Terbutaline for chronotropic support in heart transplantation.
OBJECTIVE
To report the use of oral terbutaline for chronotropic support in a patient who had undergone heart transplantation.


METHODS
A 54-year-old white man received a heart transplant secondary to ischemic dilated cardiomyopathy. His clinical course was uncomplicated until postoperative day 10, when he became hemodynamically compromised despite inotropic therapy (BP 88/53 mm Hg, mean HR 80 beats/min) secondary to stage IIIa rejection. Although a continuous intravenous infusion of dobutamine was maintained, therapy with oral terbutaline 2.5 mg every 6 hours was initiated. Because the patient remained bradycardic on postoperative day 11 (HR 64 beats/min; mean 75), terbutaline was titrated to a dosage of 5 mg every 8 hours. Subsequently, an improvement in the hemodynamic profile (BP 140/78 mm Hg, mean HR 91 beats/min) was noted. Treatment with terbutaline was continued for 13 days and was well tolerated.


CONCLUSIONS
As of February 11, 2004, this is the first case, to our knowledge, to describe the use of oral terbutaline therapy for chronotropic support in the setting of acute rejection after heart transplantation. Terbutaline is a beta2-adrenergic agonist that may mediate its effects via direct beta2-receptor stimulation, baroreceptor-mediated increases in sympathetic tone, or via presynaptic beta2-stimulation. Although isoproterenol has been the mainstay of therapy for chronotropic support in this setting, its availability has been an issue in recent years. Terbutaline, therefore, may represent a useful alternative for chronotropic support in the setting of heart transplantation.


CONCLUSIONS
Terbutaline therapy did not appear to be associated with any significant adverse effects and warrants further application and study in this setting.
University of Pittsburgh Medical Center Health System, and University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA. jcoons@wpahs.org
James C
JC
Coons
Michael
M
Shullo
Kristine
K
Schonder
Robert
R
Kormos
D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D001919:Bradycardia / Q000188:drug therapy* / Q000209:etiology; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D006084:Graft Rejection / Q000209:etiology; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013726:Terbutaline / Q000627:therapeutic use*; D016896:Treatment Outcome
D000318:Adrenergic beta-Agonists; D002316:Cardiotonic Agents; D013726:Terbutaline