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Adverse effects of terbutaline: response to Dr. JoeFrom: Luis Sanchez-Ramos (sanchez-ramos@worldnet.att.net)Mon Dec 29 16:52:29 1997
If you doubt the numerous serious adverse effects of terbutaline therapy for patients in preterm labor then perhaps you are getting TOO carried away. The literature contains numerous reports of serious morbidity in part due to terbutaline therapy as a tocolytic agent : 1) serious cardio-pulmonary problems (angina, pulmonary edema, myocardial infarction, arrythmias, 2) marked glucose intolerance, 3) profound hypokalemia, 4) massive vulvar edema, 5)neonatal myocardial necrosis and yes, 6) maternal death! The maternal death cited by Dr. Joe as having MULTIPLE "other problems" perhaps was one with Type IV Ehlers-Danlos syndrome reported in the Am J Perinatol 1996;13:181-3. The one I am referring to was published in the Am J Obstet Gynecol 1993;169:120-1 The patient did not appear to have other medical problems prior to initiating terbutaline therapy. Signs and symptoms of cardio-pulmonary problems began after one week of therapy with terbutaline. By the way, she also was carrying twins. The group from the Netherlands (Milliez et al) reported a fatal case of pulmonary edema after prolonged treatment with beta-mimetics (Eur J Obstet Gynecol Reprod Biol 1980;11:95-100). This patient did not have MULTIPLE problems prior to initiation of tocolytics. In a national survey on preterm labor, the authors noted that the replies reflected a high degree of awareness of and many instances of first hand experience with severe betamimetic therapy complications, including MATERNAL DEATH. The mother whose neonate had myocardial necrosis was not OVERDOSED. The dose used was in excess of those dosages commonly used with subcutaneous terbutaline pump therapy. The daily dose was less than 20 mg/day of terbutaline (similar to oral therapy). Of course not much is known about the pharmacokinetics of terbutaline administered by pump. The doses recommended are not based on sound clinical trials or basic research. Stating that the patient OVERDOSED is an exageration. I encourage all to take these potential adverse effects seriously.
-- Luis Sanchez-Ramos, MD
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