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adenosine

C01EB10

Forms & Strengths

Injectable solution: 3 mg/mL in 2 mL vials
Injectable solution: 3 mg/mL in 5 mL vials
Injectable solution: 3 mg/mL in 30 mL vials

Adult Dosing

Paroxysmal supraventricular tachycardia (PSVT): Initial 6 mg rapid IV bolus (over 1-2 seconds) followed by normal saline flush
PSVT repeat dose: If no conversion within 1-2 minutes, give 12 mg rapid IV bolus
PSVT max single dose: 12 mg
Myocardial perfusion imaging: 0.14 mg/kg/min constant infusion over 6 minutes (total dose 0.84 mg/kg)

Pediatric Dosing

PSVT initial dose: 0.05 mg/kg to 0.1 mg/kg rapid IV/IO bolus (max initial dose 6 mg)
PSVT repeat dose: May increase by 0.05 mg/kg to 0.1 mg/kg every 1-2 minutes if not effective (max single dose 12 mg)

Indications

Conversion of paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm
Pharmacologic stress agent in myocardial perfusion imaging

Mechanism of Action

Endogenous purine nucleoside that acts on A1 adenosine receptors in the heart
Slows conduction time through the AV node
Interrupts reentry pathways through the AV node, restoring normal sinus rhythm in PSVT

Contraindications

Second- or third-degree AV block (in patients without a functioning artificial pacemaker)
Sick sinus syndrome (in patients without a functioning artificial pacemaker)
Bronchospastic lung disease (e.g., asthma)
Known hypersensitivity to adenosine

Adverse Reactions

Facial flushing
Chest pain or tightness
Dyspnea or shortness of breath
Transient asystole, bradycardia, or AV block
Nausea
Lightheadedness or dizziness

Drug Interactions

Dipyridamole blocks cellular uptake of adenosine, potentiating its effects (reduce adenosine dose)
Theophylline and caffeine are competitive antagonists; larger doses of adenosine may be required
Carbamazepine may increase the risk of heart block

Curated Content: Needs Vetting Before Put to Clinical Use