UK Clinical Pharmacy Association

Terbutaline

Brands of Short-acting beta-2 adrenoreceptor agonists - inhaled, nebulised and oral

  • Salbutamol: Airomir®, Salamol®, Ventolin®
  • Terbutaline: 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 – including the following combination product:

Salbutamol with ipratropium (also see Antimuscarinics - Inhaled and nebulised drug records.

Oral preparations

Consider checking serum potassium pre-operatively.

Inhaled or nebulised 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 beta2 adrenoceptor agonist post-operatively consideration should be given to alternative routes of administration.

Inhaled or nebulised preparations

Restart when required post-operatively.

Interactions with common anaesthetic agents

Halogenated anaesthetics

Short-acting beta-2 adrenoceptor agonists 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 short-acting beta2 adrenoceptor agonist 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]

Summary of Product Characteristics – Ventolin® (salbutamol) Evohaler 100 micrograms. GlaxoSmithKline UK. Accessed via www.medicines.org.uk 27/06/2021 [date of revision of the text December 2019]

Summary of Product Characteristics – Salbutamol 2 mg Tablets BP. Accord-UK Ltd. Accessed via www.medicines.org.uk 27/06/2021 [date of revision of the text February 2021]