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Adenosine

    Brands

    DEA Class; Rx

    Common Brand Names; Adenocard, Adenoscan

    • Antidysrhythmics, V

    Parenteral pharmacologic stress agent and antiarrhythmic
    Used for adjunct to thallium-201 myocardial perfusion scintigraphy in patients unable to exercise adequately and for conversion to sinus rhythm of paroxysmal supraventricular tachycardia (PSVT)
    Associated with cardiac arrest, sustained ventricular tachycardia, myocardial infarction, bronchoconstriction, and respiratory compromise; appropriate resuscitative measures should be available

    Indicated for conversion to sinus rhythm of paroxysmal supraventricular tachycardia (PSVT), including that associated with accessory bypass tracts (Wolff-Parkinson-White Syndrome)

    Indicated as an adjunct to thallium-201 myocardial perfusion scintigraphy in patients unable to exercise adequately

    Hypersensitivity

    2nd or 3rd degree AV block (except those on pacemakers)

    Sinus node disease, such as sick sinus syndrome or symptomatic bradycardia (except in patients with a functioning artificial pacemaker)

    Adenoscan: Contraindicated in bronchoconstrictive or bronchospastic lung disease (eg, asthma)

    • Flushing (18%)
    • Dyspnea (12%)
    • Chest pressure (7%)
    • HA (2%)
    • Lightheadedness (2%)
    • Dizziness (1%)
    • Tingling in arms (1%)
    • Numbness (1%)
    • Nausea (3%)
    • Hypotension
    • Palpitations
    • Apprehension
    • Head pressure
    • Chest pain
    • Hyperventilation
    • Blurred vision
    • Burning sensation
    • Heaviness in arms, neck and back pain
    • Metallic taste
    • Tightness in throat
    • Pressure in groin
    • Sweating
    • Prolonged asystole
    • Ventricular tachycardia
    • Venricular fibrillation
    • Transient increase in blood pressure
    • Bradycardia
    • Atrial fibrillation
    • Cardiac failure
    • Infusion site pain
    • Hypersensitivity
    • Torsades de Pointes
    • Seizure
    • Bronchospasm

    Symptomatic bradycardia, cardiac arrest, heart block, heart transplant patients, HTN, hypotension, MI, proarrhythmic events, unstable angina

    Adenocard: Caution with bronchoconstrictive or bronchospastic lung disease (eg, asthma)

    Cerebrovascular accident hemorrhagic and ischemic cerebrovascular accidents reported; hemodynamic effects of adenosine including hypotension or hypertension possibly associated with these adverse reactions

    Nucleoside transport inhibitors (eg, dipyridamole) and potentiate the vasoactive effects of adenosine; withhold for 5 half-lives before adenosine administration

    Methylxanthines (eg, caffeine, theophylline) are adenosine receptor antagonists and inhibit adenosine’s vasoactive effects; withhold methylxanthines for 5 half-lives before adenosine administration

    New-onset or recurrence of convulsive seizures reported following adenosine; some seizures are prolonged and require emergent anticonvulsive management; aminophylline may increase risk of seizures associated with adenosine; methylxanthine use not recommended in patients who experience seizures in association with adenosine administration

    Dyspnea, throat tightness, flushing, erythema, rash, and chest discomfort reported that may require symptomatic treatment; resuscitative measures may be necessary if symptoms progress; have trained personnel and treatment available during treatment

    Arrhythmia at time of cardioversion (Adenocard): Ventricular fibrillation reported following administration, including both resuscitated and fatal events; in most instances, these cases were associated with the concomitant use of digoxin and, less frequently with digoxin and verapamil

    Pregnancy Category: C

    Lactation: Potential for serious adverse reactions in nursing infants; decision to interrupt nursing after administration of adenosine or not should take into account importance of drug to mother

    Adults

    12 mg/dose IV, with maximum total dosage up to 30 mg for PSVT; 0.84 mg/kg/dose (Max: 60 mg) IV for coronary artery disease diagnosis.

    Geriatric

    12 mg/dose IV, with maximum total dosage up to 30 mg for PSVT; 0.84 mg/kg/dose (Max: 60 mg) IV for coronary artery disease diagnosis.

    Adolescents

    Weighing 50 kg or more: 12 mg/dose IV/IO, with maximum total dosage up to 30 mg per PSVT episode; safety and efficacy for coronary artery disease diagnosis have not been established.
    Weighing less than 50 kg: 0.3 mg/kg/dose IV/IO (Max: 12 mg); safety and efficacy for coronary artery disease diagnosis have not been established.

    Children

    Weighing 50 kg or more: 12 mg/dose IV/IO, with maximum total dosage up to 30 mg per PSVT episode; safety and efficacy for coronary artery disease diagnosis have not been established.
    Weighing less than 50 kg: 0.3 mg/kg/dose IV/IO (Max: 12 mg); safety and efficacy for coronary artery disease diagnosis have not been established.

    Infants

    0.3 mg/kg/dose IV/IO; safety and efficacy for coronary artery disease diagnosis have not been established.

    Neonates

    0.3 mg/kg/dose IV/IO; safety and efficacy for coronary artery disease diagnosis have not been established.

    Sotalol hydrochloride

    injectable solution

    • 6mg/2mL prefilled syringe
    • 12mg/4mL prefilled syringe