Adenosine

Revision as of 16:38, 19 September 2019 by ClaireLewis (talk | contribs)

See critical care quick reference for drug doses by weight.

General

  • Type: Antiarrhythmics
  • Dosage Forms: IV
  • Common Trade Names: Adenocard, Adenoscan

Indications

  • Conversion of reentrant PSVT to NSR

Adult Dosing

Stable, narrow complex tachycardia

  • 6mg rapid IV push over 1-2s
    • If ineffective can try 12mg 2min later
    • If still ineffective can try another 12mg
  • Caveat
    • For patients taking methylxanthines (ie caffeine, theophylline):
      • Blocks adenosine binding at receptor sites (competitive antagonist) and can lead to bronchospasm
    • Consider using lower dose (1st 3mg, 2nd/3rd 6mg) in patient taking carbamazepine (Tegretol), diazepam (Valium) or dipyridamole (Persantine) OR with a heart transplant.

Pediatric Dosing

PALS guidelines for infants, children, and adolescents[1] See critical care quick reference for drug doses by weight.

  • 0.1mg/kg rapid IV/IO push (max 6mg/dose)
    • If not effective, increase to 0.2 mg/kg (max 12mg/dose)

Special Populations

Pregnancy Rating

  • May use during pregnancy; risk of fetal harm not expected based on limited human data

Lactation

  • Cardiac Stress Testing: may use while breastfeeding; no human data available, though risk of infant harm and adverse effects on milk production not expected based on drug properties.
  • All other uses: N/A; drug unlikely to be used during breastfeeding based on indication

Renal Dosing[2]

  • Adult
    • Not defined - not renally eliminated
  • Pediatric
    • Not defined - not renally eliminated

Hepatic Dosing[3]

  • Adult
    • Not defined - not hepatically eliminated
  • Pediatric
    • Not defined - not hepatically eliminated

Contraindications

  • Allergy to class/drug
  • 2nd, 3rd AV block
  • Sick sinus syndrome
  • Reentrant SVTs not involving AV node are not terminated
  • No effect on anterograde WPW

Adverse Reactions

  • Bronchoconstriction (responds to bronchodilators)
  • Bradyarrhythmia
  • Hypotension(if given too slowly)

Pharmacology

  • Kinetics: Onset of action = 20-30s Duration of action = 60-90s
  • Half-life: <10 seconds
  • Metabolism: vascular endothelial cells
  • Excretion:

Mechanism of Action

  • Negative inotropic, dromotropic, chronotropic effects
  • Transient AV nodal block

See Also

References

  1. PALS [Klienman 2010]
  2. Adenosine: Drug information. UpToDate. www.uptodate.com. Accessed April 2, 2019.
  3. Adenosine: Drug information. UpToDate. www.uptodate.com. Accessed April 2, 2019.