Terbutaline for Slowing Preterm Labor

Terbutaline is sometimes used as a tocolytic medicine to slow uterine contractions during preterm labor.

The use of terbutaline for the treatment of preterm labor is an unlabeled use of the medicine. Terbutaline has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of asthma and other breathing conditions, but it is also widely used to treat preterm labor.

Terbutaline should not be used for longer than 72 hours for the treatment of preterm labor.

How It Works

Terbutaline can relax smooth muscles, like the uterus. It also affects the smooth muscles of the blood vessels and the small airways of the lungs.

Why It Is Used

Terbutaline can be used during preterm labor when:

• Labor needs to be delayed for 24 to 48 hours to:
  • Let corticosteroids, given to the mother, help fetal lungs mature.
  • Provide time to move a mother to a hospital that provides neonatal intensive care, if her local hospital does not.
• Regular uterine contractions have thinned (effaced) the cervix less than 80% and opened (dilated) it less than 4 cm, and the mother's amniotic sac has not broken.
• The mother is healthy.
• The fetus is alive and not in distress.

Depending on the medical facility, terbutaline may be the first medicine used to delay premature birth.

How Well It Works

Terbutaline can be effective when labor needs to be delayed for 24 to 48 hours. But the medicine usually does not completely stop contractions. Nor has it been shown to lower risks for the premature baby.^{1, 2}

Side Effects

Side effects are common with terbutaline use and may affect both the mother and fetus.

Common side effects of this medicine include:

• Rapid heartbeat or palpitations.
• Headache and dizziness.
• Nausea, vomiting, and diarrhea.
• Anxiety.
• Nervousness or tremor (such as unsteady, shaky hands).

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

If terbutaline treatment is effective, its effect typically lasts no more than 48 hours. Long-term treatment is not advised (based on the risk of serious side effects), nor is it effective.¹

• The risks of treatment with terbutaline must be weighed against the benefit of delaying birth.
• Terbutaline can greatly increase the mother's and fetus's pulse. The mother must have her blood pressure and pulse checked frequently during the first few hours of treatment.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

1. Cunningham FG, et al., eds. (2010). Preterm birth. In Williams Obstetrics, 23rd ed., pp. 804–831. New York: McGraw-Hill.

2. Haas DM (2010). Preterm birth, search date June 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.

Other Works Consulted

• U.S. Food and Drug Administration (2011). FDA Drug Safety Communication: New warnings against use of terbutaline to treat preterm labor. Available online: http://www.fda.gov/Drugs/DrugSafety/ucm243539.htm.