Generic Name: adenosine
Brand Names: Adenocard, Adenoscan (both brands discontinued)
Drug Class: Antidysrhythmics, V
What is adenosine, and what is it used for?
Adenosine is a medication belonging to class V antidysrhythmics, used to treat a type of irregular heart rhythm disorder known as paroxysmal supraventricular tachycardia (PSVT). PSVT is a condition in which intermittent episodes of rapid heart rate occur starting from the region above the ventricles. Adenosine is also used for diagnostic purposes in myocardial perfusion scintigraphy, a test that determines how well blood flows through the heart muscles.
Specialized cells in the right atrium known as the sinoatrial (SA) node, the heart’s natural pacemaker, generates electrical impulses at a regular rhythm to make the atria and ventricles contract in coordination to pump blood. The impulses make the atria contract first and the atrioventricular (AV) node delays the signal till the atria are empty. The impulses then travel through nerve fibers to the ventricles and make them contract.
PSVT is caused by abnormal functioning of the cardiac electrical circuit. Adenosine restores normal rhythm in PSVT by acting on the adenosine receptors in the atrioventricular node, slowing down the impulse conduction time and interrupting abnormal re-entry pathways of electrical impulses in the AV node.
Adenosine also binds to adenosine A2 receptors in the coronary arteries, dilating them and increasing the blood flow. Adenosine significantly increases blood flow in normal coronary arteries, but little or no increase in arteries that are narrowed due to plaque. Adenosine is used with the radioactive agent thallium-201 to identify narrowed coronary blood vessels and the risk for heart disease.
- Do not use adenosine in patients with heart rhythm disorders including:
- Second or third-degree AV block (except in patients with a functioning artificial pacemaker)
- Sinus node disease, such as sick sinus syndrome or symptomatic bradycardia (except in patients with a functioning artificial pacemaker)
- Do not use adenosine in patients with:
- Known or suspected bronchoconstrictive or bronchospastic lung disease such as asthma
- Known hypersensitivity to adenosine
- Use adenosine with caution in patients with first-degree AV block
- Cardiac arrest (fatal and nonfatal), heart attack (myocardial infarction), cerebrovascular accident (hemorrhagic and ischemic), and sustained ventricular tachycardia (requiring resuscitation) have occurred following adenosine use; avoid use in patients with unstable angina, acute myocardial ischemia, or cardiovascular instability, conditions in which the heart doesn’t get enough blood flow and oxygen
- Adenosine use in PSVT patients has caused atrial flutter/fibrillation; use with caution, particularly in Wolff-Parkinson-White syndrome, a condition with an extra electrical pathway in the heart
- Adenosine can cause hypertension or hypotension; use with caution in patients at risk
- At the time of conversion to normal sinus rhythm, abnormal rhythms may occur for a short period
- New-onset or recurrence of convulsive seizures have been reported following administration of adenosine; some seizures are prolonged and require emergency anticonvulsive management; aminophylline may increase risk of seizures associated with adenosine and methylxanthines use is not recommended
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What are the side effects of adenosine?
Common side effects of adenosine include:
- Chest pressure and discomfort
- Shortness of breath (dyspnea)
- Throat, neck and jaw discomfort
- Gastrointestinal discomfort
- Upper extremity discomfort
- Electrical disturbances in the heart
- Abnormal ECG readings
- Low blood pressure (hypotension)
- Numbness and tingling (paresthesia)
- Irregular heart rhythms (arrhythmia)
Less common side effects of adenosine include:
- Chest pain
- Ventricular arrhythmia
- Heart attack (myocardial infarction)
- Low heart rate (bradycardia)
- High blood pressure (hypertension)
- Rapid breathing (hyperventilation)
- Head pressure
- Emotional instability
- Back discomfort
- Lower extremity discomfort
- Heaviness in arms
- Neck and back pain
- Burning sensation
- Blurred vision
- Metallic taste
- Dry mouth
- Tongue discomfort
- Tightness in throat
- Ear discomfort
- Nasal congestion
- Pressure in the groin
- Urinary urgency
Rare side effects of adenosine include:
- Injection site reaction
- Nausea and vomiting
- Respiratory arrest
- Prolonged flatline (asystole)
- Rapid ventricular contractions (ventricular tachycardia)
- Irregular ventricular rhythm (ventricular fibrillation)
- Abnormal ventricular rhythm (torsades de pointes)
- Slow heart rate (bradycardia)
- Atrial fibrillation
- Transient increase in blood pressure
- Loss of consciousness
This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug.
Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.
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What are the dosages of adenosine?
- 3 mg/ml
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 intravenous push over 1-3 seconds (maybe given as an intraosseous infusion) followed by a rapid flush with 20 ml normal saline, if no conversion within 1-2 minutes give 12 mg intravenous push, repeat a second time if necessary (30 mg total)
- When clinically advisable for paroxysmal supraventricular tachycardia (PSVT), appropriate vagal maneuvers (Valsalva maneuver), should be attempted before adenosine administration
Stress Testing (Diagnostic)
Adenoscan: 140 mcg/kg/minute intravenous infusion for 6 minutes
Other Indications and Uses
- Off label: sustained ventricular tachycardia (SVT)
Paroxysmal Supraventricular Tachycardia
- Under 50 kg: 0.05 to 0.1 mg/kg rapid intravenous push over 1-3 seconds or intraosseous infusion, no more than 0.2 mg/kg/dose, followed by rapid flush with up to 5 ml 0.9% sodium chloride
- If necessary may give a second dose of 0.2 mg/kg intravenous push/intraosseous infusion, not to exceed the cumulative dose of 12 mg
The elderly may experience more adverse effects from adenosine; they may be more sensitive
- 6 mg intravenously (IV) over 1-3 seconds (maybe given by intraosseous infusion [IO]) followed by a rapid flush with 20 ml normal saline (NS), if no conversion within 1-2 minutes give 12 mg IV, repeat a second time if necessary (30 mg total)
- Stress testing (Adenoscan): 140 mcg/kg/minute intravenous infusion for 6 minutes
- Adenosine has a half-life of less than 10 seconds, toxic effects of adenosine usually resolve quickly once the drug is discontinued, although there have been reports of severe effects involving flatline (asystole), development of heart block, and cardiac ischemia.
- Theophylline has been used to treat persistent symptoms, in addition to appropriate supportive care.
What drugs interact with adenosine?
Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.
- Adenosine has no known severe interactions with other drugs.
- Adenosine has no known serious interactions with other drugs.
- Moderate interactions of adenosine include:
- Mild interactions of adenosine include:
The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.
It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information.
Check with your doctor or health care provider if you have any questions about the medication.
Pregnancy and breastfeeding
- Neither animal reproduction studies nor studies on pregnant women have been conducted with adenosine. It is not known if adenosine can cause fetal harm, use in pregnant women only if clearly needed.
- It is not known if adenosine is present in breast milk; decision should be made to interrupt nursing or not administer adenosine, taking into account the importance of treatment to the mother because of the potential for serious adverse reactions in nursing infants.
Adenosine is an antidysrhythmic drug used to treat a type of irregular heart rhythm disorder known as paroxysmal supraventricular tachycardia (PSVT). Common side effects of adenosine include flushing, chest pressure and discomfort, shortness of breath (dyspnea), headache, throat, neck and jaw discomfort, gastrointestinal discomfort, lightheadedness, dizziness, upper extremity discomfort, electrical disturbances in the heart, abnormal ECG readings, low blood pressure (hypotension), numbness and tingling (paresthesia), irregular heart rhythms (arrhythmia), and nausea. Consult your doctor before taking if pregnant or breastfeeding.
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A Widowmaker is a type of heart attack, which is deadlier than most others. A widowmaker heart attack occurs when the left ascending artery (LAD) that supplies blood to the front part of the heart (largest part) is clogged-up because of clots in the arterial wall. This causes the death of heart muscle in this area, medically termed myocardial infarction. Because the widowmaker damages a major portion of the heart, timely management is necessary to prevent fatalities.
Can Kawasaki Disease Cause Heart Failure?
Approximately 50 percent of children with Kawasaki disease may develop inflammation of the heart muscle and potentially heart failure, in severe cases.
What Heart Rate Is Bradycardia?
Most researchers consider bradycardia to be a heart rate less 60 beats per minute (bpm).
Can You Have Sex Right After a Heart Attack?
It is important not to put any pressure on yourself or your heart after heart attack. Initially, you might feel less interested in sex. That is perfectly normal, and the feeling goes away quickly.
When Should I Be Worried About Heart Palpitations?
You should be worried about heart palpitations if they are accompanied by dizziness, lightheadedness, confusion, chest pain, shortness of breath, nausea, vomiting, and more.
Can You Still Exercise With Heart Failure?
Performing light to moderate exercises is a great way to strengthen your heart muscles after being diagnosed with heart failure.
Does COVID-19 Affect My Heart?
As per the American Heart Association, COVID-19 may have a long-term effect on the heart. Having a heart condition doesn't make a person more likely to catch COVID-19, but an individual with heart disease or a serious heart condition is more likely to become severely ill from COVID-19 and has a higher risk of death.
What Does a Sudden Heart Attack Feel Like?
In most cases, a sudden heart attack may feel like pain, pressure, fullness, or squeezing in the chest that lasts for a few minutes or goes away and comes back.
Treatment & Diagnosis
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