Adenosine


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : IV Paroxysmal supraventricular tachycardia; Differential diagnosis of supraventricular tachycardias Initial: 3 mg over 2 seconds; 6 mg may be given after 1-2 minutes, then 12 mg after a further 1-2 minutes. Myocardial imaging 140 mcg/kg/min for 6 minutes; inject radionuclide after 3 minutes of infusion.
Dosage Details
Intravenous
Myocardial imaging
Adult: 140 mcg/kg/min for 6 minutes as a continuous infusion via infusion pump (total dose: 0.84 mg/kg). The radionuclide is injected at midpoint (after 3 minutes) of infusion.

Intravenous
Paroxysmal supraventricular tachycardia
Adult: Initially, 3 mg via rapid inj into a central or large peripheral vein over 2 seconds; 6 mg may be given after 1-2 minutes if necessary, then 12 mg after a further 1-2 minutes. Alternatively, an initial dose of 6 mg, followed by 2 further doses of 12 mg, if necessary, at 1-2 minute intervals. Follow each dose with normal saline flush.
Child: <50 kg: Initially, 50-100 mcg/kg as rapid bolus, may be increased by 50-100 mcg/kg increments at 1-2 minute intervals until sinus rhythm is established. Max: 300 mcg/kg. Alternatively, an initial dose of 100 mcg/kg (Max: 6 mg), followed by 200 mcg/kg (Max: 12 mg) if necessary; ≥50 kg: Same as adult dose.

Intravenous
Differential diagnosis of supraventricular tachycardias
Adult: Initially, 3 mg via rapid inj into a central or large peripheral vein over 2 seconds; 6 mg may be given after 1-2 minutes if necessary, then 12 mg after a further 1-2 minutes.
Special Patient Group
Patients w/ transplanted heart; Patients receiving dipyridamole or carbamazepine; Admin via central line: Use regimen w/ initial dose of 3 mg.
Contraindications
2nd or 3rd degree AV block, sick sinus syndrome (except in patient w/ functional pacemaker), long QT syndrome, severe hypotension, unstable angina, decompensated heart failure, asthma, COPD.
Special Precautions
Patient w/ QT prolongation, emphysema, bronchitis, autonomic dysfunction, pericarditis, pericardial effusion, left main coronary stenosis, stenotic valvular heart disease, stenotic carotid artery disease (w/ cerebrovascular insufficiency), uncorrected hypovolemia, left to right shunt, recent MI or heart transplant, severe heart failure, minor conduction defects (e.g. 1st degree AV block, bundle branch block), atrial fibrillation/flutter, history of convulsion/seizure. Pregnancy and lactation.
Adverse Reactions
Nausea, light-headedness, flushing, headache, angina-like chest pain, apprehension, dyspnoea, bronchospasm; bradycardia, heart block; tachy- and bradyarrhythmia, AF, MI; abdominal, throat, neck, and jaw discomfort. Rarely, hypotension, reflex tachycardia, severe bradycardia.
Potentially Fatal: Cardiac and resp arrest, asystole. Rarely, ventricular fibrillation.
IV/Parenteral: C
MonitoringParameters
Monitor ECG, BP, and heart rate. Continuously monitor cardiac and haemodynamic states during infusion.
Overdosage
Symptoms: Severe hypotension, bradycardia, asystole. Management: IV aminophylline/theophylline or caffeine may be used.
Drug Interactions
Increased effect w/ dipyridamole. Reduced effect w/ xanthines (e.g. aminophylline, theophylline). May produce higher degree of heart block w/ carbamazepine. May cause ventricular fibrillation w/ digoxin or digoxin and verapamil combination.
Food Interaction
Reduced effect w/ food and drinks containing xanthines (e.g. tea, coffee, chocolate, cola).
Action
Description: Adenosine is an endogenous purine nucleoside that is involved in numerous biological processes. It stimulates A1 receptors to slow conduction time through the AV node; and A2 receptors to produce peripheral and coronary vasodilation, thus, increasing blood flow in normal arteries w/ little to no increase in stenotic arteries.
Onset: Rapid.
Duration: Very brief.
Pharmacokinetics:
Distribution: Rapidly taken up by an active transport system into erythrocytes and vascular endothelial cells.
Metabolism: Rapidly metabolised intracellularly by adenosine kinase into adenosine monophosphate (AMP), and by adenosine deaminase into inosine.
Excretion: Plasma elimination half-life: <10 seconds.
Chemical Structure

Chemical Structure Image
Adenosine

Source: National Center for Biotechnology Information. PubChem Database. Adenosine, CID=60961, https://pubchem.ncbi.nlm.nih.gov/compound/Adenosine (accessed on Jan. 20, 2020)

Storage
Store between 15-30°C. Do not refrigerate.
MIMS Class
ATC Classification
C01EB10 - adenosine ; Belongs to the class of other cardiac preparations.
References
Adenosine Injection (Sagent Pharmaceuticals). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 10/08/2016.

Anon. Adenosine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 10/08/2016.

Buckingham R (ed). Adenosine. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 10/08/2016.

Joint Formulary Committee. Adenosine. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 10/08/2016.

McEvoy GK, Snow EK, Miller J et al (eds). Adenosine. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 10/08/2016.

Disclaimer: This information is independently developed by MIMS based on Adenosine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
Register or sign in to continue
Asia's one-stop resource for medical news, clinical reference and education
Sign up for free
Already a member? Sign in