No

Antiarrhythmic Agent, Class IV

Adenocard®: Treatment of paroxysmal supraventricular tachycardia (PSVT) including that associated with accessory bypass tracts (Wolff-Parkinson-White syndrome); when clinically advisable, appropriate vagal maneuvers should be attempted prior to adenosine administration; not effective in atrial flutter, atrial fibrillation, or ventricular tachycardia

Adenoscan®: Pharmacologic stress agent used in myocardial perfusion thallium-201 scintigraphy

C

Clinical effects on the fetus: Case reports (4) on administration during pregnancy have indicated no adverse effects on fetus or newborn attributable to adenosine

Hypersensitivity to adenosine or any component; second- or third-degree A-V block or sick sinus syndrome (except in patients with a functioning artificial pacemaker), atrial flutter, atrial fibrillation, and ventricular tachycardia (this drug is not effective in converting these arrhythmias to sinus rhythm). The manufacturer states that Adenoscan® should be avoided in patients with known or suspected bronchoconstrictive or bronchospastic lung disease.

Patients with pre-existing S-A nodal dysfunction may experience prolonged sinus pauses after adenosine. There have been reports of atrial fibrillation/flutter in patients with PSVT associated with accessory conduction pathways after adenosine. Adenosine decreases conduction through the A-V node and may produce a short-lasting first-, second-, or third-degree heart block. Because of the very short half-life, the effects are generally self-limiting. Rare, prolonged episodes of asystole have been reported, with fatal outcomes in some cases. At the time of conversion to normal sinus rhythm, a variety of new rhythms may appear on the EKG. A limited number of patients with asthma have received adenosine and have not experienced exacerbation of their asthma. Adenosine may cause bronchoconstriction in patients with asthma, and should be used cautiously in patients with obstructive lung disease not associated with bronchoconstriction (eg, emphysema, bronchitis).

>10%:

Cardiovascular: Facial flushing (18%), palpitations, chest pain, hypotension

Central nervous system: Headache

Respiratory: Shortness of breath/dyspnea (12%)

Miscellaneous: Sweating

1% to 10%:

Central nervous system: Dizziness

Gastrointestinal: Nausea (3%)

Neuromuscular & skeletal: Paresthesia, numbness

Respiratory: Chest pressure (7%)

<1% (Limited to important or life-threatening symptoms): Hypotension, lightheadedness, headache, dizziness, intracranial pressure, hyperventilation

Since half-life of adenosine is <10 seconds, any adverse effects are rapidly self-limiting. Intoxication is usually short-lived since the half-life of the drug is very short.

Treatment of prolonged effects requires individualization. Theophylline and other methylxanthines are competitive inhibitors of adenosine and may have a role in reversing its toxic effects.

Theophylline and caffeine (methylxanthines) antagonize adenosine's effects; may require increased dose of adenosine.

Dipyridamole potentiates effects of adenosine; reduce dose of adenosine.

Carbamazepine may increase heart block.

Do not refrigerate, precipitation may occur (may dissolve by warming to room temperature)

Slows conduction time through the A-V node, interrupting the re-entry pathways through the A-V node, restoring normal sinus rhythm

Onset: Clinical effects occur rapidly

Duration: Very brief

Metabolism: In the blood and tissue to inosine then to adenosine monophosphate (AMP) and hypoxanthine

Half-life: <10 seconds, thus adverse effects are usually rapidly self-limiting

Adenocard®: Rapid I.V. push (over 1-2 seconds) via peripheral line:

Neonates: Initial dose: 0.05 mg/kg; if not effective within 2 minutes, increase dose by 0.05 mg/kg increments every 2 minutes to a maximum dose of 0.25 mg/kg or until termination of PSVT

Maximum single dose: 12 mg

Infants and Children: Pediatric advanced life support (PALS): Treatment of SVT: 0.1 mg/kg; if not effective, administer 0.2 mg/kg

Alternatively: Initial dose: 0.05 mg/kg; if not effective within 2 minutes, increase dose by 0.05 mg/kg increments every 2 minutes to a maximum dose of 0.25 mg/kg or until termination of PSVT; medium dose required: 0.15 mg/kg

Maximum single dose: 12 mg

Adults: 6 mg; if not effective within 1-2 minutes, 12 mg may be given; may repeat 12 mg bolus if needed

Maximum single dose: 12 mg

Follow each I.V. bolus of adenosine with normal saline flush

Note: Preliminary results in adults suggest adenosine may be administered via a central line at lower doses (ie, initial adult dose: 3 mg).

Adenoscan®: Continuous I.V. infusion via peripheral line: 140 mcg/kg/minute for 6 minutes using syringe or columetric infusion pump; total dose: 0.84 mg/kg. Thallium-201 is injected at midpoint (3 minutes) of infusion.

Hemodialysis: Significant drug removal is unlikely based on physiochemical characteristics.

Peritoneal dialysis: Significant drug removal is unlikely based on physiochemical characteristics.

Note: Patients who are receiving concomitant theophylline therapy may be less likely to respond to adenosine therapy.

Note: Higher doses may be needed for administration via peripheral versus central vein.

Avoid food or drugs with caffeine

EKG monitoring, heart rate, blood pressure

Adenosine may be effective in interrupting re-entrant tachycardias, both AV-nodal re-entrant tachycardias and supraventricular tachycardias secondary to accessory pathways. Adenosine acts via interruption of AV-nodal conduction and, when used for this purpose, requires administration as rapid intravenous push in increasing doses. Because of more direct access when administered through a central line, lower doses of adenosine may be tried in these situations. It is not uncommon to see heart block and sinus pause soon after adenosine administration. Patients will often experience shortness of breath and/or chest pain having unknown etiology. While adenosine will not convert atrial fibrillation or atrial flutter, the consequent AV-nodal conduction slowing (reduced ventricular rate), in this setting, may aid in the identification of the arrhythmia by making the atrial fibrillation or flutter electrocardiographic morphology more apparent.

May rarely see anxiety

Use caution with carbamazepine and tricyclic antidepressants, may increase heart block

No information available to require special precautions

No effects or complications reported

Adenosine is administered in emergencies, patient education should be appropriate to the situation.

Be alert for possible exacerbation of asthma in asthmatic patients

Diagnostic use: 60 mg/20 mL and 90 mg/30 mL single-dose vials

Injection, preservative free: 3 mg/mL (2 mL)

Emergency Cardiac Care Committee and Subcommittees, American Heart Association, "Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care, III: Adult Advanced Cardiac Life Support" and "VI: Pediatric Advanced Life Support," JAMA, 1992, 268(16):2199-241 and 2262-75.

Eubanks AP and Artman M, "Administration of Adenosine to a Newborn of 26 Weeks' Gestation," Pediatr Cardiol, 1994, 15(3):157-8.

Harrison JK, Greenfield RA, and Wharton JM, "Acute Termination of Supraventricular Tachycardia by Adenosine During Pregnancy," Am Heart J, 1992, 123(5):1386-8.

Konduri GG, Garcia DC, Kazzi NJ, et al, "Adenosine Infusion Improves Oxygenation in Term Infants With Respiratory Failure," Pediatrics, 1996, 97(3):295-300.

Mason BA, Ricci-Goodman J, and Koos BJ, "Adenosine in the Treatment of Maternal Paroxysmal Supraventricular Tachycardia," Obstet Gynecol, 1992, 80(3 (Pt 2)):478-80.

McIntosh-Yellin NL, Drew BJ, and Scheinman MM, "Safety and Efficacy of Central Intravenous Bolus Administration of Adenosine for Termination of Supraventricular Tachycardia," J Am Coll Cardiol, 1993, 22(3):741-5.

Podolsky SM and Varon J, "Adenosine Use During Pregnancy," Ann Emerg Med, 1991, 20(9):1027-8.

Till J, Shinebourne EA, Rigby ML, et al, "Efficacy and Safety in the Treatment of Supraventricular Tachycardia in Infants and Children," Br Heart J, 1989, 62(3):204-11.

Zeigler V, "Adenosine in the Pediatric Population: Nursing Implications," Pediatr Nurs, 1991, 17(6):600-2.