Maternal use of oral or inhaled terbutaline is unlikely to affect a breastfed infant. The authors of several reviews and an expert panel agree that use of inhaled bronchodilators is acceptable during breastfeeding because of the low bioavailability and maternal serum levels after use.
With long-term maternal intake of 2.5 or 5 mg three times daily orally, milk terbutaline levels ranged from 2.5 to 4 mcg/L at various times during the dosing interval. There was little fluctuation of milk levels. The average dose that an exclusively breastfed infant would receive based on these patients is 1.4% (range 0.7 to 2.2%) of the maternal weight-adjusted dose.
Serum levels were undetectable (<0.1 mcg/L) in one 8-week-old exclusively breastfed infant whose mother was taking oral terbutaline 5 mg three times daily.
Effects in Breastfed Infants:
Two papers have reported a total of 4 infants aged 3 to 8 weeks who were breastfed during maternal use of oral terbutaline 2.5 or 5 mg three times daily. None of the infants had any signs of sympathetic stimulation and all were developing normally. These cases were also summarized in a third publication.
Possible Effects on Lactation:
Relevant published information was not found as of the revision date.
1. McDonald CF, Burdon JGW. Asthma in pregnancy and lactation. A position paper for the Thoracic Society of Australia and New Zealand. Med J Aust. 1996;165:485-8. 2. Ellsworth A. Pharmacotherapy of asthma while breastfeeding. J Hum Lact. 1994;10:39-41. PMID:7619245 3. Nelson-Piercy C. Asthma in pregnancy. Thorax. 2001;56:325-8. PMID:11254828 4. Taddio A, Ito S. Drugs and breast-feeding. In, Koren G, ed. Maternal-fetal toxicology. A clinician's guide. 3rd ed. New York. Marcel Dekker. 2001;177-32. 5. National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program Asthma and Pregnancy Working Group. NAEPP expert panel report. Managing asthma during pregnancy: recommendations for pharmacologic treatment-2004 update. 2004;1-57. http://www.nhlbi.nih.gov/health/prof/lung/asthma/astpreg.htm 6. Boreus LO, de Chateau P, Lindberg C et al. Terbutaline in breast milk. Br J Clin Pharmacol. 1982;13:731-2. Letter. PMID:7082542 7. Lonnerholm G, Lindstrom B. Terbutaline excretion into breast milk. Br J Clin Pharmacol. 1982;13:729-30. Letter. PMID:7082541 8. Lindberg C, Boreus LO, de Chateau P et al. Transfer of terbutaline into breast milk. Eur J Resp Dis. 1984;65 (Suppl 134):87-91. PMID:6586490
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