Drug Summary

Adenosine (Adenocard®)

Pharmacologic properties:

Adenosine is an endogenous purine nucleoside that slows conduction time through the AV node and interrupts AV reentry pathways which restores normal sinus rhythm in patients with paroxysmal supraventricular tachycardia (PSVT). The onset of action is 20-30 seconds and the duration of action is < 10 seconds.

Indications:

  • PSVT (rate > 150)
  • Wide-complex tachycardia (rate > 150), stable and SVT highly likely

Contraindications:

  • 2nd or 3rd degree AV block
  • Sick sinus syndrome
  • Known hypersensitivity

Precautions:

  • Effects of adenosine are antagonized by methylxanthine (theophylline and caffeine)
  • Adenosine can provoke bronchospasm and should be used cautiously in patients with reactive airway disease
  • Tegretol and Persantine may potentiate the effect of Adenosine
  • Adenosine is not effective in converting atrial fibrillation or flutter
  • The half-life of adenosine is < 5 seconds - the drug should be administered via a large bore IV in the upper extremity, and at the port closest to the IV hub

Side effects/ adverse reactions:

  • Cardiovascular- transient chest pain
  • Facial flushing (transient)
  • Respiratory- transient dyspnea
  • Metallic taste

Dosage and administration:

  • Adult
    • 6 mg rapid IV bolus over 1-3 seconds
    • If inadequate response in 1-2 minutes, administer 12 mg rapid IV bolus over 1-3 seconds
    • If inadequate response in 1-2 minutes, repeat 12 mg rapid IV bolus over 1-3 seconds.
  • Pediatric
    • 0.1 mg/kg rapid IV/IO bolus over 1-3 seconds (maximum dose 6 mg)
    • If inadequate response in 1-2 minutes, administer 0.2 mg/kg (maximum dose 12 mg) rapid IV bolus, over 1-3 secondsM
    • If inadequate response in 1-2 minutes, repeat 0.2 mg/kg (maximum dose 12 mg) rapid IV bolus, over 1-3 seconds