Known brand names include Adenocard.
An IV drug pushed in quickly to stop paroxysmal supraventricular tachycardia (PSVT), a sudden, very fast heart rhythm. It is cleared from the blood in seconds, so its common effects, such as flushing, shortness of breath, and a brief pause in the heartbeat, pass quickly.
Labeled use. Conversion of PSVT to sinus rhythm, including PSVT with accessory bypass tracts (WPW), after vagal maneuvers when advisable.
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Adenosine is the first-line drug for stable, regular narrow-complex SVT after vagal maneuvers fail. Its very short half-life makes it safe to try, and the brief AV block it causes can unmask atrial flutter when the diagnosis is unclear. Unstable patients need synchronized cardioversion instead. Diltiazem, verapamil, or a beta blocker is the alternative when adenosine fails or SVT keeps recurring, and adenosine should be avoided in active bronchospasm and in irregular or pre-excited wide-complex tachycardia.
An endogenous nucleoside used as an antiarrhythmic. It slows AV nodal conduction and interrupts reentry pathways through the AV node, restoring sinus rhythm in PSVT, including PSVT with WPW. Methylxanthines such as caffeine and theophylline competitively antagonize it, dipyridamole potentiates it, and atropine does not block it. It is cleared by uptake into red cells and vascular endothelium, with a half-life under 10 seconds, and needs no hepatic or renal function for activation or inactivation. A 6 or 12 mg bolus usually has no systemic hemodynamic effect.
The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.
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Doses come from the FDA label. Study tool, not for clinical decisions.
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None. Adenosine needs no kidney function for activation or clearance, so renal failure is not expected to change its effect or tolerability.
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None. Adenosine needs no liver function for activation or clearance, so hepatic failure is not expected to change its effect or tolerability.
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No specific antidote. The half-life is under 10 seconds, so adverse effects usually resolve on their own; treat any prolonged effect directly. Methylxanthines such as caffeine and theophylline are competitive antagonists. Keep resuscitation equipment available, and give no further doses to a patient who develops high-level block.
Pregnancy Category C. No animal reproduction or human pregnancy studies have been done. Because adenosine occurs naturally throughout the body, fetal effects are not expected, but it should be used in pregnancy only when clearly needed.
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The label has no lactation or nursing mothers section. With a half-life under 10 seconds, meaningful exposure through breast milk is unlikely.
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No controlled pediatric studies, but IV adenosine has been used for PSVT in neonates, infants, children, and adolescents at weight-based doses equivalent to adult doses. Under 50 kg: 0.05 to 0.1 mg/kg by rapid IV bolus, centrally or peripherally, followed by a saline flush. If PSVT persists after 1 to 2 minutes, raise each bolus by 0.05 to 0.1 mg/kg until conversion or a maximum single dose of 0.3 mg/kg. At 50 kg or more, use the adult dose; single doses above 12 mg are not recommended.
Studies did not include enough patients 65 and older to show differences, and clinical experience has found none. Use with caution, because reduced cardiac function, nodal disease, other illnesses, or other drugs can lead to severe bradycardia or AV block.
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