Adenosine

Indications
 Intravenous
Differential diagnosis of supraventricular tachycardias
Adult: Initially, 3 mg by rapid IV inj into a central or large peripheral vein over 2 sec with cardiac monitoring; 6 mg may be given after 1-2 minutes if necessary, then 12 mg after a further 1-2 minutes. Avoid increments if high level AV block occurs at any particular dose.
Child: Initially, 50-100 mcg/kg; if necessary, may increase dose by 50-100 mcg/kg increments at 1-2 minute intervals or until arrhythmia is controlled. Max dose: 300 mcg/kg.
Max Dosage:
Intravenous
Paroxysmal supraventricular tachycardia
Adult: Initially, 3 mg by rapid IV inj into a central or large peripheral vein over 2 sec with cardiac monitoring; 6 mg may be given after 1-2 minutes if necessary, then 12 mg after a further 1-2 minutes. Avoid increments if high level AV block occurs at any particular dose.
Child: Initially, 50-100 mcg/kg; if necessary, may increase dose by 50-100 mcg/kg increments at 1-2 minute intervals or until arrhythmia is controlled. Max dose: 300 mcg/kg.
Max Dosage:
Intravenous
Myocardial imaging
Adult: 140 mcg/kg/minute by infusion for 6 minutes. Inject radionuclide 3 minute after infusion.
Contraindications
 2nd or 3rd degree AV block and sick sinus syndrome (unless pacemaker fitted), asthma, hypersensitivity.
Warnings / Precautions
 Pregnancy; heart transplant patients; patients on dipyridamole (lower initial dose of adenosine 0.5-1 mg); atrial fibrillation or flutter with accessory pathway (conduction along anomalous pathway may increase).
Adverse Reactions
 Facial flushing, palpitations, chest pain, bradycardia, sweating, hypotension, dyspnoea, choking sensation, headache, lightheadedness, tingling, numbness, neck and back pain, nausea, metallic taste. ECG changes suggestive of rhythm disturbances.
Drug Interactions
 Adenosine effects antagonised by methylxanthines like caffeine, theophylline, etc. Concomitant carbamazepine may increase the risk of heart block.
Potentially Fatal: Adenosine effects are potentiated by dipyridamole.
See Below for More adenosine Drug Interactions
Mechanism of Actions
 Adenosine acts rapidly to slow down conduction through the AV node via the A1 receptors. It also mediates peripheral and coronary vasodilatation by stimulating the A2 receptors. Extremely short plasma half-life (<10 sec) permits dosage titration during IV use every 1-2 min and causes no concern of cumulative effect through repeated dosing.
Absorption: Rapidly taken up into the erythrocytes and vascular endothelial cells.
Metabolism: Metabolised to adenosine monophosphate and inosine.
Excretion: Plasma half-life: <10 sec.
ATC Classification
 C01EB10 - adenosine ; Belongs to the class of other cardiac preparations.
Available As
  • Adenosine 3 mg

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