adenosine (Rx)

Brand and Other Names:Adenocard, Adenoscan
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injectable solution

  • 6mg/2mL prefilled syringe
  • 12mg/4mL prefilled syringe

Paroxysmal Supraventricular Tachycardia

Indicated for conversion to sinus rhythm of paroxysmal supraventricular tachycardia (PSVT), including that associated with accessory bypass tracts (Wolff-Parkinson-White Syndrome)

Adenocard: 6 mg IVP over 1-3 seconds (maybe given IO) followed by rapid flush with 20 mL NS, if no conversion within 1-2 minutes give 12 mg IVP, repeat a second time if necessary (30 mg total)

Dosing considerations

  • When clinically advisable for PSVT, appropriate vagal maneuvers (eg, Valsalva maneuver), should be attempted prior to adenosine administration

Stress Testing (Diagnostic)

Indicated as an adjunct to thallium-201 myocardial perfusion scintigraphy in patients unable to exercise adequately

Adenoscan: 140 mcg/kg/min IV infusion for 6 min  

Other Indications & Uses

Off-label: Sustained ventricular tachycardia (SVT)

Dosage Forms & Strengths

injectable solution

  • 6mg/2mL prefilled syringe
  • 12mg/4mL prefilled syringe

Paroxysmal Superventricular Tachycardia (per ACLS)

<50 kg: 0.05 to 0.1 mg/kg rapid IVP over 1-3 seconds or IO, no more than 0.3 mg/kg/dose, followed by rapid flush with > 5 mL 0.9% NaCl  

If necessary may give 2nd dose of 0.2 mg/kg IVP/IO, not to exceed cumulative dose of 12 mg

Elderly may experience more adverse effects from adenosine; they may be more sensitive

PSVT (Adenocard)

6 mg IVP over 1-3 seconds (maybe given IO) followed by rapid flush with 20 mL NS, if no conversion within 1-2 minutes give 12 mg IVP, repeat a second time if necessary (30 mg total)

Adenoscan (Diagnostic)

Stress testing (Adenoscan): 140 mcg/kg/min IV infusion for 6 min

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Interactions

Interaction Checker

and adenosine

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (1)

              • ponesimod

                ponesimod, adenosine. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.

              Monitor Closely (7)

              • dipyridamole

                dipyridamole increases levels of adenosine by decreasing metabolism. Use Caution/Monitor.

              • green tea

                green tea decreases effects of adenosine by unspecified interaction mechanism. Use Caution/Monitor. (Theoretical interaction).

              • hawthorn

                hawthorn increases effects of adenosine by pharmacodynamic synergism. Use Caution/Monitor.

              • nicotine inhaled

                nicotine inhaled increases effects of adenosine by unknown mechanism. Use Caution/Monitor. Adenosine associated tachycardia and chest pain.

              • nicotine intranasal

                nicotine intranasal increases effects of adenosine by unknown mechanism. Use Caution/Monitor. Adenosine associated tachycardia and chest pain.

              • sevelamer

                sevelamer decreases levels of adenosine by increasing elimination. Use Caution/Monitor.

              • theophylline

                theophylline decreases effects of adenosine by pharmacodynamic antagonism. Use Caution/Monitor.

              Minor (18)

              • acebutolol

                acebutolol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

              • atenolol

                atenolol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

              • betaxolol

                betaxolol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

              • bisoprolol

                bisoprolol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

              • caffeine

                caffeine decreases effects of adenosine by pharmacodynamic antagonism. Minor/Significance Unknown.

              • carvedilol

                carvedilol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

              • celiprolol

                celiprolol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

              • esmolol

                esmolol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

              • labetalol

                labetalol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

              • lily of the valley

                adenosine, lily of the valley. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown.

              • metoprolol

                metoprolol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

              • nadolol

                nadolol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

              • nebivolol

                nebivolol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

              • penbutolol

                penbutolol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

              • pindolol

                pindolol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

              • propranolol

                propranolol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

              • sotalol

                sotalol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

              • timolol

                timolol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

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              Adverse Effects

              >10%

              Flushing (18%)

              Dyspnea (12%)

              1-10%

              Chest pressure (7%)

              HA (2%)

              Lightheadedness (2%)

              Dizziness (1%)

              Tingling in arms (1%)

              Numbness (1%)

              Nausea (3%)

              <1%

              Hypotension

              Palpitations

              Apprehension

              Head pressure

              Chest pain

              Hyperventilation

              Blurred vision

              Burning sensation

              Heaviness in arms, neck and back pain

              Metallic taste

              Tightness in throat

              Pressure in groin

              Sweating

              Post Marketing (undefined)

              Prolonged asystole

              Ventricular tachycardia

              Venricular fibrillation

              Transient increase in blood pressure

              Bradycardia

              Atrial fibrillation

              Cardiac failure

              Infusion site pain

              Hypersensitivity

              Torsades de Pointes

              Seizure

              Bronchospasm

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              Warnings

              Contraindications

              Hypersensitivity

              2nd or 3rd degree AV block (except those on pacemakers)

              Sinus node disease, such as sick sinus syndrome or symptomatic bradycardia (except in patients with a functioning artificial pacemaker)

              Adenoscan: Contraindicated in bronchoconstrictive or bronchospastic lung disease (eg, asthma)

              Cautions

              Symptomatic bradycardia, cardiac arrest, heart block, heart transplant patients, HTN, hypotension, MI, proarrhythmic events, unstable angina

              Adenocard: Caution with bronchoconstrictive or bronchospastic lung disease (eg, asthma)

              Cerebrovascular accident hemorrhagic and ischemic cerebrovascular accidents reported; hemodynamic effects of adenosine including hypotension or hypertension possibly associated with these adverse reactions

              Nucleoside transport inhibitors (eg, dipyridamole) and potentiate the vasoactive effects of adenosine; withhold for 5 half-lives before adenosine administration

              Methylxanthines (eg, caffeine, theophylline) are adenosine receptor antagonists and inhibit adenosine’s vasoactive effects; withhold methylxanthines for 5 half-lives before adenosine administration

              New-onset or recurrence of convulsive seizures reported following adenosine; some seizures are prolonged and require emergent anticonvulsive management; aminophylline may increase risk of seizures associated with adenosine; methylxanthine use not recommended in patients who experience seizures in association with adenosine administration

              Dyspnea, throat tightness, flushing, erythema, rash, and chest discomfort reported that may require symptomatic treatment; resuscitative measures may be necessary if symptoms progress; have trained personnel and treatment available during treatment

              Arrhythmia at time of cardioversion (Adenocard): Ventricular fibrillation reported following administration, including both resuscitated and fatal events; in most instances, these cases were associated with the concomitant use of digoxin and, less frequently with digoxin and verapamil

              Risk for myocardial infarction and death

              • Avoid use for cardiac nuclear stress tests in patients with signs or symptoms of acute myocardial ischemia (eg, unstable angina, cardiovascular instability); use may increase risk of fatal MI
              • Screen all nuclear stress test candidates for risks
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              Pregnancy & Lactation

              Pregnancy Category: C

              Lactation: Potential for serious adverse reactions in nursing infants; decision to interrupt nursing after administration of adenosine or not should take into account importance of drug to mother

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              PSVT: Slows conduction through AV node and interrupts AV reentry pathways, which restore normal sinus symptoms

              Stress testing: A2A adenosine receptor agonist; activation of the A2A adenosine receptor produces coronary vasodilation and increases coronary blood flow

              Pharmacokinetics

              Half-life: <10 sec

              Duration: <10 sec

              Onset: 20-30 sec

              Metabolism: Blood and tissue; deaminated to inosine and subsequently to hypoxanthine; adenosine also undergoes phosphorylation to adenosine monophosphate (AMP) within blood cells

              Metabolites: Inosine, hypoxanthine, AMP (inactive)

              Total body clearance: 30 sec

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              Administration

              IV Compatibilities

              Solution: dextrose 5% in LR, D5W, LR, NS

              IV Administration

              Adenocard: given as a rapid injection (1-3 sec) by peripheral IV route directly into vein or into IV line close (proximal) to patient and is followed by rapid NS flush after each injection (20 mL for adults, 5 mL or more for pediatrics)

              Place patient in mild reverse Trendelenburg position before giving drug

              Record rhythm strip during administration

              Draw up (separate syringes)

              • Adenosine dose
              • Flush
              • Attach both syringes to IV injection port nearest to patient

              Clamp IV tubing above injection port

              Avoid drug traveling retrograde

              Push adenosine as fast as possible (1-3 sec)

              While keeping pressure on adenosine syringe plunger, push NS flush as fast as possible

              Unclamp IV tubing

              Preferred method using a stopcock

              • Have adenosine in one port and NS flush in other port
              • Simply open stopcock to adenosine and push
              • Close stopcock and open port to NS and push
              • Eliminates possibility of adenosine traveling retrograde

              May be given via central line or intraosseus

              Adenoscan: given by continuous peripheral IV infusion for 6 minutes

              Storage

              Store at controlled room temperature of 15-30°C

              Do not refrigerate; possible crystal formation

              Solution must be clear prior to administration

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              adenosine intravenous
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              3 mg/mL solution
              adenosine intravenous
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              3 mg/mL solution
              adenosine intravenous
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              3 mg/mL vial
              adenosine intravenous
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              3 mg/mL vial
              adenosine intravenous
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              3 mg/mL vial
              adenosine intravenous
              -
              3 mg/mL vial
              adenosine intravenous
              -
              3 mg/mL vial
              adenosine intravenous
              -
              3 mg/mL solution
              adenosine intravenous
              -
              3 mg/mL vial
              adenosine intravenous
              -
              3 mg/mL solution

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              adenosine intravenous

              NO MONOGRAPH AVAILABLE AT THIS TIME

              USES: Consult your pharmacist.

              HOW TO USE: Consult your pharmacist.

              SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Consult your pharmacist.

              DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: No monograph available at this time.

              MISSED DOSE: Consult your pharmacist.

              STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

              Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

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              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.