- Slows conduction time through the AV node, interrupting the re-entry pathways through the AV node, restoring normal sinus rhythm
Treatment of paroxysmal supraventricular tachycardia. When clinically advisable, appropriate vagal maneuvers should be attempted prior to adenosine administration. Preparations should be made for synchronized electrical cardioversion in case adenosine is ineffective.
Note: Not effective for conversion of atrial fibrillation, atrial flutter, or ventricular tachycardia.
- Second- or third-degree AV block, sick sinus syndrome, or symptomatic bradycardia (except in patients with a functioning artificial pacemaker)
- Asthma or COPD (can cause bronchoconstriction)
Adult
IV, IO: Initial: 6 mg over 1 to 2 seconds, followed immediately by a 20 mL NS flush (Note: Initial dose should be reduced to 3 mg for patients with a heart transplant); if initial dose is not effective within 1 to 2 minutes, administer 12 mg using the same procedures; may repeat a second 12 mg dose if needed
Pediatric
(< 50 kg; if > 50 kg follow adult dosing)
IV, IO: Initial: 0.1 mg/kg (maximum initial dose: 6 mg/dose); if not effective, increase to 0.2 mg/kg (maximum dose: 12 mg/dose); follow each bolus with NS flush.
IV: Administer rapid IV push at a peripheral IV site as proximal as possible to trunk; immediately after each bolus, administer a rapid NS flush (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.
Rapid
Very brief
- Monitoring: Run a continuous rhythm strip before, during, and after adenosine administration.
- Adverse effects: Usually resolve spontaneously within 1-2 minutes.
- Atrial fibrillation/flutter: Adenosine may produce transient blocks for diagnosis of rapid tachyarrhythmias that are not easily distinguishable as A-fib or A-flutter. Adenosine will not be effective in converting A-fib or A-flutter because it only operates on the AV node, not on the inter-nodal pathways.
- Wide-complex tachycardia: Avoid use in irregular or polymorphic wide-complex tachycardias; may cause degeneration to ventricular fibrillation
- Wolff-Parkinson-White (WPW) syndrome: Adenosine should not be used in patients with WPW syndrome and other preexcited atrial fibrillation/flutter (e.g. Lown-Ganong-Levine (LGL) Syndrome) since ventricular fibrillation may result
- Heart transplant recipients: Use with extreme caution in heart transplant recipients; adenosine may cause prolonged asystole; reduction of dose by half is recommended
Solution, Intravenous: 6 mg/2 mL (2 mL) vial
- Cardiovascular
- Cardiac arrhythmia
- Chest pressure
- Atrioventricular block
- Depression of ST segment on ECG
- Hypotension
- Central nervous system
- Headache
- Dizziness
- Nervousness
- Paresthesia
- Numbness
- Dermatologic
- Facial flushing
- Diaphoresis
- Gastrointestinal
- Gastrointestinal distress
- Nausea
- Neuromuscular & skeletal
- Neck discomfort
- Upper extremity discomfort
- Respiratory
- Dyspnea
- Hyperventilation
