The Basics
What is Terbutaline?
Used as a reliever inhaler in the management of asthma symptoms and as a tocolytic (anti-contraction medication) to delay preterm labor for up to 48 hours.
Brand names for Terbutaline
Brethine
How Terbutaline is classified
Bronchodilator Agents, Beta Adrenergic Agonists
Terbutaline During Pregnancy
Terbutaline pregnancy category
Category BNote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Terbutaline while pregnant
A reproduction study in Sprague-Dawley rats revealed terbutaline sulfate was not teratogenic when administered orally at doses up to 50 mg/kg (approximately 810 times the maximum recommended daily sc dose for adults on a mg/m2 basis). A reproduction study in New Zealand white rabbits revealed terbutaline sulfate was not teratogenic when administered orally at doses up to 50 mg/kg (approximately 1,600 times the maximum recommended daily sc dose for adults on a mg/m2 basis). There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human responses, terbutaline should be used during pregnancy only if the potential benefits justify the potential risk to the fetus.
Taking Terbutaline While Breastfeeding
What are recommendations for lactation if you're taking Terbutaline?
Maternal use of oral or inhaled terbutaline is unlikely to affect a breastfed infant. The authors of several reviews and an expert panel agree that use of inhaled bronchodilators is acceptable during breastfeeding because of the low bioavailability and maternal serum levels after use.[1][2][3][4][5] Terbutaline use as a tocolytic agent might decrease the duration of breastfeeding.
Maternal / infant drug levels
Maternal use of oral or inhaled terbutaline is unlikely to affect a breastfed infant. The authors of several reviews and an expert panel agree that use of inhaled bronchodilators is acceptable during breastfeeding because of the low bioavailability and maternal serum levels after use.[1][2][3][4][5] Terbutaline use as a tocolytic agent might decrease the duration of breastfeeding.
Possible effects of Terbutaline on milk supply
A small retrospective survey from Serbia found that mothers who received a beta agonist pharmacologically similar to terbutaline (fenoterol or hexoprenaline) as a tocolytic breastfed for a shorter period of time than those who received no tocolytic (4.5 vs 9.5 months).[9] It is not known if terbutaline has a similar effect.
Possible alternatives to Terbutaline
None listed
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/1. McDonald CF, Burdon JGW. Asthma in pregnancy and lactation. A position paper for the Thoracic Society of Australia and New Zealand. Med J Aust. 1996;165:485-8.
2. Ellsworth A. Pharmacotherapy of asthma while breastfeeding. J Hum Lact. 1994;10:39-41. PMID: 7619245
3. Nelson-Piercy C. Asthma in pregnancy. Thorax. 2001;56:325-8. PMID: 11254828
4. Taddio A, Ito S. Drugs and breast-feeding. In, Koren G, ed. Maternal-fetal toxicology. A clinician’s guide. 3rd ed. New York. Marcel Dekker. 2001;177-32.
5. National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program Asthma and Pregnancy Working Group. NAEPP expert panel report. Managing asthma during pregnancy: recommendations for pharmacologic treatment-2004 update. 2004;1-57. http://www.nhlbi.nih.gov/health/prof/lung/asthma/astpreg.htm
6. Boreus LO, de Chateau P, Lindberg C et al. Terbutaline in breast milk. Br J Clin Pharmacol. 1982;13:731-2. Letter. PMID: 7082542
7. Lonnerholm G, Lindstrom B. Terbutaline excretion into breast milk. Br J Clin Pharmacol. 1982;13:729-30. Letter. PMID: 7082541
8. Lindberg C, Boreus LO, de Chateau P et al. Transfer of terbutaline into breast milk. Eur J Resp Dis. 1984;65 (Suppl 134):87-91. PMID: 6586490
9. Bjelakovic L, Trajkovic T, Kocic G et al. The association of prenatal tocolysis and breastfeeding duration. Breastfeed Med. 2016;11:561-3. PMID: 27704871
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
