Adenosine Class
Antiarryhthmic, endogenous nucleosides
Adenosine MOA
- Slows conduction time through AV node; can interrupt re-entrant pathways through the AV node.
- Slows sinus rate.
- Larger doses decrease BP by decreasing peripheral resistance.
Adenosine Indications and Field Use
- Conversion of supraventricular tachycardias with no known atrial fibrillation or atrial flutter.
- Undifferentiated regular monomorphic wide-complex tachycardia
Adenosine Contraindications
- Sick sinus syndrome, 2nd or 3rd degree AV blocks; except in patients with a functioning ventricular pacemaker.
- Use cautiously in patients with known asthma (has precipitated acute bronchospasm).
- Patients on theophylline and related methylxanthines.
- Patients on dipyridamole (Persantine) or carbamazepine (Tegretol).
- Cardiac transplant patients are more sensitive to adenosine and require only a small dose (relative).
- Known atrial fibrillation or atrial flutter.
- Pregnancy (no controlled studies)
Adenosine Adverse Reactions
CV: Transient dysrhythmias (systole, bardycardia, PVC’s) occur in 55% of patients (none reported as irreversible). Palpitations, chest pressure, chest pain, hypotension, transient hypertension; facial flushing, sweating.
Resp: Dyspnea, hyperventilation, tightness in throat, bronchospasm.
CNS: Lightheadedness, headache, dizziness, paresthesias, apprehension, blurred vision, neck-back pain.
GI: Nausea, metallic taste.
Adenosine Incompatibilities/Drug Interactions
• Adenosine is not blocked by Atropine.
• Theophylline and related methylxanthines (caffeine & theobromine-xanthine) in therapeutic concentrations decrease effectiveness.
-Dipyridamole (Persantine) & carbamazepine (Tegretol, Atretol) block uptake and potentiate effects.
Adenosine Adult Dosage
• Initial: 6 mg rapid IV bolus over 1-3 seconds
• Special administration procedure: Follow immediately with 20 ml normal saline flush.
IV site recommended is antecubital fossa (close to central circulation); use injection port nearest hub of IV catheter; arm elevated during procedure; constant ECG monitoring.
• Repeat: If no response in 1-2 minutes (of each dose, respectively) may repeat 12 mg utilizing the same procedure for the repeat dose.
Adenosine Pediatric Dosage
(Drug of choice for treating SVT in symptomatic infants and children)
• Initial: 0.1 mg/kg as a rapid IV bolus.
• Special administration procedure: Follow immediately with 2-3 ml normal saline flush. Use injection port nearest the hub of IV catheter for procedure; constant ECG monitoring.
• Repeat: If no response, dose may be doubled 1 time (0.2 mg/kg) using same administration procedure.
• Maximum single dose: Should not exceed 12 mg.
• Infants with SVT associated with shock: Adenosine may precede cardioversion if
vascular access is available, but cardioversion should not be delayed while IV access is achieved.
Adenosine Routes
Rapid IV push
Adenosine Onset
Seconds
Adenosine Peak
Seconds
Adenosine Duration
10-12 seconds
Adenosine AZ Drug Box Minimum
18 mg
