Adenosine

Name: Adenosine

Adverse Effects

>10%

Flushing (18%)

Dyspnea (12%)

1-10%

Chest pain (7%)

HA (2%)

Lightheadedness (2%)

Dizziness (1%)

Tingling in arms (1%)

Numbness (1%)

Nausea (3%)

<1%

Hypotension

Palpitations

Apprehension

Head pressure

Chest pain

Hyperventilation

Blurred vision

Burning sensation

Heaviness in arms, neck & back pain

Metallic taste

Tightness in throat

Pressure in groin

Sweating

Post Marketing (undefined)

Prolonged asystole

Ventricular tachycardia

Venricular fibrillation

Transient increase in blood pressure

Bradycardia

Atrial fibrillation

Cardiac failure

Infusion site pain

Hypersensitivity

Torsades de Pointes

Seizure

Bronchospasm

Interactions for Adenosine

Specific Drugs

Drug

Interaction

Comments

ACE inhibitors

Potential for additive/synergistic depressant effects on SA and AV nodes1

Use with caution1

β-Adrenergic blocking agents

Potential for additive/synergistic depressant effects on SA and AV nodes1 2

Use with caution1 2

Calcium channel-blocking agents

Potential for additive/synergistic depressant effects on SA and AV nodes1 2

Use with caution1 2

Carbamazepine

Possible increased degree of heart block1 27

Digoxin or digoxin/verapamil

Potential for additive/synergistic depressant effects on SA and AV nodes; serious and/or life-threatening effects (asystole, ventricular fibrillation) reported rarely1 2

Use with caution and with appropriate resuscitative measures available1

Dipyridamole

Potentiation of adenosine vasoactive effects1 2 4 24

Safety and efficacy of adenosine in presence of dipyridamole not established; in general, withhold administration of drugs that inhibit or augment pharmacologic effects of adenosine for at least 5 half-lives prior to adenosine administration2

Methylxanthines (aminophylline, caffeine, theophylline)

Inhibition of adenosine vasoactive effects1 2 4 20 24 27

Aminophylline: Concomitant use may increase risk of seizures2

Increased doses of adenosine may be required1 7 20 24

Safety and efficacy of adenosine in presence of methylxanthines not established; in general, withhold administration of drugs that inhibit or augment pharmacologic effects of adenosine for at least 5 half-lives prior to adenosine administration2

Do not use methylxanthines in patients who experience adenosine-induced seizures2

Quinidine

Potential for additive/synergistic depressant effects on SA and AV nodes1

Use with caution1

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Adenosine

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection, for rapid IV injection only

3 mg/mL*

Adenocard

Astellas

Adenosine Injection

Injection, for IV infusion only

3 mg/mL

Adenoscan

Astellas

Uses of Adenosine

  • It is used to treat certain types of abnormal heartbeats.
  • It is used during a stress test of the heart.
  • It may be given to you for other reasons. Talk with the doctor.

How is this medicine (Adenosine) best taken?

Use adenosine as ordered by your doctor. Read all information given to you. Follow all instructions closely.

  • It is given as a shot into a vein.

What do I do if I miss a dose?

  • Call your doctor to find out what to do.

What are some side effects that I need to call my doctor about right away?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Signs of high or low blood pressure like very bad headache or dizziness, passing out, change in eyesight.
  • Weakness on 1 side of the body, trouble speaking or thinking, change in balance, drooping on one side of the face, or blurred eyesight.
  • Chest pain or pressure.
  • Fast or slow heartbeat.
  • A heartbeat that does not feel normal.
  • Shortness of breath.
  • Seizures.
  • Throat, neck, or jaw pain.

Contraindications

Adenosine is contraindicated in patients with:

• Second- or third-degree AV block (except in patients with a functioning artificial pacemaker) [see Warnings and Precautions (5.2)] • Sinus node disease, such as sick sinus syndrome or symptomatic bradycardia (except in patients with a functioning artificial pacemaker) [see Warnings and Precautions (5.2)] • Known or suspected bronchoconstrictive or bronchospastic lung disease (e.g., asthma) [see Warnings and Precautions (5.3)] • Known hypersensitivity to Adenosine [see Warnings and Precautions (5.7)]

Clinical Studies

In two crossover comparative studies involving 319 subjects who could exercise (including 106 healthy volunteers and 213 patients with known or suspected coronary disease), Adenosine and exercise thallium images were compared by blinded observers. The images were concordant for the presence of perfusion defects in 85.5% of cases by global analysis (patient by patient) and up to 93% of cases based on vascular territories.

In the two studies, 193 patients also had recent coronary arteriography for comparison (healthy volunteers were not catheterized). The sensitivity for detecting angiographically significant disease (≥ 50% reduction in the luminal diameter of at least one major vessel) was 64% for Adenosine and 64% for exercise testing. The specificity was 54% for Adenosine and 65% for exercise testing. The 95% confidence limits for Adenosine sensitivity were 56% to 78% and for specificity were 37% to 71%.

Intracoronary Doppler flow catheter studies have demonstrated that a dose of intravenous Adenosine of 0.14 mg/kg/min produces maximum coronary hyperemia (relative to intracoronary papaverine) in approximately 95% of cases within two to three minutes of the onset of the infusion. Coronary blood flow velocity returns to basal levels within one to two minutes of discontinuing the Adenosine infusion.

How Supplied/Storage and Handling

How Supplied

Adenosine Injection, USP is supplied as 20 mL and 30 mL single-dose vials of sterile, nonpyrogenic solution in normal saline as follows:

NDC

Adenosine Injection, USP (3 mg per mL)

Package Factor

67457-856-20

60 mg per 20 mL Single-Dose Vial

1 vial per carton

67457-857-30

90 mg per 30 mL Single-Dose Vial

1 vial per carton

Storage and Handling

Store at 20° to 25°C (68° to 77°F); excursions permitted between 15° and 30°C (59° and 86°F). [See USP Controlled Room Temperature.]

Do not refrigerate as crystallization may occur. If crystallization has occurred, dissolve crystals by warming to room temperature. The solution must be clear at the time of use.

Discard unused portion.

Sterile, Nonpyrogenic, Preservative-free.

The container closure is not made with natural rubber latex.

Use Labeled Indications

Paroxysmal supraventricular tachycardia: Adenocard: Treatment of paroxysmal supraventricular tachycardia (PSVT) including that associated with accessory bypass tracts (Wolff-Parkinson-White syndrome); when clinically advisable, appropriate vagal maneuvers should be attempted prior to adenosine administration; not effective for conversion of atrial fibrillation, atrial flutter, or ventricular tachycardia

Note: While adenosine will not convert atrial fibrillation or atrial flutter, the transient AV-nodal block may aid in the identification of the arrhythmia by exposing the underlying atrial fibrillation or flutter electrocardiographic morphology.

Guideline recommendations: The American College of Cardiology/American Heart Association/Heart Rhythm Society supraventricular tachycardia (SVT) guidelines recommends adenosine in the acute management of a variety of SVTs (eg, AV nodal reentrant tachycardia [AVNRT], AV reentrant tachycardia [AVRT]) (ACC/AHA/HRS [Page 2015]).

Diagnostic aid: Adenoscan: Pharmacologic stress agent used in myocardial perfusion thallium-201 scintigraphy

Adverse Reactions

Note: Frequency varies based on use and is not always defined; higher frequency of infusion-related effects, such as flushing and lightheadedness/dizziness, were reported with continuous infusion (Adenoscan).

>10%:

Cardiovascular: Cardiac arrhythmia (transient and new arrhythmia after cardioversion; eg, atrial premature contractions, atrial fibrillation, premature ventricular contractions; 55%), chest pressure (and discomfort; 7% to 40%)

Central nervous system: Headache (2% to 18%), dizziness (≤12%)

Dermatologic: Facial flushing (18% to 44%)

Gastrointestinal: Gastrointestinal distress (13%)

Neuromuscular & skeletal: Neck discomfort (includes throat, jaw; <1% to 15%)

Respiratory: Dyspnea (12% to 28%)

1% to 10%:

Cardiovascular: Atrioventricular block (infusion 6%; third-degree <1%), depression of ST segment on ECG (3%), hypotension (<1% to 2%), chest pain, palpitations

Central nervous system: Nervousness (2%), paresthesia (≤2%), numbness (1%), apprehension

Dermatologic: Diaphoresis

Gastrointestinal: Nausea (3%)

Neuromuscular & skeletal: Upper extremity discomfort (≤4%)

Respiratory: Hyperventilation

<1% (Limited to important or life-threatening): Atrial fibrillation, blurred vision, bradycardia, bronchospasm, cardiac arrest, increased intracranial pressure, injection site reaction, myocardial infarction, respiratory arrest, torsades de pointes, transient hypertension, ventricular arrhythmia, ventricular fibrillation, ventricular tachycardia

Monitoring Parameters

ECG, heart rate, blood pressure; consult individual institutional policies and procedures

Adenosine Drug Class

Adenosine is part of the drug class:

  • Miscellaneous Cardiac Preparations

Adenosine Dosage

Take adenosine exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The Adenosine dose your doctor recommends will be based on the following (use any or all that apply):

  • the condition being treated
  • other medical conditions you have
  • other medications you are taking
  • how you respond to this medication
  • your weight
  • your height
  • your age
  • your gender

Adenosine is available in the following doses:

  • Adenosine 25 Mg/ml Intravenous Solution
  • Adenosine 3 Mg/ml Intravenous Solution
  • Adenosine Compounding Powder
  • Adenosine Monophosphate Compounding Powder
  • Adenosine Sublingual Spray
  • Adenosine Triphosphate Compounding Powder
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