Adenosine

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See critical care quick reference for drug doses by weight.

General

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

Adult Dosing

  • 6mg rapid IV bolus over 1-2s
    • If ineffective can try 12mg 2min later
      • If still ineffective can try another 12mg
  • Caveat
    • Higher dose (1st 12mg, 2nd/3rd 18mg) in patient taking methylxanthines (ie caffeine, theophylline)
      • Blocks adenosine binding at receptor sites (competitive antagonist)
    • Lower dose (1st 3mg, 2nd/3rd 6mg) in patient taking carbamazepine (Tegretol), diazepam (Valium) or dipyridamole (Persantine) OR with a heart transplant.

Indications

  • Conversion of reentrant PSVT to NSR

Pediatric Dosing

See critical care quick reference for drug doses by weight.

Special Populations

  • Pregnancy Rating: Category C
  • Lactation:
  • Renal Dosing
    • Adult
    • Pediatric
  • Hepatic Dosing
    • Adult
    • Pediatric

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