Pharm

Adenosine

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Adenosine

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