Adenosine

Registered South African indications:

• Conversion to sinus rhythm of paroxysmal supraventricular tachycardia, including those associated with accessory bypass tracts (Wolff-Parkinson-White Syndrome)

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Sick sinus syndrome (except in patients with a functioning artificial pacemaker)
• Second or third degree AV block (except in patients with a functioning artificial pacemaker)
• Chronic obstructive lung disease with evidence of bronchospasm
• Long QT syndrome
• Severe hypotension
• Decompensated states of heart failure

Cautions

• Pregnancy
• Breastfeeding
• Elderly
• Children with Wolff-Parkinson-White syndrome
• Atrial fibrillation or flutter (especially in patients with accessory bypass tract)
• Recent myocardial infarction
• Left main coronary stenosis
• Uncorrected hypovolemia
• Stenotic valvular heart disease
• Left to right shunt
• Pericarditis  
• Pericardial effusion
• Autonomic dysfunction
• Stenotic carotid artery disease with cerebrovascular insufficiency
• Severe heart failure
• Minor conduction defects (first degree AV block, bundle branch block)
• Occult sino-atrial disease
• Recent heart transplantation (< 1 year)
• History of seizures
• Prolonged QT interval
• Sodium-controlled diet
• Intraosseous administration

Forms avail. in SA and covered in this monograph: inj

Rapid conversion to normal sinus rhythm of paroxysmal supraventricular tachycardias, including those associated with accessory bypass tracts (Wolff-Parkinson-White Syndrome)

• IV: Initial: 3mg over 2sec; If no elimination of tachycardia, second dose: 6mg over 2sec; If no elimination of tachycardia, third dose: 12mg over 2sec

Additional or higher doses are not recommended

To be certain the solution reaches the systemic circulation administer either directly into a vein or into an IV line. If given into an IV line it should be injected as proximally as possible, and followed by a rapid saline flush

Cardio-respiratory resuscitation equipment must be available

Diagnostic indications
- Aid the diagnosis of broad or narrow complex supraventricular tachycardias (adenosine will not convert atrial flutter, atrial fibrillation or ventricular tachycardia to sinus rhythm, however, the slowing of AV conduction helps diagnosis of atrial activity)
- Sensitisation of intra-cavitary electrophysiological investigations

• Use the ascending dosage schedule above; Employ until sufficient diagnostic information has been obtained

Rapid IV injection only

No information available for children in South Africa

Rapid conversion to normal sinus rhythm of paroxysmal supraventricular tachycardia

• IV: Initial: 0.1mg/kg, bolus; Max: 6mg; Then: 0.1mg/kg, increments as needed to achieve termination of supraventricular tachycardia; Max: 12mg

Cardio-respiratory resuscitation equipment must be available

Administer by rapid IV bolus injection into a vein or into an IV line. If given into an IV line it should be injected through as proximally as possible, and followed by a rapid saline flush. If administered through a peripheral vein, a large bore cannula should be used

Pregnancy

• Caution
• There are no or limited amount of data from the use of adenosine in pregnant women. Animal studies are insufficient with respect to reproductive toxicity. Adenosine is not recommended during pregnancy unless the benefits to outweigh the potential risks

Breastfeeding

• Caution; not recommended
• It is unknown whether adenosine metabolites are excreted in human milk. Adenosine should not be used in mothers who are breastfeeding

Renal Impairment

• No dose adjustment recommended

Hepatic Impairment

• No dose adjustment recommended

Elderly

• Caution; no dosage adjustment recommended 

Porphyria Information

• Not porphyrinogenic (NP)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Headache
• Dizziness
• Light-headedness
• Head pressure
• Transient and spontaneously rapidly reversible worsening of intracranial hypertension
• Loss of consciousness
• Syncope
• Seizures
• Apprehension

Cardiovascular Disorders

• Bradycardia
• Sinus pause
• Skipped beats
• Atrial extrasystoles
• Atrio-ventricular block
• Ventricular excitability disorders
• Ventricular extrasystoles
• Non-sustained ventricular tachycardia
• Sinus tachycardia
• Palpitations
• Atrial fibrillation
• Severe bradycardia
• Ventricular excitability disorders
• Ventricular fibrillation
• Torsades de pointes
• Hypotension
• Asystole
• Cardiac arrest

Respiratory Disorders

• Dyspnoea
• Urge to take a deep breath
• Hyperventilation
• Bronchospasm (may result in fatal outcome)
• Respiratory failure (may result in fatal outcome)
• Apnoea (may result in fatal outcome)
• Respiratory arrest (may result in fatal outcome)

Gastrointestinal Disorders

• Nausea  and vomiting

Skin and Subcutaneous Tissue Disorders

• Injection site reactions
• Flushing
• Sweating

Sensory Disorders

• Blurred vision
• Metallic taste

Others

• Chest discomfort  
• Burning sensation
• General discomfort
• Pain
• Weakness

• Dipyridamole  
• Xanthines
• Theophylline
• Aminophylline  
• Agents that impair cardiac conduction
• Food and drinks containing xanthines
  - Tea
  - Coffee
  - Chocolate
  - Cola

(See additional prescribing points)

• ECG
• Heart rate
• Blood pressure

Coadministration with dipyridamole

As dipyridamole is a known inhibitor of adenosine uptake, it may potentiate the action of adenosine injection. It is therefore suggested that adenosine IV should not be administered to patients receiving dipyridamole; if the use of adenosine IV is essential, dipyridamole should be stopped 24 hours beforehand, or the dose of adenosine solution for injection should be greatly reduced

Adenosine is a purine nucleoside which is present in all cells of the body. Adenosine slows conduction through the AV node. This action can interrupt re-entry circuits involving the AV node and restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardias. Once the circuit has been interrupted, the tachycardia stops and normal sinus rhythm is re-established. Since atrial fibrillation and atrial flutter do not involve the AV node as part of a re-entry circuit, adenosine will not terminate these arrhythmias. 

Injection (per 2ml) 6mg

• Adenocor (Sanofi) originator
• Adenosine 6mg/2ml PS Fresenius (Fresenius Kabi SA)