Terbutaline

How it works

It selectively stimulates beta-2 adrenoceptors on airway smooth muscle, raising intracellular cyclic AMP and producing rapid bronchodilatation.

Prescribing in practice

• Increasing or excessive use signals deteriorating asthma control and the need to review and step up preventer therapy rather than simply relying on more reliever.
• Use with caution in cardiovascular disease, hyperthyroidism and diabetes, and be alert to additive hypokalaemia with corticosteroids, theophylline and diuretics.
• High parenteral or nebulised doses can cause tachycardia, tremor and significant hypokalaemia requiring monitoring.

Monitoring

Monitor asthma control and reliever frequency, and check serum potassium when high doses are given, especially in severe acute asthma.

Counselling the patient

• This is a reliever for symptoms, not a preventer; seek urgent help if it is needed more often or works less well.
• Some shakiness or a faster heartbeat after dosing is common and usually settles.

Evidence & guidelines

Terbutaline is an established SABA whose efficacy and safety profile underpin its place in UK asthma guidance alongside other short-acting bronchodilators.