Terbutaline (Terbutaline Sulphate)
Also sold as: Bricanyl, Terbulin, Terbasmin, Droxyl (with guaifenesin), Brethine
Pregnancy
Cat B
Lactation
Safe
Schedule
H
Forms
Tablet 2.5mg +5
Indications
- Acute bronchospasm in asthma
- COPD-related bronchospasm
- Prevention of exercise-induced bronchospasm
- Preterm labor tocolysis (SC/IV injection — off-label in many guidelines)
- Acute hyperkalemia (IV, temporizing measure)
Adult Dosing
Acute bronchospasm (oral)
2.5–5mg three times daily
TDS; may increase to 5mg TDS if needed
Inhaled route preferred; oral has greater systemic side effects (tremor, tachycardia)
Acute severe bronchospasm (SC injection)
0.25mg subcutaneously; may repeat after 15–30 minutes if no response
Maximum 0.5mg in 4 hours
For acute attacks when inhaled salbutamol is not available or insufficient. Monitor pulse and blood pressure after injection.
Acute bronchospasm (MDI/Turbuhaler)
250–500mcg (1–2 puffs) as needed
May repeat every 4–6 hours PRN
Turbuhaler (500mcg/dose) provides breath-actuated dry powder delivery
Preterm labor (tocolysis)
250mcg SC every 20 minutes for 3 doses; IV infusion 10–80 mcg/min titrated
Until contractions stop or maternal heart rate exceeds 130 bpm
FDA withdrawn approval for IV tocolytic use due to cardiovascular risks. SC use continues in some clinical settings. Nifedipine preferred. Use in hospital setting with cardiac monitoring.
Pediatric Dosing
Use syrup for young children. Monitor heart rate carefully in children.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CrCl 10–50 mL/min | Use 50% of usual dose; terbutaline is primarily renally excreted |
| CrCl <10 mL/min | Avoid use or use with extreme caution and very low doses |
Hepatic Adjustment
No specific guidance; use with caution in severe hepatic impairment. Monitor for enhanced effects.
Pregnancy & Lactation
Pregnancy: Category B
Category B — animal studies show no harm; used as tocolytic for preterm labor. IV terbutaline for tocolysis: FDA issued safety communication in 2011 warning against IV or prolonged (>48–72h) SC use due to maternal cardiotoxicity (arrhythmia, pulmonary edema) and fetal tachycardia. Short-term SC use (<48h) may still be used where benefits outweigh risks. Acute asthma treatment in pregnancy: benefits outweigh risks.
Lactation: Safe
Excreted in breast milk at low levels. No adverse effects reported in nursing infants. Compatible with breastfeeding at therapeutic doses.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Non-selective beta-blockers (propranolol) | Mutual antagonism — beta-blockers block bronchodilator effect and may precipitate severe bronchospasm. Avoid combination in asthma. | Major |
| MAO inhibitors / Tricyclic antidepressants | Significant potentiation of cardiovascular effects (tachycardia, hypertension, arrhythmias). Avoid concurrent use. | Major |
| Corticosteroids and diuretics | Additive hypokalemia, particularly with high-dose terbutaline. Monitor serum potassium. | Moderate |
| Sympathomimetics (adrenaline, dopamine) | Additive adrenergic effects: tachycardia, palpitations, hypertension, arrhythmias | Moderate |
| Halothane anaesthesia | Risk of serious ventricular arrhythmias; avoid terbutaline during halothane anaesthesia | Major |
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Side Effects
Common
- Tremor (especially hands — dose-dependent)
- Tachycardia / palpitations
- Headache
- Dizziness
- Hypokalemia
- Muscle cramps
- Nervousness / anxiety
- Nausea
Serious / Discontinue If
- Severe hypokalemia (with high doses)
- Ventricular arrhythmias
- Pulmonary edema (especially with IV tocolytic use)
- Myocardial ischemia (rare)
- Paradoxical bronchospasm (rare)
- Lactic acidosis (rare, with IV high-dose)
Contraindications
- Hypersensitivity to terbutaline or sympathomimetic amines
- Cardiac arrhythmias associated with tachycardia
- IV terbutaline for tocolysis (FDA contraindication — risk of maternal cardiac toxicity and death)
- Severe hypertension or eclampsia (tocolytic context)
- Antepartum haemorrhage requiring immediate delivery
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Bricanyl 2.5mg | AstraZeneca India | 20 tab ₹48 |
| Bricanyl Turbuhaler | AstraZeneca India | 100 dose ₹320 |
| Terbulin 5mg | Alkem Laboratories | 10 tab ₹38 |
| Terbasmin | Pharmos Ltd | 10 tab ₹32 |
| Bricanyl Injection | AstraZeneca India | 5 amp ₹85 |
Monitoring Required
- Heart rate (resting and post-dose)
- Serum potassium (hypokalemia risk with high doses)
- Blood pressure
- Fetal heart rate (when used for tocolysis)
- Maternal cardiovascular status (with tocolytic use)
- Peak expiratory flow rate (bronchospasm response)
- Blood glucose in diabetic patients
Patient Counseling Points
- Tremor (shaking of hands) is a very common side effect — it usually reduces with regular use.
- Do not exceed the prescribed dose — high doses increase risk of heart palpitations and low potassium.
- For asthma, the inhaler (Turbuhaler) is preferred over tablets for faster, more targeted effect.
- Report immediately: severe fast heartbeat, chest pain, significant breathlessness.
- If you are pregnant and using this for premature labour, it must only be used under close hospital supervision.
- Avoid double dosing — if you miss a dose, skip it and take the next one at the scheduled time.
- Keep your doctor informed if symptoms are not well controlled.
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Clinically reviewed by: Dr. Kavitha Reddy, MD (Obstetrics & Gynaecology), Osmania Medical College Hyderabad
Last reviewed: 2026-03-15
References
- FDA Drug Safety Communication: New warnings against use of terbutaline to treat preterm labor. 2011.
- FDA Prescribing Information: Bricanyl (terbutaline sulphate). AstraZeneca.
- Indian Pharmacopoeia Commission. Terbutaline Sulphate monograph. IP 2022.
- CIMS India Drug Database 2025 — Terbutaline
- ACOG Committee Opinion No. 455. Magnesium sulfate before anticipated preterm birth for neuroprotection. Obstet Gynecol. 2010.