adenosine (Adenocard, Adenoscan)
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Introduction
Purine nucleoside & neurotransmitter.
Pharmacology
Tradename Adenocard. Indication(s):
- paroxysmal supraventricular tachycardia (PSVT)
- re-entrant supraventricular tachycardia susceptible to termination by AV block
- diagnosis of adenosine-induced AV nodal atrial flutter, atrial fibrillation, ventricular tachycardia by causing transient AV dissociation
- diagnosis of wide complex tachycardia believed to be of supraventricular origin
- cardiac nuclear stress test agent (Adenoscan)
Contraindications
Dosage
- 6 mg rapid IV
- if no response after 1-2 min, give 12 mg
- a 3rd dose of 12 mg may be given
* use at a reduced dose in patients with a history of cardiac transplantation
Pharmacokinetics
elimination via plasma
1/2life = 10 seconds
Adverse effects
- common (> 10%)
- facial flushing (18%)
- palpitations
- transient hypotension
- dyspnea (12%)
- headache
- sweating
- less common (1-10%)
- dizziness, paresthesias/numbness, chest pain/pressure
- uncommon (< 1%)
- lightheadedness, apprehension, head pressure, metallic taste, tightness in throat, pressure in groin, heaviness in arms, neck & back, blurred vision, hypoventilation, burning sensation
- other
- atrial standstill
- prolonged asystole in patients with sick sinus syndrome
- 2nd degree AV block or 3rd degree AV block
- rare but serious risk of myocardial infarction & death (Adenoscan)[4]
Drug interactions
- effects antagonized by methylxanthines
- effects potentiated by dipyridamole (blocks adenosine uptake & metabolism)
- effects potentiated by carbamazepine
- digitalis: rarely associated with ventricular fibrillation
Mechanism of action
- adenosine A1 receptor agonist[6]
- inhibition of sinus node automaticity
- prolongation of AV node conduction time
- prolongation of AV refractoriness
- does not affect heart rate in fetal when used to treat supraventricular tachycardia during pregnancy[6]
More general terms
More specific terms
Additional terms
- adenosine receptor
- paroxysmal supraventricular tachycardia (PSVT)
- Wolff-Parkinson-White (WPW) syndrome
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (ed), Companion Handbook, McGraw Hill, NY, 1994
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 163
- ↑ 4.0 4.1 Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ 6.0 6.1 6.2 Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17. American College of Physicians, Philadelphia 2009, 2012, 2015
- ↑ FDA MedWatch. Nov 20, 2013 Lexiscan (regadenoson) and Adenoscan (adenosine): Drug Safety Communication - Rare but Serious Risk of Heart Attack and Death. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm375981.htm