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Adenosine

Class
Antiarrhythmics
Subclass
Adenosine receptor agonists
Substance name
Adenosine
Brand names
Adenocard®
Common formulations
Solution for injection
Dosage and administration
Adults patients
Treatment
Paroxysmal SVT
•
Maintenance: 6 mg IV bolus
•
Maximum: 12 mg per day
Consider titrating dose to 12 mg every 1 to 2 min as needed for 2 doses.
Facilitation
Facilitation of myocardial perfusion scintigraphy
•
140 mcg/kg/min IV continuous infusion for 6 minutes
Indications for use
Labeled indications
Adults
•
Treatment of paroxysmal SVT
•
Facilitation of acute vasodilator testing in patients with pulmonary hypertension
•
Facilitation of myocardial perfusion scintigraphy
Safety risks
Contraindications
Hypersensitivity to adenosine or its components
Cardiogenic shock
Sick sinus syndrome, second- or third-degree AV block, bradycardia leading to syncope without a functioning pacemaker.
Warnings and precautions
Bronchospasm
•
Use caution in patients with asthma or reactive airway diseases.
COPD
•
Use caution in patients with bronchoconstrictive or bronchospastic lung disease.
Exacerbation of bradycardia, myocardial infarction
•
Use caution in patients with severe coronary artery disease.
Respiratory alkalosis
•
Use caution in patients with obstructive lung disease not associated with bronchoconstriction.
Severe hypotension, bradycardia
•
Use caution in elderly patients.
Specific populations
Renal impairment
eGFR 20-50 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
eGFR 10-20 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
eGFR < 10 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
Renal replacement therapy
Continuous renal replacement
•
Use acceptable. No dose adjustment required.
Intermittent hemodialysis
•
Use acceptable. No dose adjustment required.
Peritoneal dialysis
•
Use acceptable. No dose adjustment required.
Hepatic impairment
Any severity
•
Use acceptable. No dose adjustment required.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B2
•
Use only if benefits outweigh potential risks.
Breastfeeding
Little information available on breastfeeding safety.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Adverse reactions
Very common > 10%
•
Dyspnea, skin flushing
Common 1-10%
•
↓ serum HDL, chest tightness, dizziness, lightheadedness, nausea, numbness, paresthesia
Uncommon < 1%
•
Asystole, hypotension, VF, VT
Interactions
Drug(s)
Check Interactions
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