Adenosine (Adenocard)

Generic Name: Adenosine

Adenosine is a prescription drug used for conversion to sinus rhythm of paroxysmal supraventricular tachycardia (PVST), including that associated with accessory bypass tracts (Wolff-Parkinson-White Syndrome). When clinically advisable, appropriate vagal maneuvers (Valsalva maneuver), should be attempted prior to adenosine administration.

Adenosine is available under the following different brand names: Adenocard, and Adenoscan.

Dosages of Adenosine:

Injectable solution

  • 3 mg/ml
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When it is administered intravenously, adenosine causes transient heart block in the atrioventricular (AV) node. This is mediated via the A1 receptor, inhibiting adenylyl cyclase, reducing cAMP and so causing cell hyperpolarization by increasing K+ efflux via inward rectifier K+ channels, subsequently inhibiting Ca2+ current. It also causes endothelial-dependent relaxation of smooth muscle as is found inside the artery walls. This causes dilation of the "normal" segments of arteries, i.e. where the endothelium is not separated from the tunica media by atherosclerotic plaque. This feature allows physicians to use adenosine to test for blockages in the coronary arteries, by exaggerating the difference between the normal and abnormal segments.

The administration of adenosine also reduces blood flow to coronary arteries past the occlusion. Other coronary arteries dilate when adenosine is administered while the segment past the occlusion is already maximally dilated. This leads to less blood reaching the ischemic tissue, which in turn produces the characteristic chest pain.

In individuals with supraventricular tachycardia (SVT), adenosine is used to help identify and convert the rhythm.

Certain SVTs can be successfully terminated with adenosine. This includes any re-entrant arrhythmias that require the AV node for the re-entry, e.g., AV reentrant tachycardia (AVRT), AV nodal reentrant tachycardia (AVNRT). In addition, atrial tachycardia can sometimes be terminated with adenosine.

Fast rhythms of the heart that are confined to the atria (e.g., atrial fibrillation, atrial flutter) or ventricles (e.g., monomorphic ventricular tachycardia) and do not involve the AV node as part of the re-entrant circuit are not typically converted by adenosine. However, the ventricular response rate is temporarily slowed with adenosine in such cases.

Because of the effects of adenosine on AV node-dependent SVTs, adenosine is considered a class V antiarrhythmic agent. When adenosine is used to cardiovert an abnormal rhythm, it is normal for the heart to enter ventricular asystole for a few seconds. This can be disconcerting to a normally conscious patient, and is associated with angina-like sensations in the chest.

Side effects of adenosine include:

  • facial flushing
  • difficulty breathing
  • chest pain
  • heart attack
  • lightheadedness
  • dizziness
  • tingling in arms
  • numbness
  • nausea
  • low blood pressure (hypotension)
  • irregular heartbeat (palpitations)
  • apprehension
  • head pressure
  • chest pain
  • blurred vision
  • burning sensation
  • heaviness in arms, neck and back pain
  • metallic taste
  • tightness in throat
  • pressure in groin
  • sweating
  • hyperventilation

Post marketing side effects of adenosine reported include:

  • prolonged flat line
  • elevated heart rate
  • rhythm disturbance (ventricular fibrillation)
  • transient increase in blood pressure
  • slow heart rate
  • irregular heartbeats (atrial fibrillation)
  • cardiac failure
  • infusion site pain
  • hypersensitivity
  • abnormal heart rhythm (torsades de pointes)
  • seizure
  • sudden difficulty breathing (bronchospasm)

Dosage Considerations – Should be Given as Follows:

Paroxysmal Supraventricular Tachycardia

Adult Dosage

  • Indicated for conversion to sinus rhythm of paroxysmal supraventricular tachycardia (PSVT), including that associated with accessory by pass tracts (Wolff-Parkinson-White Syndrome)
  • Adenocard: 6 mg intravenous push over 1-3 seconds (maybe given as intraosseous infusion) followed by rapid flush with 20 ml normal saline, if no conversion within 1-2 minutes give 12 mg intravenous pyelogram, repeat a second time if necessary (30 mg total)

Dosing considerations

  • When clinically advisable for paroxysmal supraventricular tachycardia (PSVT), appropriate vagal maneuvers (Valsalva maneuver), should be attempted prior to adenosine administration

Pediatric Dosage

  • Under 50 kg: 0.05 to 0.1 mg/kg rapid intravenous pyelogram over 1-3 seconds or intraosseous infusion, no more than 0.2 mg/kg/dose, followed by rapid flush with up to 5 ml 0.9% sodium chloride
  • If necessary may give second dose of 0.2 mg/kg intravenous pyelogram/intraosseous infusion, not to exceed cumulative dose of 12 mg

Geriatric Dosage

  • Elderly may experience more adverse effects from adenosine; they may be more sensitive
  • PSVT (Adenocard)
  • 6 mg intravenously (IV) over 1-3 seconds (maybe given by intraosseous infusion [IO]) followed by rapid flush with 20 ml normal saline (NS), if no conversion within 1-2 minutes give 12 mg IV, repeat a second time if necessary (30 mg total)
  • Adenoscan (Diagnostic)
  • Stress testing (Adenoscan): 140 mcg/kg/minute intravenous infusion for 6 minutes

Stress Testing (Diagnostic)

  • Indicated as an adjunct to thallium-201 myocardial perfusion scintigraphy in patients unable to exercise adequately
  • Adenoscal: 140 mcg/kg/minute intravenous infusion for 6 minutes

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Adenosine has no known severe interactions with other drugs.

Adenosine has no known serious interactions with other drugs.

Moderate interactions of adenosine include:

  • dipyridamole
  • dyphylline
  • green tea
  • hawthorn
  • nicotine inhaled
  • nicotine intranasal
  • sevelamer
  • theophylline

Mild interactions of adenosine include:

  • acebutolol
  • atenolol
  • betaxolol
  • bisoprolol
  • caffeine
  • carvedilol
  • celiprolol
  • esmolol
  • labetalol
  • lily of the valley
  • metoprolol
  • nadolol
  • nebivolol
  • penbutolol
  • pindolol
  • propranolol
  • sotalol
  • timolol

Alclofenac is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store alclofenac in the bathroom or the freezer. There may be different brands of alclofenac that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

Before using this drug, tell your doctor if:

  • You are pregnant or breastfeeding. This is because, while you are expecting or feeding a baby, you should only take medicines on the recommendation of a doctor.
  • You are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, such as herbal and complementary medicines.
  • You have allergy with any of active or inactive ingredients of alclofenac or other medications.
  • You have any other illnesses, disorders, or medical conditions.
  • You have moderate to severe renal impairment. Dose reduction may be needed

All Relative Medicines

ADENOSINE ADENOJECT

(1 amp Inj.) of 30mg/10ml
Rs. 898.00 INR
View Details

ADENOSINE ADENOJECT

(1 amp Inj.) of 6mg/2ml
Rs. 215.60 INR
View Details

ADENOSINE ADENOCOR

(2ml vial Inj.) of 6mg/2ml
Rs. 242.00 INR
View Details

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