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Terbutaline

Classification: A

Drug products: Bricanyl, Bricanyl LP, Bricanyl Turbuhaler, Bricanyl®, Bricanyl® Depot, Bricanyl® Turbuhaler®, Terbasmin, Terbasmin Turbuhaler, Terbutalin AL retard, Terbutaline Sulfate

ATC code: R03AC03, R03CC03

Substances: terbutaline, terbutaline sulfate

Summary

Terbutaline has shown good effect in treatment of acute asthma in both children and adults, however published studies with a clinically relevant sex-analysis are lacking.

A smaller study found generally poorer inhalation technique in women leading to lower effective dose.

We do not recommend to generally differentiate the use for men and women but emphasize the importance of ensuring a good inhalation technique.

Additional information

Terbutaline inhalation, tablets, or parenteral therapy is used for relief and prevention of bronchospasm in bronchial asthma or COPD. Parenteral terbutaline is also sometimes used in pregnant women to prevent premature labor.

Pharmacokinetics and dosing

In spite of terbutaline being a very hydrophilic substance, a small study on pharmacokinetics of bambuterol and terbutaline (4 men, 4 women), no differences were seen between men and women in distribution volume of terbutaline after parenteral administration [1].

Effects

No published studies with a clinically relevant sex analysis regarding the effects of terbutaline have been found.

Adverse effects

In a randomized, placebo-controlled trial, healthy volunteers (10 men, 10 women) were given either inhaled terbutaline 5 mg or placebo. Terbutaline lowered potassium levels more in women than in men (-15.4% in women vs. -8.5% in men after 1 h). After three hours however, no sex differences were seen. Terbutaline also increased heart rate in both sexes but the effect duration was greater in women. Terbutaline also caused prolongation of QTc in both sexes, an effect that was found to be greater, longer-lasting and more deleterious in women than in men [2]. However, terbutaline is not on the list of QT prolongation drugs with risk of Torsade de Pointes [3].

Reproductive health issues

Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).

Other information

In a study on inhalation technique using metered dose inhalers (33 men, 26 women), 75% of the participants had an incorrect inhalation technique, especially women, regardless of age. Only 4% of women and 43% of men had an acceptable inhalation technique. The authors speculate that this may add to the worse asthma prognosis in women, shown in a meta-analysis of six trials of randomly assigned asthma treatment [1].

Several studies have shown worse prognosis for women with asthma. In an observational registry study (416 men, 498 women), women were found to have more asthmatic symptoms, worse quality of life and require more health care due to their asthma [2]. In a Danish prospective study on hospitalization due to asthma (6104 men of whom 2.5% had asthma, 7436 women of whom 2.2% had asthma), women had a 1.7 higher relative risk to be hospitalized [3]. An observational study from Singapore found hospitalization due to asthma to be more common in boys than girls aged 0-4 years (boys/girls ratio 1.69). In adults aged 35-64 years, women were more hospitalized (men/women ratio 0.81) [4].

Updated: 2019-02-26

Date of litterature search: 2016-10-17

References

  1. Nyberg L, Rosenborg J, Weibull E, Jönsson S, Kennedy BM, Nilsson M. Pharmacokinetics of bambuterol in healthy subjects. Br J Clin Pharmacol. 1998;45:471-8. PubMed
  2. Rahman AR, McDevitt DG, Struthers AD, Lipworth BJ. Sex differences in hypokalaemic and electrocardiographic effects of inhaled terbutaline. Thorax. 1992;47:1056-9. PubMed
  3. CredibleMeds. www.crediblemeds.org/healthcare-providers [cited 2016-12-05]. länk
  4. Goodman DE, Israel E, Rosenberg M, Johnston R, Weiss ST, Drazen JM. The influence of age, diagnosis, and gender on proper use of metered-dose inhalers. Am J Respir Crit Care Med. 1994;150:1256-61. PubMed
  5. Osborne ML, Vollmer WM, Linton KL, Buist AS. Characteristics of patients with asthma within a large HMO: a comparison by age and gender. Am J Respir Crit Care Med. 1998;157:123-8. PubMed
  6. Prescott E, Lange P, Vestbo J. Effect of gender on hospital admissions for asthma and prevalence of self-reported asthma: a prospective study based on a sample of the general population Copenhagen City Heart Study Group. Thorax. 1997;52:287-9. PubMed
  7. Ng TP, Niti M, Tan WC. Trends and ethnic differences in asthma hospitalization rates in Singapore, 1991 to 1998. Ann Allergy Asthma Immunol. 2003;90:51-5. PubMed
  8. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2015 [cited 2016-11-08.] Socialstyrelsens statistikdatabas
  9. Goodman DE, Israel E, Rosenberg M, Johnston R, Weiss ST, Drazen JM. The influence of age, diagnosis, and gender on proper use of metered-dose inhalers. Am J Respir Crit Care Med. 1994;150:1256-61. PubMed
  10. Osborne ML, Vollmer WM, Linton KL, Buist AS. Characteristics of patients with asthma within a large HMO: a comparison by age and gender. Am J Respir Crit Care Med. 1998;157:123-8. PubMed
  11. Prescott E, Lange P, Vestbo J. Effect of gender on hospital admissions for asthma and prevalence of self-reported asthma: a prospective study based on a sample of the general population Copenhagen City Heart Study Group. Thorax. 1997;52:287-9. PubMed
  12. Ng TP, Niti M, Tan WC. Trends and ethnic differences in asthma hospitalization rates in Singapore, 1991 to 1998. Ann Allergy Asthma Immunol. 2003;90:51-5. PubMed

Authors: Helena Sundvall, Linnéa Karlsson Lind

Reviewed by: Mia von Euler

Approved by: Karin Schenck-Gustafsson