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adenosine (Rx)Brand and Other Names:Adenocard, Adenoscan

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injectable solution

  • 3mg/mL
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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

  • 3mg/mL
more...

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

adenosine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Flushing (18%)

            Dyspnea (12%)

            1-10%

            Chest pain (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 & 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), sick sinus syndrome, atrial flutter or fib, V-tach

            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 & tissue; deaminated to inosine & 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 & is followed by rapid NS flush after each inj (20 mL for adults, 5 mL or more for peds)

            Place pt 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 & NS flush in other port
            • Simply open stopcock to Adenosine & push
            • Close stopcock & open port to NS & push Eliminates possibility of Adenosine traveling retrograde

            May be given via central line or intraosseus

            Adenoscan: given by continuous peripheral IV infusion for 6 min

            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

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            Formulary

            FormularyPatient Discounts

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            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.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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