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Adenosine: Indications, Dosing, Side Effects and Interactions
Adenosine clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Adenosine: Indications, Dosing, Side Effects and Interactions
Adenosine clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Used in conjunction with radionuclide myocardial perfusion imaging in patients who cannot exercise adequately or**
- **Adult** (By Intravenous Infusion): for whom exercise is inappropriate (consult product literature).
**Used in conjunction with radionuclide myocardial perfusion imaging in patients who cannot exercise adequately or for whom exercise is inappropriate for adenosine**
- **Child** (By intravenous infusion): (consult product literature).
**Termination of supraventricular tachycardias, including those associated with accessory conducting pathways (e.g. Wolff-Parkinson-White syndrome), Diagnosis of supraventricular arrhythmias for adenosine**
- **Neonate** (By rapid intravenous injection): Initially 150 micrograms/kg, then increased in steps of 50-100 micrograms/kg every 1-2 minutes if required, dose to be repeated until tachycardia terminated or maximum single dose of 300 micrograms/kg given.
- **Child 1-11 months** (By rapid intravenous injection): Initially 150 micrograms/kg, then increased in steps of 50-100 micrograms/kg every 1-2 minutes if required, dose to be repeated until tachycardia terminated or maximum single dose of 500 micrograms/kg given.
- **Child 1-11 years** (By rapid intravenous injection): Initially 100 micrograms/kg, then increased in steps of 50-100 micrograms/kg every 1-2 minutes if required, dose to be repeated until tachycardia terminated or maximum single dose of 500 micrograms/kg (max.12 mg) given.
- **Child 12-17 years** (By rapid intravenous injection): Initially 3 mg, followed by 6 mg after 1-2 minutes if required, followed by 12 mg after 1-2 minutes if required, in some children over 12 years 3 mg dose ineffective (e.g. if a small peripheral vein is used for administration) and higher initial dose sometimes used; however, those with heart transplant are very sensitive to the effects of adenosine, and should not receive higher initial doses.
Cautions
Atrial fibrillation; atrial fibrillation with accessory pathway (conduction down anomalous pathway may increase); atrial flutter; atrial flutter with accessory pathway (conduction down anomalous pathway may increase); autonomic dysfunction; bundle branch block; first-degree AV block; heart transplant; left main coronary artery stenosis; left to right shunt; pericardial effusion; pericarditis; QT-interval prolongation; recent myocardial infarction; severe heart failure; stenotic carotid artery disease with cerebrovascular insufficiency; stenotic valvular heart disease; uncorrected hypovolaemia
Contraindications
Asthma; chronic obstructive lung disease; decompensated heart failure; long QT syndrome; second- or third-degree AV block and sick sinus syndrome (unless pacemaker fitted); severe hypotension
Side effects
Common or very common Abdominal discomfort; arrhythmias; atrioventricular block; chest discomfort; chest pain (discontinue); dizziness; dry mouth; dyspnoea; flushing; headache; hypotension (discontinue if severe); pain; paraesthesia; throat discomfort Uncommon Asthenia; back discomfort; bradycardia (discontinue if asystole or severe bradycardia occur); hyperhidrosis; limb discomfort; nervousness; taste metallic Rare or very rare Drowsiness; nasal congestion; nipple tenderness; respiratory disorders; respiratory failure (discontinue); tinnitus; tremor; urinary urgency; vision blurred Frequency not known Apnoea; cardiac arrest; loss of consciousness; nausea; seizure; syncope; vomiting
Interactions
**Other interactions (6):**
- Dipyridamole inhibits adenosine cellular uptake and metabolism, and potentiates the action of Adenosine 30 mg/10 ml solution for infusion.
- In one study dipyridamole was shown to produce a 4 fold increase in adenosine actions.
- It is therefore suggested that Adenosine 30 mg/10 ml solution for infusion should not be administered to patients receiving dipyridamole; if use of Adenosine 30 mg/10 ml solution for infusion is...
- Aminophylline, theophylline and other xanthines are competitive adenosine antagonists and should be avoided for 24 hours prior to use of Adenosine 30 mg/10 ml solution for infusion.
- Food and drinks containing xanthines (tea, coffee, chocolate and cola) should be avoided for at least 12 hours prior to use of Adenosine 30 mg/10 ml solution for infusion.
- Adenosine may interact with drugs tending to impair cardiac conduction.
Pregnancy
Large doses may produce fetal toxicity; manufacturer advises use only if potential benefit outweighs risk.
Breast feeding
No information available-unlikely to be present in milk owing to short half-life.
Medicinal forms
Solution,Solution,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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