Drug class: Selective beta-2-Adrenergic Agonists

Medically reviewed by Drugs.com on Aug 10, 2025. Written by ASHP.

Introduction

Short-acting β₂-agonist bronchodilator (SABA); synthetic sympathomimetic amine.^{12 198 199}

Uses for Terbutaline

Bronchospasm

Used orally and sub-Q for prevention and reversal of bronchospasm in patients ≥12 years of age with asthma and reversible bronchospasm associated with COPD, including bronchitis and emphysema (oral and sub-Q injection).^{198 199 252}

Global Initiative for Asthma (GINA) guidelines state that oral bronchodilators (e.g., oral short-acting β₂-adrenergic agonists [SABA], theophylline) have a higher risk of adverse events than inhaled bronchodilators and are no longer recommended for asthma management.¹² Sub-Q terbutaline is generally reserved for prehospital management of severe asthma exacerbations when inhaled SABA agents are not readily available.²⁰⁹

GINA guidelines state that IV terbutaline^{† [off-label]} (administered as an initial IV bolus dose followed by continuous IV infusion) may be used as an alternative to inhaled SABA (if inhalation is not possible) for initial emergency department management of asthma exacerbations in children ≤5 years of age^{† [off-label]} .¹²

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline states that inhaled bronchodilators are recommended over oral bronchodilators; terbutaline is not mentioned in the most recent (2025) guidelines.²⁵

Preterm Labor

Has been used for acuteIV^{† [off-label]} or sub-Q therapy in selected women to inhibit uterine contractions in preterm labor (tocolysis)^{† [off-label]} and prolong gestation when beneficial.^{108 109 110 115 116 117 118 119 120 121 122 123 125 126 128 253}

Manufacturers warn that the injection formulation is not FDA labeled and is contraindicated for prolonged tocolysis (beyond 48–72 hours), because of potential for serious maternal adverse reactions, including death.¹⁹⁸

Manufacturers also warn that the oral tablets are not FDA labeled and are contraindicated for acute or maintenance tocolysis, because of potential for serious maternal adverse reactions, including death.^{199 254}

Do not use injection or oral tablets for maintenance tocolysis, particularly in the outpatient or home setting.^{198 199 200 254 255}

ACOG mentions terbutaline as one of several possible tocolytic agents.¹⁸⁸ Use of terbutaline sulfate or other tocolytics may effectively delay delivery for up to 48 hours, but no direct benefit of tocolytic therapy on neonatal outcomes observed.¹⁸⁸ Primary goal is to allow time for transport to a tertiary facility and/or allow time for administration of other therapies that improve neonatal outcomes (i.e., antenatal corticosteroids, magnesium sulfate).¹⁸⁸

Extravasation

Has been used sub-Q for treatment of vasopressor extravasation^{† [off-label]} .²⁵⁶

Terbutaline Dosage and Administration

General

Pretreatment Screening

• Screen for cardiovascular disorders, hyperthyroidism, diabetes, and convulsive disorders.^{198 199}

• Check baseline BP.^{198 199}

• Screen for current or past use of beta-blockers, non-potassium sparing diuretics, monoamine oxidase inhibitors, and tricyclic antidepressants.^{198 199}

Patient Monitoring

• Monitor BP, heart rate, and cardiac symptoms in patients with cardiovascular disorders, including coronary insufficiency, cardiac arrhythmias, and hypertension.^{198 199}

• Monitor potassium in patients taking concomitant non-potassium sparing diuretics.^{198 199}

Administration

Administer orally or sub-Q.^{198 199}

Has been administered IV^† for emergency department management of asthma exacerbation in children ≤5 years of age when recommended inhalation treatment not possible.¹²

Has been administered IV^† to inhibit uterine contractions in preterm labor^† (tocolysis).^{109 117 187 188}

Administration of injection preparation by other routes (e.g., IV) or methods other than sub-Q not recommended by manufacturer.¹⁹⁸

Oral Administration

Administer orally 3 times daily during waking hours, at approximately 6-hour intervals.¹⁹⁹

Sub-Q Administration

Inject into lateral deltoid area.¹⁹⁸

IV Administration†

Standardize 4 Safety

Standardized concentrations for IV terbutaline have been established through Standardize 4 Safety (S4S), a national patient safety initiative to reduce medication errors, especially during transitions of care.²⁴⁹ Because recommendations from the S4S panels may differ from the manufacturer’s prescribing information, caution is advised when using concentrations that differ from labeling, particularly when using rate information from the label.²⁴⁹ For additional information on S4S (including updates that may be available), see [Web]. ²⁴⁹

dosing units differ from concentration units

Dosage

Available as terbutaline sulfate; dosage expressed in terms of the sulfate salt.^{198 199}

Pediatric Patients

Prevention and Reversal of Bronchospasm Associated with Asthma, Bronchitis, and Emphysema

Oral

Children or adolescents 12–15 years of age: 2.5 mg 3 times daily.¹⁹⁹ Do not exceed total dosage of 7.5 mg within a 24-hour period.¹⁹⁹

Sub-Q

Adolescents ≥12 years of age: Administer a dose of 0.25 mg.¹⁹⁸ Repeat dose (0.25 mg) if substantial clinical improvement does not occur within 15–30 minutes.¹⁹⁸ If no response within another 15–30 minutes, consider other therapeutic measures.¹⁹⁸ Donot exceed total dosage of 0.5 mg within a 4-hour period.¹⁹⁸

IV

For initial emergency department management of asthma exacerbations in children ≤5 years of age^†, terbutaline has been given as an IV bolus dose^† of 2 mcg/kg over 5 minutes, followed by continuous IV infusion^† of 5 mcg/kg/hour.¹² Closely monitor the child and adjust dosage according to response.¹²

Adults

Prevention and Reversal of Bronchospasm Associated with Asthma, Bronchitis, and Emphysema

Oral

5 mg 3 times daily, given approximately every 6 hours during waking hours.¹⁹⁹ If disturbing adverse effects occur, reduce dosage to 2.5 mg 3 times daily.¹⁹⁹ Do not exceed total dosage of 15 mg within a 24-hour period.¹⁹⁹

Sub-Q

Administer a dose of 0.25 mg.¹⁹⁸ Repeat dose (0.25 mg) if substantial clinical improvement does not occur within 15–30 minutes.¹⁹⁸ If no response within another 15–30 minutes, consider other therapeutic measures.¹⁹⁸ Do not exceed total dosage of 0.5 mg within a 4-hour period.¹⁹⁸

Preterm Labor†

IV†

Carefully adjust rate and duration of infusion according to patient’s response as indicated by uterine response, maternal BP, and maternal and fetal heart rates.^{108 109 110 114 115 117 118 126}

For acute tocolytic therapy, has been initiated at a dosage of 2.5–20 mcg/minute.^{108 110 114 115 117 118 126 128} Dosage may be increased gradually as tolerated at 10- to 20-minute intervals until desired effects achieved.^{108 109 110 114 115 117 118 126 128} Effective maximum dosages have ranged from 17.5–30 mcg/minute, although higher maximum dosages (e.g., 70–80 mcg/minute) used cautiously in some patients.^{108 109 110 114 115 117 118 126}

Injection is contraindicated for prolonged tocolysis (beyond 48–72 hours).¹⁹⁸

Sub-Q

0.25 mg every 0.3–3 hours has been recommended.¹⁸⁷

Temporarily discontinue if pulse rate is >120 bpm.¹⁸⁷

Injection is contraindicated for prolonged tocolysis^† (beyond 48–72 hours).¹⁹⁸

Special Populations

Hepatic Impairment

No specific dosage recommendations.^{198 199}

Renal Impairment

No specific dosage recommendations.^{198 199}

Geriatric Patients

No specific dosage recommendations.^{198 199} Select dose with caution because of age-related decreases in hepatic, renal, and/or cardiac function and potential for concomitant disease and drug therapy.^{198 199}

Cautions for Terbutaline

Contraindications

• Prolonged or maintenance tocolysis (terbutaline injection).¹⁹⁸

• Acute or maintenance tocolysis (terbutaline tablets).¹⁹⁹

• Hypersensitivity to sympathomimetic amines or any component of the drug product.^{198 199}

Warnings/Precautions

Warnings

Prolonged Tocolysis

Oral terbutaline sulfate not approved and should not be used for acute or maintenance tocolysis. ¹⁹⁹ Terbutaline injection not been approved and should not be used for prolonged tocolysis (beyond 48-72 hours).¹⁹⁸ (See Boxed Warning.) In particular, terbutaline sulfate should not be used for maintenance tocolysis in the outpatient or home setting.^{198 199}

Serious adverse reactions, including death, reported after administration of terbutaline sulfate to pregnant women.^{198 199} In the mother, these adverse reactions include increased heart rate, transient hyperglycemia, hypokalemia, cardiac arrhythmias, pulmonary edema and myocardial ischemia.^{198 199}

Increased fetal heart rate and neonatal hypoglycemia may occur as a result of maternal administration.^{198 199}

Other Warnings/Precautions

Deterioration of Asthma

Asthma and/or bronchospasm may deteriorate.^{198 199} If higher than usual doses of terbutaline are required, re-evaluate patient for asthma destabilization and consider need for corticosteroid treatment.^{198 199}

Use of Anti-Inflammatory Agents

Anti-inflammatory agents are a mainstay of asthma treatment.^{198 199} Avoid terbutaline monotherapy and give early consideration to adding anti-inflammatory agents.^{198 199}

Cardiovascular Effects

Effects on BP, heart rate, and the ECG can occur.^{198 199} Use with caution in patients with cardiovascular disorders.^{198 199}

Seizures

Seizures reported rarely.^{198 199}

Hypokalemia

Hypokalemia may occur; generally transient and does not require supplementation.^{198 199}

Diabetes and Ketoacidosis

Large doses of IV terbutaline^† may aggravate preexisting diabetes and ketoacidosis.^{198 199}

Hyperthyroidism

Use with caution in patients with hyperthyroidism. r198, r199

Specific Populations

Pregnancy

No adequate and well-controlled studies in pregnant women.^{198 199} Adverse behavioral and developmental changes reported in animal studies with sub-Q terbutaline administered during late stage of pregnancy and lactation period.^{198 199}

Do not use oral terbutaline for acute or maintenance tocolysis nor terbutaline injection for prolonged tocolysis (beyond 48-72 hours).^{198 199}

Terbutaline crosses the placenta.^{198 199} Restrict use for relief of bronchospasm during labor to women in whom benefits clearly outweigh risks.^{198 199}

Lactation

Unknown whether terbutaline is excreted in human milk.^{198 199} Administer to nursing women only if potential benefits outweigh possible risk to infant.^{198 199}

Pediatric Use

Safety and efficacy not established in children <12 years of age.^{198 199} However, has been used in children as young as 2 years of age for treatment of asthma exacerbations.^{12 250 251}

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.¹⁹⁸

Common Adverse Effects

Most common adverse effects (≥1%) of terbutaline sulfate tablets: nervousness, tremor, somnolence, dizziness, anxiety, insomnia, palpitations, tachycardia, ventricular extrasystoles, vasodilation, nausea, dry mouth, headache, asthenia, and sweating.¹⁹⁹

Most common adverse effects (≥2%) of terbutaline sulfate injection: tremor, nervousness, dizziness, headache, drowsiness, palpitations, tachycardia, dyspnea, nausea/vomiting, flushed feeling, and sweating.¹⁹⁸

Drug Interactions

Specific Drugs

Terbutaline Pharmacokinetics

Absorption

Bioavailability

Oral: About 30-50%.¹⁹⁹

Sub-Q: Well absorbed.¹⁹⁸

Onset

Oral: Measurable changes in pulmonary flow rate usually occur within 30 minutes.¹⁹⁹ Substantial clinical improvement in pulmonary function occurs within 1–2 hours.¹⁹⁹ Maximum effects occur within 2–3 hours.¹⁹⁹

Sub-Q: Measurable changes in expiratory flow rate occur within 5 minutes.¹⁹⁸ Clinically important increases in FEV₁ occur within 15 minutes.¹⁹⁸ Maximum effects occur within 30–60 minutes.¹⁹⁸

Duration

Oral: Clinically important decreases in airway and pulmonary resistance may persist for ≥4 hours.¹⁹⁹

Sub-Q: Clinically important bronchodilator activity may continue for 1.5–4 hours.¹⁹⁸ Duration of clinical improvement similar to equivalent doses (mg for mg) of epinephrine.¹⁹⁸

Distribution

Extent

Crosses placenta.^{198 199}

Elimination

Metabolism

Partially metabolized in liver, principally to inactive sulfate conjugate.^{198 199}

Elimination Route

Following oral administration, renal (30–50%) and fecal elimination.¹⁹⁹

Following sub-Q administration, excreted principally as unchanged drug (60%) in urine.¹⁹⁸

Half-life

Oral single-dose administration in patients with asthma: Approximately 3.4 hours.¹⁹⁹

Sub-Q administration: Mean 5.7 hours.¹⁹⁸

Stability

Storage

Oral

Tablets

Tight, light-resistant containers at 20–25°C.¹⁹⁹

Parenteral

Solution for Injection

20–25°C.¹⁹⁸ Protect from light by storing in original carton until use.¹⁹⁸

Actions

• Short-acting β₂-agonist bronchodilator (SABA); synthetic sympathomimetic amine.^{12 198 199}

• Exerts preferential effect on β₂-adrenergic receptors of sympathetic nervous system.^{198 199}

• Stimulates production of cyclic adenosine-3′,5′-monophosphate (cAMP), which mediates numerous cellular responses, including bronchial smooth muscle relaxation and inhibition of release of mediators from mast cells in airways.^{198 199}

• Decreases resistance of airways.^{198 199}

Advice to Patients

• Inform patients of the risk of using terbutaline for tocolysis and during pregnancy.^{198 199}

• Importance of patients informing their healthcare provider of any underlying cardiovascular, endocrine, or seizure disorder.^{198 199}

• Importance of not using terbutaline more frequently than recommended and to not increase the dose or frequency of terbutaline sulfate without consulting their healthcare provider.^{198 199}

• Inform patients to seek medical attention immediately if terbutaline becomes less effective for symptomatic relief, their symptoms become worse, and/or they need to use the product more frequently than usual.^{198 199}

• Inform patients that terbutaline sulfate and other inhaled drugs and asthma medications should be taken only as directed by their physician.^{198 199} Common adverse effects include palpitations, chest pain, rapid heart rate, tremor or nervousness.^{198 199}

• Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.^{198 199} Inform patients on the proper administration and use of terbutaline.^{198 199}

• Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription (particularly, concomitant or recent use of monoamine oxidase inhibitors and tricyclic antidepressants) and OTC drugs.^{198 199}

• Inform patients of other important precautionary information.^{198 199}

Additional Information

The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer’s labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.

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