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Pharmacologic class: Endogenous nucleoside
Therapeutic class: Antiarrhythmic
Pregnancy risk category C
Converts paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm by slowing conduction through atrioventricular (AV) node and interrupting reentry pathway. Also used as a diagnostic agent in thallium scanning.
Injection: 3 mg/ml
Indications and dosages
➣ PSVT, including that associated with Wolff-Parkinson-White syndrome (after attempting vagal maneuvers, when appropriate)
Adults and children weighing more than 50 kg (110 lb): Initially, 6 mg by rapid I.V. bolus over 1 to 2 seconds. If desired effect isn't achieved within 1 to 2 minutes, give 12 mg by rapid I.V. bolus; may repeat 12-mg I.V. bolus dose as needed. Maximum single dosage is 12 mg.
Children weighing less than 50 kg (110 lb): 0.05 to 0.1 mg/kg by rapid I.V. bolus. If this dosage proves ineffective, increase in 1 to 2 minutes by 0.05 mg/kg q 2 minutes, to a maximum single dosage of 0.3 mg/kg. Maximum single dosage is 12 mg.
➣ Diagnosis of coronary artery disease in conjunction with thallium-201 myocardial perfusion scintigraphy in patients unable to exercise adequately during testing
Adults: 140 mcg/kg/minute by I.V. infusion over 6 minutes, for a total dosage of 0.84 mg/kg. Required dose of thallium-201 is injected at midpoint (after first 3 minutes) of Adenoscan infusion.
• Diagnosis of supraventricular arrhythmias
• Pulmonary hypertension
• Hypersensitivity to drug
• Second- or third-degree AV block
• Sinus node disease
• Bronchoconstrictive lung disease
Use cautiously in:
• asthma, angina
• elderly patients
• pregnant patients
• Don't administer through central line (may cause asystole).
• Don't give more than 12 mg Adenocard as a single dose.
• Don't dilute Adenocard. Administer Adenocard by I.V. injection as a rapid bolus directly into vein whenever possible during cardiac monitoring.
• After administering Adenocard, flush I.V. line immediately and rapidly with normal saline solution to drive drug into bloodstream.
• Dilute a single dose of Adenoscan in sufficient normal saline solution to be given by continuous infusion over 6 minutes.
CNS: light-headedness, dizziness, apprehension, headache, tingling in arms, numbness
CV: chest pain, palpitations, hypotension, ST-segment depression, first- or second-degree AV block, atrial tachyarrhythmias, other arrhythmias
EENT: blurred vision, tightness in throat
GI: nausea, pressure in groin
Musculoskeletal: discomfort in neck, jaw, and arms
Respiratory: chest pressure, dyspnea and urge to breathe deeply, hyperventilation
Skin: burning sensation, facial flushing, sweating
Other: metallic taste
Drug-drug. Carbamazepine: worsening of progressive heart block
Digoxin, verapamil: increased risk of ventricular fibrillation
Dipyridamole: increased adenosine effect
Theophylline: decreased adenosine effect
Drug-food. Caffeine: decreased adenosine effect
Drug-herbs. Aloe, buckthorn bark or berry, cascara sagrada, rhubarb root, senna leaf or fruits: increased adenosine effect
Guarana: decreased adenosine effect
Drug-behaviors. Smoking: increased risk of tachycardia
• Monitor heart rhythm for new arrhythmias after administering dose.
• Check vital signs. Assess for chest pain or pressure, dyspnea, and sweating.
☞ Watch for bronchoconstriction in patients with asthma, emphysema, or bronchitis.
• Ask patient if he has recently used aloe, buckthorn, cascara sagrada, guarana, rhubarb root, or senna. If response is positive, notify prescriber.
• Advise patient to report problems at infusion site.
• Tell patient he may experience 1 to 2 minutes of flushing, chest pain and pressure, and breathing difficulty during administration. Assure him that these effects will subside quickly.
• Advise patient to minimize GI upset by eating small, frequent servings of healthy food and drinking plenty of fluids.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, foods, herbs, and behaviors mentioned above.
Time/action profile (antiarrhythmic effect)
Adverse Reactions/Side Effects
Central nervous system
- head pressure
Ear, Eye, Nose, Throat
- blurred vision
- throat tightness
- shortness of breath (most frequent)
- chest pressure
- facial flushing (most frequent)
- transient arrhythmias (most frequent)
- chest pain
- metallic taste
- burning sensation
- facial flushing
- neck and back pain
- heaviness in arms
- pressure sensation in groin
Drug-Drug interactionCarbamazepine may ↑ risk of progressive heart block.Dipyridamole ↑ effects of adenosine (dose ↓ of adenosine recommended).Effects of adenosine ↓ by theophylline or caffeine (↑ doses of adenosine may be required).Concurrent use with digoxin may ↑ risk of ventricular fibrillation.
Availability (generic available)
- Monitor heart rate frequently (every 15–30 sec) and ECG continuously during therapy. A short, transient period of 1st-, 2nd-, or 3rd-degree heart block or asystole may occur following injection; usually resolves quickly due to short duration of adenosine. Once conversion to normal sinus rhythm is achieved, transient arrhythmias (premature ventricular contractions, atrial premature contractions, sinus tachycardia, sinus bradycardia, skipped beats, AV nodal block) may occur, but generally last a few seconds.
- Monitor BP during therapy.
- Assess respiratory status (breath sounds, rate) following administration. Patients with history of asthma may experience bronchospasm.
Potential Nursing DiagnosesDecreased cardiac output (Indications)
- pH: 4.5–7.5.
- Intravenous: Crystals may occur if adenosine is refrigerated. Warm to room temperature to dissolve crystals. Solution must be clear before use. Do not administer solutions that are discolored or contain particulate matter. Discard unused portions.
- Diluent: Administer undiluted.Concentration: 3 mg/mL.
- Rate: Administer over 1–2 seconds via peripheral IV as proximal as possible to trunk. Slow administration may cause increased heart rate in response to vasodilation. Follow each dose with 20 mL rapid saline flush to ensure injection reaches systemic circulation.
- Intermittent Infusion: (for use in diagnostic testing)Diluent: Administer 30-mL vial undiluted.Concentration: 3 mg/mL.
- Rate: Administer at a rate of 140 mcg/kg/min over 6 min for a total dose of 0.84 mg/kg. Thallium-201 should be injected as close to the venous access as possible at the midpoint (after 3 min) of the infusion.
- Caution patient to change positions slowly to minimize orthostatic hypotension. Doses >12 mg decrease BP by decreasing peripheral vascular resistance.
- Instruct patient to report facial flushing, shortness of breath, or dizziness.
- Conversion of supraventricular tachycardia to normal sinus rhythm.
- Diagnosis of myocardial perfusion defects.