Adenosine (adenosine)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Adenosine, an endogenous nucleoside present in all cells of the body, is an antiarrhythmic and pharmacologic stress test agent.
Adenosine is an endogenous nucleoside present in all cells of the body. Adenosine may exert its pharmacologic effects by activation of purine (cell-surface A1 and A2 adenosine) receptors; relaxation of vascular smooth muscle may be mediated by reduction in calcium uptake through inhibition of slow inward calcium current and activation of adenylate cyclase in smooth muscle cells. Adenosine may reduce vascular tone by modulation of sympathetic neurotransmission.
Adenosine has negative chronotropic, dromotropic, and inotropic effects on the heart. The drug slows conduction time through the AV node and can interrupt AV nodal reentry pathways, leading to restoration of normal sinus rhythm in patients with paroxysmal supraventricular tachycardia (PSVT), including that associated with Wolff-Parkinson-White syndrome.
Adenosine is a potent vasodilator in most vascular beds; however, vasoconstriction is produced in renal afferent arterioles and hepatic veins. The drug typically produces a net mild to moderate reduction in systolic, diastolic, and mean arterial blood pressure and a reflex increase in heart rate. Adenosine increases blood flow in normal coronary arteries with little or no increase in stenotic arteries, resulting in a relative difference in thallous (thallium) chloride TI 201 uptake in myocardium supplied by normal versus stenotic coronary arteries.
Adenosine is a respiratory stimulant, probably because of activation of carotid body chemoreceptors; IV administration produces an increase in minute ventilation and a reduction in arterial PCO2, resulting in respiratory alkalosis.
Adenosine is rapidly metabolized intracellularly to the inactive metabolites adenosine monophosphate and inosine; the plasma half-life of adenosine is less than 10 seconds. The drug is cleared by cellular uptake, principally by erythrocytes and vascular endothelial cells, via a specific transmembrane nucleoside transport system.
Generic name: adenosine
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Adenosine
Indications
The following indications are listed for Adenosine:
- Myocardial Perfusion Image, Adjunct
Also known as: Adjunct Myocardial Perfusion Imaging.
Dosing
No dosing information is available for this tab.
No dosing information is available for this tab.
No dosing information is available for this tab.
No dosing information is available for this tab.
Drug interactions
When possible, drugs that may augment or inhibit adenosine effects should be withheld for 5 half-lives prior to adenosine administration.
There are no contraindication interactions for this drug.
There are no severe interactions for this drug.
There are no moderate interactions for this drug.
Contraindications
Known hypersensitivity to adenosine.
Second- or third-degree AV block (except in patients with a functioning artificial pacemaker).
Sinus node disease, such as sick sinus syndrome or symptomatic bradycardia (except in patients with a functioning artificial pacemaker).
Known or suspected bronchoconstrictive or bronchospastic lung disease (e.g., asthma).
There are no contraindication contraindications for this drug.
There are no severe contraindications for this drug.
There are no moderate contraindications for this drug.
Adverse reactions
Adverse effects reported in at least 1% of patients receiving adenosine for the treatment of PSVT in controlled clinical trials include facial flushing, shortness of breath/dyspnea, chest pressure, nausea, headache, lightheadedness, dizziness, numbness, and tingling in the arms.
Adverse effects reported in at least 1% of patients receiving adenosine as an adjunct to thallium stress testing in controlled and uncontrolled clinical trials include facial flushing; chest discomfort; dyspnea or urge to breathe deeply; headache; discomfort in the throat, neck, or jaw; GI discomfort; lightheadedness/dizziness; upper extremity discomfort; ST-segment depression; first-degree AV block; second-degree AV block; paresthesia; hypotension; nervousness; and arrhythmias.
There are no severe adverse reactions for this drug.
There are no less severe adverse reactions for this drug.
Precautions
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Although the manufacturer states that controlled studies establishing the safety and efficacy of adenosine for treatment of PSVT in pediatric patients are lacking, the drug has been used for the treatment of PSVT in neonates, infants, children, and adolescents, and some clinicians consider it a drug of choice for SVT in pediatric patients.
Safety and efficacy as an adjunct to thallium stress testing not established in children 18 years of age or younger.
Category C. Some clinicians suggest that because of its rapid onset and brief duration of action, adenosine may have advantages over other antiarrhythmic agents (e.g., verapamil, digoxin) in the acute treatment of PSVT in pregnant women in whom vagal maneuvers have failed. However, caution is advised because hypotension may compromise placental (fetal) blood flow.
It is not known whether adenosine is distributed into human milk. Because of the potential for serious adverse reactions from adenosine in nursing infants, a decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the woman. Some clinicians suggest that use of adenosine during lactation may be possible because of the drug's short half-life.
Insufficient experience in patients 65 years of age or older to determine whether geriatric patients respond differently than younger adults. However, use with caution because increased sensitivity cannot be ruled out; some geriatric patients may have diminished cardiac function, nodal dysfunction, or concomitant disease or drug therapy that may alter hemodynamic function and result in severe bradycardia or AV block.
ICD codes
No ICD codes are available for this drug.
Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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