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March 6, 1978

Terbutaline and Muscular Symptoms

Author Affiliations

Topeka, Kan

JAMA. 1978;239(10):930. doi:10.1001/jama.1978.03280370026014

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To the Editor.—  The new β-2-adrenergic bronchodilator drugs are well known to cause muscle tremor by stimulation of β-2-adrenergic receptors in skeletal muscle. Not previously noted is that in predisposed persons they may also cause persistent and widespread muscle twitching and cramping.

Report of a Case.—  At 60 years of age a male physician had left radical nephrectomy for localized renal cell carcinoma. This left him with stable mild uremia (serum creatinine level, 1.5 to 1.9 mg/dl; urea level, 30 to 36 mg/dl), manifested symptomatically only by polyuria and occasional nocturnal leg cramp.Five years later following acute viral sinusitis, chronic intrinsic asthma developed and was severe enough to require corticosteroid (aerosol beclomethasone) and β-2-adrenergic agents. Terbutaline sulfate, 5 mg three times daily at intervals of six to eight hours, caused not only prominent muscle tremor but also widespread muscle twitchings and frequent (numerous times daily) muscle cramping involving not