ADENOSINE

Indications & Dose:

Rapid reversion to sinus rhythm of paroxysmal supraventricular tachycardias, including those associated with accessory conducting pathways (e.g. Wolff-Parkinson -White syndrome) | Used to aid to diagnosis of broad or narrow complex supraventricular tachycardias

% BY RAPID INTRAVENOUS INJECTION

% Adult: Initially 6 mg, administer into central or large peripheral vein and give over 2 seconds, cardiac monitoring required, followed by 12 mg after 1–2 minutes if required, then 12 mg after 1–2 minutes if required, increments should not be given if high level AV block develops at any particular dose Rapid reversion to sinus rhythm of paroxysmal supraventricular tachycardias, including those associated with accessory conducting pathways (e.g. Wolff-Parkinson-White syndrome) in patients with a heart transplant Aid to diagnosis of broad or narrow complex supraventricular tachycardias in patients with a heart transplan

%BY RAPID INTRAVENOUS INJECTION

% Adult: Initially 3 mg, administer into a central or large peripheral vein and give over 2 seconds, followed by 6 mg after 1–2 minutes if required, then 12 mg after 1–2 minutes if required, patients with a heart transplant are very sensitive to the effects of adenosine Used in conjunction with radionuclide myocardial perfusion imaging in patients who cannot exercise adequately or for whom exercise is inappropriate

%BY INTRAVENOUS INFUSION

%Adult: (consult product literature)

DOSE ADJUSTMENTS DUE TO INTERACTIONS If essential to give with dipyridamole reduce adenosine dose to a quarter of the usual dose.

UNLICENSED USE Adenosine doses in the BNF may differ from those in the product literature. 

Contraindications:

Asthma . chronic obstructive lung disease . decompensated heart failure . long QT syndrome . second- or third-degree AV block and sick sinus syndrome (unless pacemaker fitted) . severe hypotension

Side Effects:

%Common or very common Angina (discontinue). apprehension . arrhythmia (discontinue if asystole or severe bradycardia occur) .AV block . dizziness

dyspnoea .flushing . headache . nausea . sinus pause

% Uncommon Blurred vision . hyperventilation . metallic taste . palpitation . sweating . weakness

% Very rare Bronchospasm . injection-site reactions.

transient worsening of intracranial hypertension

% Frequency not known Cardiac arrest . convulsions .

hypotension (discontinue if severe) . respiratory failure (discontinue) . syncope . vomiting PREGNANCY Large doses may produce fetal toxicity; manufacturer advises use only if potential benefit outweighs risk.BREAST FEEDING No information available— unlikely to be present in milk owing to short half-life.

Cautions:

Atrial fibrillation with accessory pathway (conduction down anomalous pathway may increase). atrial flutter with accessory pathway (conduction down anomalous pathway may increase) . autonomic dysfunction . bundle branch block . first-degree AV block . heart transplant . left main coronary artery stenosis . left to right shunt. pericardial effusion . pericarditis . QT-interval prolongation . recent myocardial infarction . severe heart failure . stenotic carotid artery disease with cerebrovascular insufficiency . stenotic valvular heart disease . uncorrected hypovolaemia 

Precautions:

Interaction:

Appendix 1 (adenosine); also possibility of interaction with drugs tending to impair myocardial conduction.

Warnings:

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Counselling:

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Patient And Carer Advice: