Adenosine
Indications
Adenosine is used for:
Paroxysmal supraventricular tachycardia, Supraventricular tachycardia
Adult Dose
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.
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.
Myocardial imaging
Adult: 140 mcg/kg/minute by infusion for 6 minutes. Inject radionuclide 3 minute after infusion.
Child Dose
Intravenous
Differential diagnosis of supraventricular tachycardias
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.
Paroxysmal supraventricular tachycardia
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.
Myocardial imaging
Adult: 140 mcg/kg/minute by infusion for 6 minutes. Inject radionuclide 3 minute after infusion.
Renal Dose
Administration
IV Administration
Adenocard: given as a rapid injection (1-3 sec) by peripheral IV route directly into vein or into IV line close (proximal) to patient & is followed by rapid NS flush after each inj (20 mL for adults, 5 mL or more for peds)
Place pt in mild reverse Trendelenburg position before giving drug.
Contra Indications
2nd or 3rd degree AV block and sick sinus syndrome (unless pacemaker fitted), asthma, hypersensitivity.
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).
Lactation: Potential for serious adverse reactions in nursing infants; decision to interrupt nursing after administration of adenosine or not should take into account importance of drug to mother.
Pregnancy-Lactation
Pregnancy Category: C
Lactation: Potential for serious adverse reactions in nursing infants; decision to interrupt nursing after administration of adenosine or not should take into account importance of drug to mother
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.
Side Effects
Side effects of Adenosine :
>10%
Flushing (18%), Dyspnea (12%)
1-10%
Chest pain (7%), HA (2%), Lightheadedness (2%), Dizziness (1%), Tingling in arms (1%), Numbness (1%), Nausea (3%)
<1%
Hypotension, Palpitations, Apprehension, Head pressure, Chest pain, Hyperventilation, Blurred vision, Burning sensation, Heaviness in arms, neck & back pain, Metallic taste, Tightness in throat, Pressure in groin, Sweating
Mode of Action
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.