Parenteral Manual

Adenosine

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
ADENOCARD
Classification: 
Antiarrythmic
Original Date: 
August 2005
Revised Date: 
November 2009
Indications: 
  • Treatment of resistant paroxysmal supraventricular tachycardia (PSVT), including those with Wolf-Parkinson-White (WPW) syndrome
  • Not useful for recurrent arrhythmias due to ultra-short duration of action.
Reconstitution and Stability: 
  • Available as a 3 mg/mL solution
  • Store at room temperature, DO NOT REFRIGERATE (crystallization may occur - may dissolve when warmed to room temperature)
  • Discard unused portion of vial
Compatibility: 

- Solutions Compatible:  NS, D5W, ringer's lactate

 

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

YES   - undiluted rapidly over 1 - 2 seconds followed by a saline flush

-to administer doses <0.6 mg (0.2 mL) , a dilution of  0.3 mg/mL in NS may be made, e.g. mix 1 mL of drug (3 mg) with 9 mL of NS for a concentration of 0.3 mg/mL
IV Intermittent Infusion NO
IV Continuous Infusion NO

 

 

 

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Children and Adolescents < 50 kg:

  • First dose 0.1 mg/kg/dose (maximum 6 mg) by rapid IV bolus injection over 1-2 seconds
  • If ineffective give second dose 0.2 mg/kg/dose (maximum 12 mg)
  • If ineffective some references support third dose  0.3 mg/kg/dose (maximum 12 mg)

Children and Adolescents > 50 kg and Adults:

  • 6 mg by rapid IV bolus injection over 1-2 seconds
  • If not effective within 2 minutes, 12 mg can be given; repeat 12 mg bolus if needed

  -   To be certain the solution reaches the systemic circulation, it should be administered at a peripheral IV site closest to a patient's heart.

 - In rare cases, doses up to 18 mg have been used in resistant SVT  -usually lack of drug effect can be attributed to drug administration difficulties.

Potential hazards of parenteral administration: 

Noncardiac (common):

  • flushing and dyspnea
  • headache, cough, malaise and nausea (because of short half-life of adenosine, these effects usually resolve within one minute of administration)

Cardiovascular:

  • bradycardia, sinus arrest, atrial fibrillation, various degrees of AV block
  • angina-like chest pain (without ECG evidence of ischemia)
Notes: 
  • Defibrillator and personnel competent with procedures requiring such equipment  are required at bedside for the safe administration of adenosine.  Areas outside critical care and ED will activate the SPOT Team/PICU who will bring the Code Blue Cart.  The SPOT team/PICU will remain on site until the SPOT Team and Primary Care Team determine that the defibrillator and personnel are no longer required.
     
  • Drug Interactions:

       The following drugs may potentiate the effects of adenosine:
                     -  calcium channel blockers
                     -  cardiac glycosides
                     -  carbamazepine
                     -  dipyridamole

       The following drugs may antagonize the effects of adenosine:
                     -  methylxanthines (e.g. aminophylline, theophylline and caffeine)
                     -  diazepam (may inhibit cellular uptake of adenosine)

  • Monitor ECG, heart rate, blood pressure, respirations
  • Vials are latex-free      

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