Adenosine

CLINICAL USE

  • Rapid reversion to sinus rhythm ofparoxysmal supraventricular tachycardias
  • Diagnosis of broad or narrow complexsupraventricular tachycardias

    DOSE IN NORMAL RENAL FUNCTION

    Initially: 3 mg over 2 seconds with cardiac
    monitoring followed, if necessary, by 6 mg
    after 1–2 minutes and then by 12 mg after a
    further 1–2 minutes

    PHARMACOKINETICS

  • Molecular weight                           :
    267.2
  • %Protein binding                           :
    0
  • %Excreted unchanged in urine     :
    <5
  • Volume of distribution (L/kg)       :
    No data
  • half-life – normal/ESRD (hrs)      :
  • <10           : seconds/
    Unchanged

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : Dose as in normal renal function
  • 10 to 20     : Dose as in normal renal function
  • <10           :
    Dose as in normal renal function

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :
    Not dialysed. Dose as in normal renal function
  • HD                     :
    Not dialysed. Dose as in normal renal function
  • HDF/high flux   :
    Unknown dialysability. Dose as in
    normal renal function
  • CAV/VVHD      :
    Not dialysed. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs

  • Anti-arrhythmics: increased risk ofmyocardial depression
  • Antipsychotics: increased riskof ventricular arrhythmias with
    antipsychotics that prolong the QT
    interval
  • Beta-blockers: increased risk of myocardialdepression
  • Effect is enhanced and extended bydipyridamole; therefore if use of adenosine
    is essential, dosage should be reduced by a
    factor of 4 (i.e. initial dosage of 0.5–1 mg)
  • Theophylline and other xanthines arepotent inhibitors of adenosine

    ADMINISTRATION

    Reconstition

    –

    Route

    IV

    Rate of Administration

    Rapid IV bolus (see dose)

    Comments

    Do not refrigerate

    Administer into central vein, large

    peripheral vein, or into an IV line. If IV
    line used, follow dose by rapid sodium
    chloride 0.9% flush

    OTHER INFORMATION

  • Neither the kidney nor the liver isinvolved in the degradation of exogenous
    adenosine, so dose adjustments are not
    required in hepatic or renal insufficiency
  • Unlike verapamil, adenosine may be usedin conjunction with a beta-blocker
  • Common side effects: facial flushing, chestpain, dyspnoea, bronchospasm, nausea
    and lightheadedness; the side effects are
    short-lived
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