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# Bricanyl (Terbutaline) ## Overview Terbutaline is a selective $\beta_2$-adrenergic agonist that acts as a bronchodilator. While historically used to delay preterm labor (tocolysis), this use is largely discouraged by regulatory agencies (e.g., FDA boxed warning) due to serious maternal cardiac and pulmonary risks. ## Primary Indications - Symptomatic relief of reversible bronchospasm associated with asthma, bronchitis, and emphysema. - *Off-label/Historical:* Tocolysis (not recommended due to safety profile). ## Adult Dosing - **Oral:** 2.5 mg to 5 mg every 6 to 8 hours. Do not exceed 15 mg in 24 hours. - **Subcutaneous:** 0.25 mg injected into the lateral deltoid area. May repeat once after 15–30 minutes if necessary. Do not exceed 0.5 mg within a 4-hour period. ## Pediatric Dosing - **Oral (Children >12 years):** Same as adult dosing (2.5–5 mg every 6-8 hours). - **Oral (Children 6–12 years):** 2.5 mg every 8 hours. Do not exceed 7.5 mg in 24 hours. - **Subcutaneous:** Not typically used in pediatric populations; consult institutional protocols for specific airway emergencies. ## Dose Adjustments - **Renal Impairment:** Reduce initial dose in patients with significant renal impairment; monitor for toxicity as the drug is renally excreted. - **Hepatic Impairment:** No specific guidelines; use with caution. ## Contraindications - Known hypersensitivity to terbutaline or sympathomimetic amines. - Prolonged tocolysis (>48–72 hours) or use for preterm labor in outpatient settings. ## Adverse Effects - **Common:** Nervousness, tremor, headache, tachycardia, palpitations, dizziness. - **Serious:** Arrhythmias, myocardial ischemia, pulmonary edema (seen primarily in tocolytic use), hypokalemia, hyperglycemia. ## Key Drug Interactions - **Beta-blockers (non-selective):** May antagonize the effects of terbutaline and induce bronchospasm. - **Diuretics (loop/thiazide):** May potentiate ECG changes or hypokalemia induced by terbutaline. - **MAOIs/Tricyclic Antidepressants:** May potentiate the effects of terbutaline on the vascular system. ## Monitoring - Heart rate and blood pressure (especially during parenteral administration). - Serum potassium levels in prolonged therapy or high-dose scenarios. - Blood glucose (in diabetic patients). - Pulmonary function tests/clinical assessment of air entry. ## Clinical Pearls - Selective $\beta_2$ activity is dose-dependent; at higher doses, it may lose selectivity and cause $\beta_1$ (cardiac) stimulation. - The use of oral terbutaline for maintenance of asthma is generally considered second-line to inhaled corticosteroids and long-acting beta-agonists. - Always be aware of the "black box" warnings regarding maternal use for preterm labor; it is associated with maternal tachycardia, cardiac arrhythmias, and death. *** **Disclaimer:** This information is for educational purposes. Dosing and clinical protocols can vary by institution and patient demographics. Always verify current prescribing information, package inserts, and local clinical guidelines before administering medication.