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Adenosine information from DrugsUpdate  

See Available Brands of Adenosine in India

P - Caution when used during pregnancy.

Adenosine is a nucleoside composed of a molecule of adenine attached to a ribose sugar molecule (ribofuranose) moiety via a β-N9-glycosidic bond. Adenosine plays an important role in biochemical processes, such as energy transfer?as adenosine triphosphate (ATP) and adenosine diphosphate (ADP) as well as in signal transduction as cyclic adenosine monophosphate, CAMP. It is also an inhibitory neurotransmitter, believed to play a role in promoting sleep and suppressing arousal, with levels increasing with each hour an organism is awake. Adenosine is often abbreviated Ado.

Pharmacodynamics

Slows conduction through atrioventricular (AV) node; can interrupt reentry pathways through AV node and restore normal sinus rhythm.

Pharmacokinetics

Adenosine acts rapidly to slow down conduction through the AV node via the A1 receptors. It also mediates peripheral and coronary vasodilatation by stimulating the A2 receptors. Extremely short plasma half-life (<10 sec) permits dosage titration during IV use every 1-2 minutes and causes no concern of cumulative effect through repeated dosing.

Absorption
Rapidly taken up into the erythrocytes and vascular endothelial cells.

Metabolism
Metabolised to adenosine monophosphate and inosine. Excretion Plasma half-life: <10 seconds.

Adenosine Indications / Adenosine Uses

Information Not Available

Adenosine Adverse Reactions / Adenosine Side Effects

Facial flushing, palpitations, chest pain, bradycardia, sweating, hypotension, dyspnoea, choking sensation, headache, lightheadedness, tingling, numbness, neck and back pain, nausea, metallic taste. ECG changes suggestive of rhythm disturbances.

Precautions

Heart Block
Adenosine exerts its effect by decreasing conduction through the A-V node and may produce a short lasting first-, second- or third-degree heart block. Appropriate therapy should be instituted as needed. Patients who develop high-level block on one dose of Adenosine should not be given additional doses. Because of the very short halflife of Adenosine, these effects are generally self-limiting. Transient or prolonged episodes of asystole have been reported with fatal outcomes in some cases. Rarely, ventricular fibrillation has been reported following Adenosine administration, including both resuscitated and fatal events. In most instances, these cases were associated with the concomitant use of digoxin and, less frequently with digoxin and verapamil. Although no causal relationship or drug-drug interaction has been established, Adenosine should be used with caution in patients receiving digoxin or digoxin and verapamil in combination. Appropriate resuscitative measures should be available.

Arrhythmias at Time of Conversion
At the time of conversion to normal sinus rhythm, a variety of new rhythms may appear on the electrocardiogram. They generally last only a few seconds without intervention, and may take the form of premature ventricular contractions, atrial premature contractions, sinus bradycardia, sinus tachycardia, skipped beats, and varying degrees of A-V nodal block. Such findings were seen in 55% of patients.

Bronchoconstriction

Adenosine is a respiratory stimulant (probably through activation of carotid body chemoreceptors) and intravenous administration in man has been shown to increase minute ventilation (Ve) and reduce arterial PCO2 causing respiratory alkalosis. Adenosine administered by inhalation has been reported to cause bronchoconstriction in asthmatic patients presumably due to mast cell degranulation and histamine release. These effects have not been observed in normal subjects. Adenosine has been administered to a limited number of patients with asthma and mild to moderate exacerbation of their symptoms has been reported. Respiratory compromise has occurred during Adenosine infusion in patients with obstructive pulmonary disease. Adenosine should be used with caution in patients with obstructive lung disease not associated with bronchoconstriction (e.g., emphysema, bronchitis, etc.) and should be avoided in patients with bronchoconstriction or bronchospasm (e.g., asthma). Adenosine should be discontinued in any patient who develops severe respiratory difficulties.

Special Precautions

Pregnancy; heart transplant patients; patients on dipyridamole (lower initial dose of adenosine 0.5-1 mg); atrial fibrillation or flutter with accessory pathway (conduction along anomalous pathway may increase).

Other Drug Interactions

Adenosine effects antagonised by methylxanthines like caffeine, theophylline, etc. Concomitant carbamazepine may increase the risk of heart block. Potentially Fatal: Adenosine effects are potentiated by dipyridamole.

Other Interactions

Information Not Available

Dosage

Intravenous
Differential diagnosis of supraventricular tachycardias
Initially, 3 mg by rapid IV inj into a central or large peripheral vein over 2 sec with cardiac monitoring; 6 mg may be given after 1-2 minutes if necessary, then 12 mg after a further 1-2 minutes. Avoid increments if high level AV block occurs at any particular dose. Child: Initially, 50-100 mcg/kg; if necessary, may increase dose by 50-100 mcg/kg increments at 1-2 minute intervals or until arrhythmia is controlled.
Max Dosage:300 mcg/kg

Intravenous
Paroxysmal supraventricular tachycardia
Adult: Initially, 3 mg by rapid IV inj into a central or large peripheral vein over 2 sec with cardiac monitoring; 6 mg may be given after 1-2 minutes if necessary, then 12 mg after a further 1-2 minutes. Avoid increments if high level AV block occurs at any particular dose. Child: Initially, 50-100 mcg/kg; if necessary, may increase dose by 50-100 mcg/kg increments at 1-2 minute intervals or until arrhythmia is controlled. Max Dosage: 300 mcg/kg.


Intravenous
Myocardial imaging Adult: 140 mcg/kg/minute by infusion for 6 minutes. Inject radionuclide 3 minute after infusion.

Food(before/after)

Information Not Available

List of Contraindications

Adenosine and Pregnancy

Caution when used during pregnancy.


Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Adenosine and Lactation

Information Not Available

Adenosine and Children

No controlled studies have been conducted in pediatric patients to establish the safety and efficacy of Adenosinefor the conversion of paroxysmal supraventricular tachycardia (PSVT). However, intravenous Adenosine has been used for the treatment of PSVT in neonates, infants, children and adolescents.

Adenosine and Geriatic

Clinical studies of Adenosine did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between elderly and younger patients. In general, Adenosine in geriatric patients should be used with caution since this population may have a diminished cardiac function, nodal dysfunction, concomitant diseases or drug therapy that may alter hemodynamic function and produce severe bradycardia or AV block.

Adenosine and Other Contraindications

2nd or 3rd degree AV block and sick sinus syndrome (unless pacemaker fitted), asthma, hypersensitivity.

Storage

Store at 20 ℃ to 25 ℃ (68 ℃ to 77 °F).

Lab interference

Store at 20 ℃ to 25 ℃ (68 ℃ to 77 °F).

Adenosine brands in India:

Adenocor Adenoject Adenoz Cadsine Carnosin Tachyban

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