II. Mechanism
- Endogenous purine Nucleoside
- Slows AV Node conduction
- Interrupts AV Nodal Reentry pathways
III. Pharmacokinetics
- Rapidly sequestered by Red Blood Cells
- Half-Life: under 10 seconds
IV. Indications
- Chemical conversion of AV Node re-entry Tachycardias
- Diagnosis in non-reentry Tachycardias
V. Dose
-
General
- Rapid IV bolus over 1-3 seconds
- Expect brief period of Asystole (under 15 seconds)
- Follow dose immediately with saline flush (15-20 cc Normal Saline in adults)
- May also combine Adenosine with Normal Saline (15 cc in adults) and push the combined solution
- Choi (2003) J Korean Soc Emerg Med 14(3): 224-7 [PubMed]
- Children
- 0.1-0.2 mg/kg rapid IV push (Max: 12 mg)
- Adults
- Initial: 6 mg rapid IV push
- Next: 12 mg rapid IV push
- Higher starting dose indications (12 mg in adults)
- Caffeine within the last 4 hours
- Theophylline
- Lower starting dose indications (3 mg in adults)
- Carbamazepine
- Dipyridamole (Persantine)
- Heart Transplant status
- Central Line administration (risk of severe Bradycardia and Asystole)
VI. Adverse effects
- Transient effects (resolve within 2 minutes)
- Transient Arrhythmias following PSVT conversion
- Sinus Bradycardia
- Ventricular ectopy
VII. Drug Interactions
- Reduced effect of Adenosine
- Theophylline
- Methylxanthine (Caffeine, Theobromine)
- Potentiated effect of Adenosine