Adenosine

Adenosine is a prescription drug used for conversion to sinus rhythm of paroxysmal supraventricular tachycardia (PVST), including that associated with accessory bypass tracts (Wolff-Parkinson-White Syndrome). When clinically advisable, appropriate vagal maneuvers (Valsalva maneuver), should be attempted prior to adenosine administration.

• Adenosine is available under the following different brand names: Adenocard, and Adenoscan.

Injectable solution

• 3 mg/ml

Dosage Considerations – Should be Given as Follows:

Paroxysmal Supraventricular Tachycardia

Adult Dosage

• Indicated for conversion to sinus rhythm of paroxysmal supraventricular tachycardia (PSVT), including that associated with accessory bypass tracts (Wolff-Parkinson-White Syndrome)
• Adenocard: 6 mg intravenous push over 1-3 seconds (maybe given as an intraosseous infusion) followed by a rapid flush with 20 ml normal saline, if no conversion within 1-2 minutes give 12 mg intravenous push, repeat a second time if necessary (30 mg total)

Dosing considerations

• When clinically advisable for paroxysmal supraventricular tachycardia (PSVT), appropriate vagal maneuvers (Valsalva maneuver), should be attempted before adenosine administration

Pediatric Dosage

• Under 50 kg: 0.05 to 0.1 mg/kg rapid intravenous push over 1-3 seconds or intraosseous infusion, no more than 0.2 mg/kg/dose, followed by rapid flush with up to 5 ml 0.9% sodium chloride
• If necessary may give a second dose of 0.2 mg/kg intravenous push/intraosseous infusion, not to exceed the cumulative dose of 12 mg

Geriatric Dosage

• The elderly may experience more adverse effects from adenosine; they may be more sensitive
• PSVT (Adenocard)
• 6 mg intravenously (IV) over 1-3 seconds (maybe given by intraosseous infusion [IO]) followed by a rapid flush with 20 ml normal saline (NS), if no conversion within 1-2 minutes give 12 mg IV, repeat a second time if necessary (30 mg total)
• Adenoscan (Diagnostic)
• Stress testing (Adenoscan): 140 mcg/kg/minute intravenous infusion for 6 minutes

Stress Testing (Diagnostic)

• Indicated as an adjunct to thallium-201 myocardial perfusion scintigraphy in patients unable to exercise adequately
• Adenoidal: 140 mcg/kg/minute intravenous infusion for 6 minutes

Other Indications and Uses

• Off label: sustained ventricular tachycardia (SVT)

Side effects of adenosine include:

• facial flushing
• difficulty breathing
• chest pain
• heart attack
• lightheadedness
• dizziness
• tingling in arms
• numbness
• nausea
• low blood pressure (hypotension)
• irregular heartbeat (palpitations)
• apprehension
• head pressure
• chest pain
• blurred vision
• burning sensation
• heaviness in arms, neck, and back pain
• metallic taste
• tightness in throat
• pressure in groin
• sweating
• hyperventilation

Postmarketing side effects of adenosine reported include:

• prolonged flat line
• elevated heart rate
• rhythm disturbance (ventricular fibrillation)
• transient increase in blood pressure
• slow heart rate
• irregular heartbeats (atrial fibrillation)
• cardiac failure
• infusion site pain
• hypersensitivity
• abnormal heart rhythm (torsades de pointes)
• seizure
• sudden difficulty breathing (bronchospasm)

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Adenosine has no known severe interactions with other drugs.
• Adenosine has no known serious interactions with other drugs.
• Moderate interactions of adenosine include:
  • dipyridamole
  • dyphylline
  • green tea
  • hawthorn
  • nicotine inhaled
  • nicotine intranasal
  • sevelamer
  • theophylline
• Mild interactions of adenosine include:
  • acebutolol
  • atenolol
  • betaxolol
  • bisoprolol
  • caffeine
  • carvedilol
  • celiprolol
  • esmolol
  • labetalol
  • lily of the valley
  • metoprolol
  • nadolol
  • nebivolol
  • penbutolol
  • pindolol
  • propranolol
  • sotalol
  • timolol

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns, or for more information about this medicine.

Warnings

• This medication contains adenosine. Do not take Adenocard or Adenoscan if you are allergic to adenosine or any ingredients contained in this drug
• Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Hypersensitivity
• 2nd or 3rd-degree atrioventricular block (AV block) (except those on pacemakers)
• Sinus node disease, such as sick sinus syndrome or symptomatic bradycardia (except in patients with a functioning artificial pacemaker)
• Adenoscan: Contraindicated in bronchoconstrictive or bronchospastic lung disease (asthma)

Effects of Drug Abuse

• No information available

Short-Term Effects

• See "What Are Side Effects Associated with Using Adenosine?"

Long-Term Effects

• See "What Are Side Effects Associated with Using Adenosine?"

Cautions

• Symptomatic slow heart rate (bradycardia), cardiac arrest, heart block, heart transplant patients, high blood pressure (hypertension), low blood pressure (hypotension), heart attack, frequent occurrence of pre-existing arrhythmias (proarrhythmic) events, low blood flow to the heart (unstable angina)
• Adenocard: Caution with bronchoconstrictive or bronchospastic lung disease (asthma)
• Cerebrovascular accident hemorrhagic and ischemic cerebrovascular accidents reported; hemodynamic effects of adenosine including low blood pressure or high blood pressure possibly associated with these adverse reactions
• Nucleoside transport inhibitors (dipyridamole) and potentiate the vasoactive effects of adenosine; withhold for 5 half-lives before adenosine administration
• Methylxanthines (caffeine, theophylline) are adenosine receptor antagonists and inhibit adenosine's vasoactive effects; withhold methylxanthines for 5 half-lives before adenosine administration
• New-onset or recurrence of convulsive seizures reported following adenosine; some seizures are prolonged and require emergent anticonvulsive management; aminophylline may increase risk of seizures associated with adenosine;
• methylxanthine use is not recommended in patients who experience seizures in association with adenosine administration
• Difficulty breathing, throat tightness, flushing, reddening of the skin, rash, and chest discomfort reported that may require symptomatic treatment; resuscitative measures may be necessary if symptoms progress; have trained personnel and treatment available during treatment
• Arrhythmia at time of cardioversion (Adenocard): Ventricular fibrillation reported following administration, including both resuscitated and fatal events; in most instances, these cases were associated with the concomitant use of digoxin and, less frequently with digoxin and verapamil
• Risk for myocardial infarction and death
• Avoid use for cardiac nuclear stress tests in patients with signs or symptoms of acute myocardial ischemia (unstable chest pain [angina], cardiovascular instability); use may increase the risk of fatal heart attack (myocardial infarction [MI])
• Screen all nuclear stress test candidates for risks

Pregnancy and Lactation

• Use adenosine during pregnancy with caution if the benefits outweigh the risks. Animal studies show risk and human studies are not available, or neither animal nor human studies were done
• Adenosine use when breastfeeding has the potential for serious adverse reactions in nursing infants. A decision to interrupt nursing after administration of adenosine should take into account the importance of the drug to the mother