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Re: Adverse effects of terbutaline: response to Dr. JoeFrom: Luis Sanchez-Ramos (sanchez-ramos@worldnet.att.net)Wed Dec 31 12:16:20 1997
> >In a message dated 12/31/97 you wrote: > >Sorry to say, but science is science. > >Orally administered terbutaline is absorbed 30-70% (decreased by food) and you >get about a 1mcg/L serum concentration per 1 mg administered. Subcutaneous >injection, however, is obviously totally absorbed, and 0.5mg given subQ gives >a plasma level of about 7.6 mcg/L. So whether you talk about letters to the >editor or not, 20 mg of subQ terbutaline will more likely kill you than 20 mg >po. I don't see that that's any science that a freshman or sophomore medical >student can't handle... > >Joe P. It is my suspicion that the basal rate of 0.5 mg/hr quoted in the paper by Scott Fletcher probably is a typo. Apparently Dr. Fletcher is a Pediatric Cardiologist and was not the one who placed the pregnant patient on the terbutaline pump. I suspect she was managed by the MFM at the Medical University of South Carolina and more than likely she was managed through one of the home health care agencies that deal with terbutaline pumps (I would think they would not prescribe that dose). I suspect the dose was probably 0.05mg/hr. I will check on this. Thank you for the information, but I already knew that absortion is greater with SQ and IV administration versus oral. I did admit that compared to the "usual" or "standard" SQ (pump) dose, 20 mg/day was high but not FAR, FAR higher as you stated. Let's say that she did receive 0.5 mg/hr and boluses of 0.3mg/hr (19.2 mg /day). Much higher doses than these have been given without untoward effects. Kosasa et al, while assessing the longterm effects of IV tocolytic therapy, administered IV terbutaline to 1000 women for a mean duration of 61 days. The range of daily terbutaline infusions were 2.5 mg to 115 mg. It appears that 20 mg of terbutaline probably will not kill you irrespective of the mode of administration My whole point is that you cannot minimize the adverse effects of these drugs. Luis Sanchez-Ramos, MD
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