II. Indications
- Chemical conversion of AV Node re-entry Tachycardias
- Diagnosis in non-reentry Tachycardias
III. Contraindications
- Acute Coronary Syndrome
- Cardiovascular Instability
- Irregular Narrow Complex Tachycardia (pre-excited Atrial Fibrillation)
- Risk of degeneration to Ventricular Fibrillation
IV. Mechanism
- Endogenous purine Nucleoside
- Prolongs refractory period, decreases automaticity and slows conduction within the AV Node
- Interrupts AV Nodal Reentry pathways
V. Pharmacokinetics
- Activation
- Rapidly deaminated to the active metabolite Inosine
- Occurs within 30 seconds of IV administration
- Deactivation
- Rapidly sequestered by Red Blood Cells
- Half-Life: <10 seconds
VI. Dosing
-
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]
- Child (weight <50 kg)
- Initial: 50 to 100 mcg/kg rapid IV push with flush
- Next: Increase dose by 50 to 100 mcg/kg rapid IV push every 1 to 2 minutes as needed
- Maximum Dose: 300 mcg/kg up to 12 mg
- Adult
- Initial: 6 mg rapid IV push with flush
- Next: 12 mg rapid IV push with flush (may repeat once)
- 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)
VII. Adverse effects
- Transient effects (resolve within 2 minutes)
- Flushing
- Dyspnea to respiratory distress (esp. in Asthma, COPD)
- Chest Pain
- Transient Arrhythmias following PSVT conversion
- Sinus Bradycardia
- Ventricular ectopy
VIII. Drug Interactions
- Reduced effect of Adenosine
- Theophylline
- Methylxanthine (Caffeine, Theobromine)
- Potentiated effect of Adenosine
IX. Safety
- Pregnancy Category C
- Unknown Safety in Lactation
X. Resources
- Adenosine Injection Solution (DailyMed)
XI. References
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 74-5
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
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Related Studies
| Definition (CHV) | a kind of nucleic acid |
| Definition (NCI) | A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. (MeSH) |
| Definition (MSH) | A nucleoside that is composed of ADENINE and D-RIBOSE. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. |
| Definition (CSP) | nucleoside that is composed of adenine and d-ribose; adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA; adenosine itself is a neurotransmitter. |
| Concepts | Nucleic Acid, Nucleoside, or Nucleotide (T114) , Pharmacologic Substance (T121) , Neuroreactive Substance or Biogenic Amine (T124) |
| MSH | D000241 |
| SnomedCT | 108502004, 386857003, 391720004, 371177000, 35431001 |
| LNC | LP35677-1, LP35683-9, LP35974-2, MTHU047710 |
| English | Adenosine, adenosine, ADENOSINE, adenosine (medication), Adenosine [Chemical/Ingredient], Adenosine preparation (substance), Adenosine - chemical (substance), Adenosine agent, Adenosine agent (product), Adenosine - chemical, Adenosine product, Adenosine (substance), Adenosine preparation (product), Adenosine preparation |
| Swedish | Adenosin |
| Czech | adenosin |
| Finnish | Adenosiini |
| Russian | ADENOZIN, АДЕНОЗИН |
| Spanish | preparado con adenosina (producto), adenosina (producto), preparado con adenosina, preparado de adenosina, agente con adenosina, preparado de adenosina (sustancia), agente con adenosina (producto), adenosina (sustancia), adenosina, preparado de adenosina (producto), Adenosina |
| Croatian | ADENOZIN |
| Polish | Adenozyna |
| Japanese | アデニンリボシド, アデノシン |
| French | Adénosine |
| German | Adenosin |
| Italian | Adenosina |
| Portuguese | Adenosina |
