronchospasm. In acute, severe asthma, additional doses may be necessary.' MAINTENANCE CONTEXT: when used as maintenance therapy the patient should also receive optimal anti-inflammatory therapy, e.g. inhaled corticosteroids or leukotriene receptor antagonists. ELDERLY: dosage as for adults. PAEDIATRIC (weight/age bands in mg, not a per-kg dose, so not expressed in the structured paedDose field): Respules — children over 25 kg, 1 Respule (5 mg); children under 25 kg, use multidose bottles. Multidose bottles — children 0.2 to 0.5 ml (2 to 5 mg) diluted to the required nebuliser volume with sterile physiological saline, per the SPC table of undiluted solution volumes: age under 3 / average 10 kg (22 lb) = 2.0 mg = 0.2 ml; age 3 / 15 kg (33 lb) = 3.0 mg = 0.3 ml; age 6 / 20 kg (44 lb) = 4.0 mg = 0.4 ml; age 8+ / 25+ kg (55+ lb) = 5.0 mg = 0.5 ml. Verify any under-18 use against a children's formulary. HOME NEBULISER RESTRICTION (§4.2): private purchase of nebuliser devices for use at home to deliver rescue therapy for the acute treatment of asthma in children and adolescents is not recommended; only specialists in respiratory medicine should initiate and clinically manage home nebuliser use for acute asthma in children and adolescents, children should be trained in correct device use and supervised by a responsible adult, and urgent medical assistance should be sought if worsening symptoms are not relieved by rescue medicines even if there is short-term recovery. OVERUSE (§4.4): overuse of short-acting beta-agonists may mask progression of the underlying disease and contribute to deteriorating asthma control, with increased risk of severe exacerbations and mortality — patients taking more than twice a week additional 'as needed' terbutaline should be re-evaluated. Caution in thyrotoxicosis; not to be used in hypertrophic cardiomyopathy; additional blood glucose monitoring initially in diabetic patients; potentially serious hypokalaemia may result from beta2-agonist therapy, with particular caution in acute severe asthma where the risk may be augmented by hypoxia. SOURCE CAVEATS: the fetched §4.4 was cut off at the source-fetch limit and §4.5 was not captured at all. The openFDA record in this bundle is terbutaline sulfate ORAL TABLETS — a different formulation and route — and none of its figures have been used here. SUPERSEDES EARLIER HOLD: a previous draft of this page was held because the bundle then held the Bricanyl Injection SPC and had carried an obstetric tocolysis infusion regimen onto this respiratory page. The bundle has since been re-fetched to the nebuliser solution SPC; no injection or tocolysis figure appears in this draft.