Adenosine
ADENOCARD
“A dino sign”
What it isEndogenous purine nucleoside acting at A1 to A3 receptors; IV bolus for supraventricular tachycardia.
Why this oneA half-life of seconds means a transient AV block that terminates re-entrant SVT and then vanishes.
What limits itGive it fast into a large vein with a flush, and warn the patient about the brief sense of doom. Dipyridamole potentiates it; theophylline blocks it.
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Paroxysmal supraventricular tachycardia (conversion) | Adult | 6 mg rapid IV bolus | If no response in 1–2 min, 12 mg rapid IV bolus; may repeat 12 mg once | 12 mg per dose |
| Paroxysmal supraventricular tachycardia (conversion) | Pediatric <50 kg | 0.05–0.1 mg/kg rapid IV bolus | Increase by 0.05–0.1 mg/kg each repeat until sinus rhythm | 0.3 mg/kg single dose |
| Paroxysmal supraventricular tachycardia (conversion) | Pediatric ≥50 kg | Adult dose (6 mg) | 12 mg if needed | 12 mg per dose |
Renal Undefined
Hepatic Undefined
Doses greater than 12 mg are not recommended for adult or pediatric patients.
Instructions
- For rapid bolus IV use only, over 1–2 seconds.
- Give directly into a vein or into an IV line as close to the patient as possible, followed by a rapid saline flush.
- Inspect for particulate matter and discoloration before use.
Available strengths
- inj 3 mg/mL (6 mg/2 mL · 12 mg/4 mL)
Contraindications
- Second- or third-degree A-V block (unless functioning pacemaker)
- Sinus node disease — sick sinus syndrome or symptomatic bradycardia (unless functioning pacemaker)
Cautions
- Prolonged asystole, ventricular tachycardia/fibrillation, and Torsade de Pointes reported.
- Bronchospasm — caution in obstructive lung disease.
- Transient new arrhythmias/heart block at the time of conversion.
- Seizure activity and loss of consciousness reported.
Adverse reactions
- Facial flushing (18%)
- Shortness of breath/dyspnea (12%)
- Chest pressure (7%)
- Nausea (3%)
- Headache, lightheadedness/dizziness
- Chest pain, hypotension
Pregnancy No animal or human studies; as a naturally occurring substance fetal effects not anticipated, but use during pregnancy only if clearly needed (former Category C).
Lactation Undefined
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 3 mg/mL | inj | per unit | not offered |
NO BOXED WARNINGS
Principal riskA brief but severe sense of doom; theophylline blocks it