Terbutaline Sulfate

Vagal nerve denervation during the heart transplant procedure results in higher resting heart rates in these recipients compared to the general population. Relative bradycardia (RB) is a common and often temporary post‐operative complication that can be managed with agents like terbutaline; however, little data exist on the efficacy, safety, and necessity of long‐term terbutaline use post‐heart transplant.

This was a single‐center, retrospective, descriptive study conducted at a large academic medical center investigating oral terbutaline use for RB management in heart transplant recipients. Outcomes included time to and reason for terbutaline discontinuation post‐transplant, adverse event rates, and permanent pacemaker (PPM) placement rates.

In the 229 patients included, the median (IQR) time to terbutaline initiation was 8 (5, 12) days post‐heart transplant, with a median (IQR) time to discontinuation of 56 (20, 96) days from the first dose. In most cases, terbutaline was successfully tapered off outpatient due to the resolution of RB. Tachyarrhythmias occurred in 29 (12.7%) patients without long‐term sequelae. At 3 months post‐transplant, PPM had been placed for chronotropic support in 15 patients (6.6%) with a median time (IQR) to PPM placement of 24 (19, 77) days from transplant.

This study's overall low PPM placement rate suggests that early sinus node dysfunction can be treated with pharmacotherapy without committing to a permanent device, and that terbutaline can be used safely in early post‐heart transplant recipients. If patients require long‐term chronotropic support, the risk‐benefit of PPM placement versus continued terbutaline should be considered.

Frequent detection of terbutaline in wastewater highlights its potential risks to human health associated in the environment. Exposure to terbutaline through contaminated water sources or food chain have adverse effects to human health. This work emphasized on the removal of terbutaline from wastewater using adsorption technology. Mechanochemically synthesized [Cu(INA)₂] metal-organic frameworks (MOFs) and its magnetic composite ([Cu(INA)₂]-MOF@Fe₃O₄) are designed with higher specific surface areas and tailored features to accommodate the molecular size and structure of terbutaline. Thus, batch experiment has been conducted using the [Cu(INA)₂]-MOF and [Cu(INA)₂]-MOF@Fe₃O₄ for the terbutaline adsorption. The adsorption efficiency achieved by the MOFs was 91.8% and 99.3% for the Cu(INA)₂]-MOF and [Cu(INA)₂]-MOF@Fe₃O₄ respectively. The optimum for the adsorption study included terbutaline concentration of 40 mg/L, adsorbent dose of 5 mg/L, pH of 11, temperature of 25 °C and equilibrium time of 40 min. The kinetics and isotherms have been described by pseudo-second order and Langmuir models, while the thermodynamics revealed the exothermic and spontaneous nature of the process. The promising performance of the MOFs is manifested on the ease of regeneration and reusability, achieving adsorption efficiency of 85.0% and 94.7% by the Cu(INA)₂]-MOF and [Cu(INA)₂]-MOF@Fe₃O₄, respectively at five consecutive cycles. The higher performance of the MOFs demonstrates their excellent potentialities for the terbutaline adsorption from the aqueous solution.