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Back Terbutaline and Salbutamol in children 20 Sep, 2025
Medicines Medicines
  • Report Note

💊 Salbutamol (Albuterol)

  • Duration: Short-acting (4–6 hours).

  • Onset: Quick relief within minutes (good for acute wheeze).

  • Formulations: Syrup, inhaler, nebulizer.

  • Common Side Effects:

    • Tremors, jitteriness

    • Fast heartbeat (tachycardia)

    • Irritability or restlessness

  • Safety:

    • Widely used worldwide, including for toddlers.

    • Considered first-line in guidelines (like GINA & WHO) for acute relief.

💊 Terbutaline

  • Duration: Slightly longer (up to 6–8 hours).

  • Onset: Not as fast as Salbutamol.

  • Formulations: Syrup, nebulizer, injection (less commonly used in very young kids orally).

  • Common Side Effects:

    • Tremors, jitteriness

    • More palpitations / tachycardia compared to salbutamol

    • Occasionally irritability, sleep disturbance

  • Safety:

    • Used in children, but less preferred in many countries because adverse effects can be stronger.

    • More often reserved when Salbutamol is not available or not effective.

✅ Which is Safer for Toddlers?

  • Salbutamol is generally considered safer and better tolerated in toddlers, with fewer and milder side effects at therapeutic doses.

  • Terbutaline works, but tends to cause more jitteriness and heart-related side effects in small children.

  • That’s why most international pediatric and asthma guidelines prefer Salbutamol as first choice.

⚠️ Important for Toddlers

  • Inhaled / nebulized forms (with spacer or mask) are preferred over syrup, because:

    • Direct action on lungs

    • Lower systemic side effects

    • Faster relief

👉 Summary:

  • Both are effective bronchodilators.

  • Salbutamol = safer, fewer side effects, first-line choice.

  • Terbutaline = more side effects, used less commonly in toddlers.

  • If your paediatrician prescribed syrup, watch for jitteriness, fast heartbeat, sleep changes, and always stick to exact dose by weight.

📊 Salbutamol vs Terbutaline in Toddlers

Feature Salbutamol (Albuterol) Terbutaline
Class Short-acting β2 agonist (SABA) Short-acting β2 agonist (SABA)
Usual Oral Dose (Syrup) 0.1 mg/kg/dose, 3 times daily (≈ 1–2 mg per dose; in syrup 2 mg/5 ml → ~2.5–5 ml TDS) 0.05 mg/kg/dose, 3 times daily (≈ 0.25–0.5 mg per dose; in syrup 1.5 mg/5 ml → ~1–2 ml TDS)
Nebulization Dose 0.15 mg/kg/dose (min 1.25 mg, max 5 mg), every 6–8 hrs 0.05 mg/kg/dose (≈1–2.5 mg), every 6–8 hrs
Onset of Action Fast: 5–15 minutes Moderate: 15–30 minutes
Duration 4–6 hours 6–8 hours
Common Side Effects Tremors, jitteriness, restlessness, mild ↑ heart rate Tremors, jitteriness, more pronounced ↑ heart rate, sleep disturbance
Safety Profile Widely used, well-studied, first-line choice in guidelines (GINA, WHO) Less preferred due to more cardiovascular side effects
Cost/Availability Widely available, cheaper Less common, slightly costlier
Preferred Use First-line for wheezing, asthma, bronchitis in toddlers Alternative if Salbutamol not tolerated or not available

✅ Summary

  • Salbutamol → Faster, safer, fewer side effects → preferred in toddlers.

  • Terbutaline → Longer duration but more jitteriness & palpitations → used less often.

  • Nebulized forms are always safer and more effective in small children than syrups.