Adenosine

Name: Adenosine

Introduction

Antiarrhythmic and pharmacologic stress test agent; endogenous nucleoside.1 2 4 17 24

Stability

Storage

Parenteral

Injection

15–30°C.1 2 Do not refrigerate.1 2

If crystallization occurs, warm to room temperature.1 2

Contains no preservative; discard unused solution.1 2

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Solution CompatibilityHID

Compatible

Dextrose 5% in Ringer’s injection, lactated

Dextrose 5% in water

Ringer’s injection, lactated

Sodium chloride 0.9%

Y-Site Injection Compatibility

Compatible

Abciximab

What do I need to tell my doctor BEFORE I take Adenosine?

  • If you have an allergy to adenosine or any other part of adenosine.
  • If you are allergic to any drugs like this one, any other drugs, foods, or other substances. Tell your doctor about the allergy and what signs you had, like rash; hives; itching; shortness of breath; wheezing; cough; swelling of face, lips, tongue, or throat; or any other signs.
  • If you have any of these health problems: Certain types of abnormal heartbeats (heart block, sick sinus syndrome) without a working pacemaker.
  • If you have a certain type of chest pain (unstable angina).
  • If you have any of these health problems: Asthma or other breathing problems like COPD (chronic obstructive pulmonary disease).

This is not a list of all drugs or health problems that interact with this medicine.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take adenosine with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

Use in specific populations

Pregnancy

Pregnancy Category C. Animal reproduction studies have not been conducted with Adenosine; nor have studies been performed in pregnant women. Because it is not known whether Adenosine can cause fetal harm when administered to pregnant women, Adenosine should be used during pregnancy only if clearly needed.

Nursing Mothers

It is not known whether Adenosine is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions from Adenosine in nursing infants, the decision to interrupt nursing after administration of Adenosine or not to administer Adenosine, should take into account the importance of the drug to the mother.

Pediatric Use

The safety and effectiveness of Adenosine in patients less than 18 years of age have not been established.

Geriatric Use

Clinical studies with Adenosine did not include sufficient numbers of subjects aged younger than 65 years to determine whether they respond differently. Other reported experience has not revealed clinically relevant differences of the response of elderly in comparison to younger patients.

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous:

Adenocard: 6 mg/2 mL (2 mL); 12 mg/4 mL (4 mL)

Adenoscan: 3 mg/mL (20 mL, 30 mL)

Generic: 3 mg/mL (20 mL, 30 mL); 6 mg/2 mL (2 mL)

Solution, Intravenous [preservative free]:

Generic: 3 mg/mL (20 mL, 30 mL); 6 mg/2 mL (2 mL); 12 mg/4 mL (4 mL)

Dosing Hepatic Impairment

There are no dosage adjustments provided in the manufacturer's labeling. However, adenosine is not hepatically eliminated.

Reconstitution

Parenteral: IV:

Doses ≥0.6 mg: Give undiluted.

Doses <0.6 mg: Further dilution of dose may be necessary to ensure complete and accurate administration; dilution with NS to a final concentration of 0.3 to 1 mg/mL has been used; to prepare a 0.3 mg/mL solution, add 3 mg of adenosine (1 mL) to 9 mL of NS; to prepare a 1 mg/mL, add 3 mg of adenosine (1 mL) to 2 mL of NS.

Administration

Adenocard: For rapid bolus IV use only; administer IV push over 1 to 2 seconds at a peripheral IV site as proximal as possible to trunk (not in lower arm, hand, lower leg, or foot); follow each bolus with a rapid normal saline flush (infants and children ≥5 mL; adults 20 mL). Use of 2 syringes (one with adenosine dose and the other with NS flush) connected to a T-connector or stopcock is recommended. If administered via central line in adults, reduce initial dose to 3 mg (ACLS 2010; Chang 2002).

Adenoscan: For IV infusion only via peripheral line

Dietary Considerations

Avoid dietary caffeine for at least 12 hours prior to pharmacologic stress testing.

Pregnancy Risk Factor C Pregnancy Considerations

Animal reproduction studies have not been conducted. Adenosine is an endogenous substance and adverse fetal effects would not be anticipated. Adenosine is recommended for the acute treatment of SVT in pregnant women. The usual recommended doses may be used, although higher doses may be needed in some cases (Page [ACC/AHA/HRS 2015]). ACLS guidelines suggest use is safe and effective in pregnancy (ACLS [Neumar 2010]).

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