TERBUTALINE SULFATE

Rx only A sterile aqueous solution for subcutaneous injection. WARNING: PROLONGED TOCOLYSIS Terbutaline sulfate has not been approved and should not be used for prolonged tocolysis (beyond 48 to 72 hours). In particular, terbutaline sulfate should not be used for maintenance tocolysis in the outpatient or home setting. Serious adverse reactions, including death, have been reported after administration of terbutaline sulfate to pregnant women. In the mother, these adverse reactions include increased heart rate, transient hyperglycemia, hypokalemia, cardiac arrhythmias, pulmonary edema and myocardial ischemia. Increased fetal heart rate and neonatal hypoglycemia may occur as a result of maternal administration (see CONTRAINDICATIONS, Prolonged Tocolysis). DESCRIPTION Terbutaline Sulfate Injection, USP, is a beta-adrenergic agonist bronchodilator available as a sterile, nonpyrogenic, aqueous solution in vials, for subcutaneous administration. Each mL of solution contains: 1 mg of terbutaline sulfate USP (0.82 mg of the free base), and Water for Injection, USP. Sodium chloride is used for isotonicity, and hydrochloric acid for adjustment to a pH of 3.0 to 5.0. Terbutaline sulfate is (±)-a-[(tert-butyl-amino) methyl]-3,5-dihydroxybenzyl alcohol sulfate (2:1) (salt). The structural formula is: Terbutaline sulfate USP is a white to gray-white crystalline powder. It is odorless or has a faint odor of acetic acid. It is soluble in water and in 0.1N hydrochloric acid, slightly soluble in methanol, and insoluble in chloroform. Formula1.jpg

INDICATIONS & USAGE Terbutaline Sulfate Injection, USP is indicated for the prevention and reversal of bronchospasm in patients 12 years of age and older with asthma and reversible bronchospasm associated with bronchitis and emphysema.

DOSAGE & ADMINISTRATION Terbutaline Sulfate Injection, USP should be used only for subcutaneous administration and not intravenous infusion. Sterility and accurate dosing cannot be assured if the vials are not used in accordance with DOSAGE AND ADMINISTRATION. Discard unused portion after single patient use. The usual subcutaneous dose of Terbutaline Sulfate Injection, USP is 0.25 mg injected into the lateral deltoid area. If significant clinical improvement does not occur within 15 to 30 minutes, a second dose of 0.25 mg may be administered. If the patient then fails to respond within another 15 to 30 minutes, other therapeutic measures should be considered. The total dose within 4 hours should not exceed 0.5 mg. Note: Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

Prolonged Tocolysis Terbutaline sulfate has not been approved and should not be used for prolonged tocolysis (beyond 48 to 72 hours). In particular, terbutaline sulfate should not be used for maintenance tocolysis in the outpatient or home setting (see BOXED WARNING: PROLONGED TOCOLYSIS). Hypersensitivity Terbutaline sulfate injection is contraindicated in patients known to be hypersensitive to sympathomimetic amines or any component of this drug product.

Adverse reactions observed with terbutaline are similar to those commonly seen with other sympathomimetic agents. All these reactions are transient in nature and usually do not require treatment. The following table compares adverse reactions seen in patients treated with terbutaline (0.25 mg and 0.5 mg), with those seen in patients treated with epinephrine injection (0.25 mg and 0.5 mg), during eight double-blind crossover studies involving a total of 214 patients. Incidence (%) of Adverse Reactions Terbutaline (%) Terbutaline (%) 0.25 mg N=77 0.5 mg N=205 Reaction Central Nervous System Tremor 7.8 38 Nervousness 16.9 30.7 Dizziness 1.3 10.2 Headache 7.8 8.8 Drowsiness 11.7 9.8 Cardiovascular Palpitations 7.8 22.9 Tachycardia 1.3 1.5 Respiratory Dyspnea 0 2 Chest discomfort 1.3 1.5 Gastrointestinal Nausea/vomiting 1.3 3.9 Systemic Weakness 1.3 0.5 Flushed feeling 0 2.4 Sweating 0 2.5 Pain at injection site 2.6 0.5 Epinephrine (%) Epinephrine (%) 0.25 mg N=153 0.5 mg N=61 Reaction Central Nervous System Tremor 16.3 18 Nervousness 8.5 31.1 Dizziness 7.8 3.3 Headache 3.3 9.8 Drowsiness 14.4 8.2 Cardiovascular Palpitations 7.8 29.5 Tachycardia 2.6 0 Respiratory Dyspnea 2 0 Chest discomfort 2.6 0 Gastrointestinal Nausea/vomiting 1.3 11.5 Systemic Weakness 2.6 1.6 Flushed feeling 1.3 0 Sweating 0 0 Pain at injection site 2.6 1.6 Note: Some patients received more than one dosage strength of terbutaline and epinephrine. In addition, there were reports of anxiety, muscle cramps, and dry mouth (less than 0.5%). There have been rare reports of elevations in liver enzymes and of hypersensitivity vasculitis with terbutaline administration.