Adenosine
ADENOCARD
What it isEndogenous purine nucleoside acting at A1 to A3 receptors; IV bolus for supraventricular tachycardia.
Why this oneA half-life of seconds means a transient AV block that terminates re-entrant SVT and then vanishes.
What limits itGive it fast into a large vein with a flush, and warn the patient about the brief sense of doom. Dipyridamole potentiates it; theophylline blocks it.
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Paroxysmal supraventricular tachycardia (conversion) | Adult | 6 mg rapid IV bolus | If no response in 1–2 min, 12 mg rapid IV bolus; may repeat 12 mg once | 12 mg per dose |
| Paroxysmal supraventricular tachycardia (conversion) | Pediatric <50 kg | 0.05–0.1 mg/kg rapid IV bolus | Increase by 0.05–0.1 mg/kg each repeat until sinus rhythm | 0.3 mg/kg single dose |
| Paroxysmal supraventricular tachycardia (conversion) | Pediatric ≥50 kg | Adult dose (6 mg) | 12 mg if needed | 12 mg per dose |
Renal Undefined
Hepatic Undefined
Doses greater than 12 mg are not recommended for adult or pediatric patients.
Instructions
- For rapid bolus IV use only, over 1–2 seconds.
- Give directly into a vein or into an IV line as close to the patient as possible, followed by a rapid saline flush.
- Inspect for particulate matter and discoloration before use.
Contraindications
- Second- or third-degree A-V block (unless functioning pacemaker)
- Sinus node disease — sick sinus syndrome or symptomatic bradycardia (unless functioning pacemaker)
Cautions
- Prolonged asystole, ventricular tachycardia/fibrillation, and Torsade de Pointes reported.
- Bronchospasm — caution in obstructive lung disease.
- Transient new arrhythmias/heart block at the time of conversion.
- Seizure activity and loss of consciousness reported.
Adverse reactions
- Facial flushing (18%)
- Shortness of breath/dyspnea (12%)
- Chest pressure (7%)
- Nausea (3%)
- Headache, lightheadedness/dizziness
- Chest pain, hypotension
Pregnancy No animal or human studies; as a naturally occurring substance fetal effects not anticipated, but use during pregnancy only if clearly needed (former Category C).
Lactation Undefined
NO BOXED WARNINGS
Principal riskA brief but severe sense of doom; theophylline blocks it
Classes and tags
Clinical profile
Mechanism of action: Adenosine ballicule
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