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Re: Terbutaline, MgSO4From: Luis Sanchez-Ramos (sanchez-ramos@worldnet.att.net)Tue Dec 30 17:19:32 1997
At Tue, 30 Dec 1997, Richard Lowensohn wrote: > >I want to agree (as usual) with Dr. Joe. The FDA warning was about use of the >sub-cutaneous pump for administration of terbutaline, as was their evidence >base. I have been using terbutaline sub-cutaneously in individual doses acutely >for close to 15 years. In the early years, I saw patients who were given terb + >MgSO4 + steroids, who came to us with chest pain and/or congestive heart >failure. I have NEVER seen congestive heart failure from terbutaline given sub-q >in individual doses as a single drug, or in combination with steroids. I will >not administer it if the maternal heart rate is 130 or above. As with Dr. >Morrison-Boczar, I use it only prn in oral form, as tachyphylaxis limits its >value when given around the clock. > >With both terbutaline and MgSO4, I think that the plethora of studies and >meta-analyses are pretty worthless, as they use the drugs (in my view) >incorrectly. The terbutaline problem I have covered in the last paragraph. For >MgSO4, if you go back to Dr. Sabai's earlier work, he showed - in pre-eclamptics >- that a constant IV infusion of Mag will result in a therapeutic level 6-12 >hours after you start. Women with preterm labor have wonderful kidneys - far >better than those in preeclampsia - and you must be very aggressive to get a >therapeutic level in a clinically useful period of time. I use a loading dose of >5 or 6 grams, then 3 grams per hour for the first few hours. I haven't seen >regimens like that used in the published studies. > >I am all for evidence-based medicine. Until it comes around, however, I'll stay >with clinical practice based upon basic pharmacologic principles. > >-- >Richard Lowensohn MD >Depts Ob/Gyn and Medical Informatics & Outcomes Research >Oregon Health Sciences University >lowensoh@ohsu.edu > Richard: First of all, the number of randomized trials assessing the efficacy and safety of magnesium sulfate as a tocolytic is small (hardly a "plethora" (see recent meta-analysis in ObGyn Survey) The way you use terbutaline and your protocol for MgSO4......"3 grams for the first few hours" hardly qualify as "basic pharmacologic principles" LSanchez-Ramos MD
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