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.
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.
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.
Description: Mechanism of Action: 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
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)
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.
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