Brands of terbutaline
Inhaled and oral: Bricanyl®
Issues for surgery
For asthma and chronic obstructive pulmonary disease (COPD) – no symptomatic relief of acute exacerbation if omitted.
Advice in the perioperative period
Elective and emergency surgery
Continue.
Oral preparations
Consider checking serum potassium pre-operatively.
Inhaled preparations
If patient requiring several ‘reliever’ doses per week confirm adherence to any prescribed ‘preventer’ medication before considering addition/up-titration of ‘preventer’ medication to optimise disease control prior to elective surgery.
Confirm the inhaler device with patient.
Post-operative advice
Oral preparations
Restart post-operatively, at usual dose, as soon as next dose is due.
If patients are unable to resume their usual oral short-acting beta-2 adrenoceptor agonist post-operatively consideration should be given to alternative routes of administration.
Inhaled preparations
Restart when required post-operatively.
Interactions with common anaesthetic agents
Halogenated anaesthetics
Terbutaline may cause hypokalaemia. Concomitant use with medications that prolong the QT-interval (e.g. desflurane, isoflurane, sevoflurane and possibly thiopental) increases the risk of torsades de pointes. Monitor serum potassium and QT-interval with concomitant treatment.
Interactions with other common medicines used in the perioperative period
Corticosteroids
Dexamethasone and hydrocortisone may cause hypokalaemia which would potentiate any terbutaline-mediated hypokalaemia. Hypokalaemia increases the risk of torsades de pointes with medicines which prolong the QT-interval e.g. antiemetics (domperidone, droperidol, granisetron, haloperidol, ondansetron and possibly prochlorperazine), antimicrobials (ciprofloxacin, clarithromycin, erythromycin) and loperamide.
Further information
None relevant.
References
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://about.medicinescomplete.com [Accessed on 27th June 2021]
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://about.medicinescomplete.com [Accessed on 27th June 2021]
Summary of Product Characteristics – Bricanyl® (terbutaline) Turbohaler, 0.5mg/dose, inhalation powder. AstraZeneca UK Limited. Accessed via www.medicines.org.uk 27/06/2021 [date of revision of the text March 2021]