Drugs List

Therapeutic Indications

Uses

Coronary vasodilator in myocardial imaging where exercise inappropriate

Administration

For administration in its undiluted form as a continuous peripheral intravenous infusion using an infusion pump.

This medication is for single use only. Use immediately after opening.

Contraindications

Children under 18 years
Family history of long QT syndrome
Asthma
Chronic obstructive pulmonary disease
Decompensated cardiac failure
Long QT syndrome
Non-paced second degree atrioventricular block
Non-paced sinus node dysfunction
Non-paced third degree atrioventricular block
Severe hypotension
Unstable angina

Precautions and Warnings

Left-to-right cardiovascular shunt
Predisposition to seizures
Restricted sodium intake
Atrial fibrillation
Autonomic neuropathy
Breastfeeding
Bundle branch block
Cardiac failure
Cerebral arteriosclerosis
Cerebrovascular insufficiency
First degree atrioventricular block
Flutter with accessory pathway
Heart transplant within 1 year
History of seizures
History of torsade de pointes
Hypocalcaemia
Hypokalaemia
Hypomagnesaemia
Hypovolaemia
Left main coronary artery stenosis
Obstructive valvular heart disease
Pericardial effusion
Pericarditis
Pregnancy
Recent myocardial infarction

Contains more than 1 mmol (23 mg) sodium per dose
Correct hypovolaemia prior to administration
Treatment to be initiated by specialist
Resuscitation facilities must be immediately available
Monitor cardiac function by ECG
Monitor patients with first degree AV block
May cause bronchospasm
May cause convulsions
Discontinue if bronchospasm or decreased respiratory function occur
Discontinue if persistent or symptomatic hypotension occurs
Discontinue if severe bradycardia occurs
Discontinue if sustained second or third degree AV block occurs
Discontinue treatment if angina appears or worsens
Avoid food/drink containing xanthines for 24 hours prior to administration

Life threatening arrhythmias may occur; monitor ECG continuously.

Severe bradycardia has been reported. Some occurred in early post-transplant patients; in the other cases occult sino-atrial disease was present. Any occurrence of severe bradycardia should be taken as a warning of underlying disease and adenosine should be discontinued in these cases. Severe bradycardia would favour the occurrence of torsades de pointes, especially in patients with prolonged QT interval.

Side effects are generally of short duration, however serious reactions can occur. Discontinuation of the infusion may be necessary if the effect is intolerable. Methylxanthines, such as intravenous aminophylline or theophylline have been used to terminate persistent side effects.

If use of adenosine is considered essential, treatment with concomitant dipyridamole should be stopped 24 hours before administration of adenosine.

Pregnancy and Lactation

Pregnancy

Use adenosine with caution in pregnancy.

Animal studies are insufficient with respect to reproductive toxicity. In pregnant sheep, constant infusions and single injections of adenosine produced alterations in maternal heart rate and a decrease in diastolic pressure but no changes in maternal systolic pressure or arterial blood gases and had no effect on the foetal heart rate, arterial pressure or arterial blood gases.

It is unknown whether adenosine can cause harm when administered to pregnant women. However, adenosine is an endogenous purine-based nucleotide found in all the cells of the body. Adenosine has a very short half life (less than ten seconds) and has to be administered intravenously. Briggs comments the maternal administration of large intravenous doses of adenosine may potentially produce foetal toxicity that has been observed with other endogenous agents (e.g. adrenaline). Schaefer states no specific foetal effects have been described so far, whether that pregnant women or the foetus is the patient. A number of reports have described the safe use of adenosine to treat maternal or foetal supraventricular tachycardia during all phases of gestation (Briggs, 2011). Schaefer (2007) comments that if a pregnant women is exposed to adenosine then it dose not necessitate termination of pregnancy. In the case of first trimester exposure, a detailed ultrasound should be offered. Adenosine is not recommended during pregnancy unless the physician considers the benefits to outweigh the potential risks.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use adenosine with caution in breastfeeding.

Adenosine is used only by intravenous injection in acute situations, therefore it is doubtful that any reports will be located describing the use of adenosine during breastfeeding. It is unknown whether adenosine metabolites are excreted in human milk, however due to its short half-life it is unlikely that any of the drug will pass into milk. The manufacturer states that adenosine should not be used during breastfeeding. Schaefer (2007) concludes that because of its extremely short half-life, and the very brief time for which it is used, adenosine should not be considered a cause for concern during breastfeeding. Weaning is not necessarily required.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal discomfort
Angina
Apnoea
Apprehension
Arrhythmias
Asystole
Atrial extrasystoles
Atrial fibrillation
Atrioventricular block
Blurred vision
Bradycardia
Bronchospasm
Burning sensation
Cardiac arrest
Chest pain
Convulsions
Discomfort in back
Discomfort in limb
Dizziness
Drowsiness
Dry mouth
Dyspnoea
Flushing
Headache
Hyperventilation
Hypotension
Impaired consciousness
Injection site reactions
Intracranial hypertension
Light-headedness
Metallic taste
Nasal congestion
Nausea
Neck and jaw discomfort
Nervousness
Nipple discomfort
Pain
Palpitations
Paraesthesia
Reflex tachycardia
Respiratory arrest
Respiratory failure
Sensation of pressure
Sinus pause
Sinus tachycardia
Skipped beat
ST segment depression
Sweating
Syncope
Throat discomfort
Tinnitus
Torsades de pointes
Transient rhythm disturbances
Tremor
Urinary urgency
Ventricular excitability disorders
Ventricular extrasystoles
Ventricular fibrillation
Ventricular tachycardia
Vomiting
Weakness

Presentation

Infusion of adenosine

Drugs List

Therapeutic Indications

Uses

Coronary vasodilator in myocardial imaging where exercise inappropriate

Dosage

Monitor heart rate and blood pressure at 1 minute intervals. Measure blood pressure in the arm opposite to adenosine infusion.

Adenosine should be administered following the same procedure as for exercise testing.

Patients who develop high-level AV block at a particular dose should not be given further dosage increments.

Adults

Elderly

Administration

For administration in its undiluted form as a continuous peripheral intravenous infusion using an infusion pump.

This medication is for single use only. Use immediately after opening.

Contraindications

Children under 18 years
Family history of long QT syndrome
Asthma
Chronic obstructive pulmonary disease
Decompensated cardiac failure
Long QT syndrome
Non-paced second degree atrioventricular block
Non-paced sinus node dysfunction
Non-paced third degree atrioventricular block
Severe hypotension
Unstable angina

Precautions and Warnings

Left-to-right cardiovascular shunt
Predisposition to seizures
Restricted sodium intake
Atrial fibrillation
Autonomic neuropathy
Breastfeeding
Bundle branch block
Cardiac failure
Cerebral arteriosclerosis
Cerebrovascular insufficiency
First degree atrioventricular block
Flutter with accessory pathway
Heart transplant within 1 year
History of seizures
History of torsade de pointes
Hypocalcaemia
Hypokalaemia
Hypomagnesaemia
Hypovolaemia
Left main coronary artery stenosis
Obstructive valvular heart disease
Pericardial effusion
Pericarditis
Pregnancy
Recent myocardial infarction

Contains more than 1 mmol (23 mg) sodium per dose
Correct hypovolaemia prior to administration
Treatment to be initiated by specialist
Resuscitation facilities must be immediately available
Monitor cardiac function by ECG
Monitor patients with first degree AV block
May cause bronchospasm
May cause convulsions
Discontinue if bronchospasm or decreased respiratory function occur
Discontinue if persistent or symptomatic hypotension occurs
Discontinue if severe bradycardia occurs
Discontinue if sustained second or third degree AV block occurs
Discontinue treatment if angina appears or worsens
Avoid food/drink containing xanthines for 24 hours prior to administration

Life threatening arrhythmias may occur; monitor ECG continuously.

Severe bradycardia has been reported. Some occurred in early post-transplant patients; in the other cases occult sino-atrial disease was present. Any occurrence of severe bradycardia should be taken as a warning of underlying disease and adenosine should be discontinued in these cases. Severe bradycardia would favour the occurrence of torsades de pointes, especially in patients with prolonged QT interval.

Side effects are generally of short duration, however serious reactions can occur. Discontinuation of the infusion may be necessary if the effect is intolerable. Methylxanthines, such as intravenous aminophylline or theophylline have been used to terminate persistent side effects.

If use of adenosine is considered essential, treatment with concomitant dipyridamole should be stopped 24 hours before administration of adenosine.

Pregnancy and Lactation

Pregnancy

Use adenosine with caution in pregnancy.

Animal studies are insufficient with respect to reproductive toxicity. In pregnant sheep, constant infusions and single injections of adenosine produced alterations in maternal heart rate and a decrease in diastolic pressure but no changes in maternal systolic pressure or arterial blood gases and had no effect on the foetal heart rate, arterial pressure or arterial blood gases.

It is unknown whether adenosine can cause harm when administered to pregnant women. However, adenosine is an endogenous purine-based nucleotide found in all the cells of the body. Adenosine has a very short half life (less than ten seconds) and has to be administered intravenously. Briggs comments the maternal administration of large intravenous doses of adenosine may potentially produce foetal toxicity that has been observed with other endogenous agents (e.g. adrenaline). Schaefer states no specific foetal effects have been described so far, whether that pregnant women or the foetus is the patient. A number of reports have described the safe use of adenosine to treat maternal or foetal supraventricular tachycardia during all phases of gestation (Briggs, 2011). Schaefer (2007) comments that if a pregnant women is exposed to adenosine then it dose not necessitate termination of pregnancy. In the case of first trimester exposure, a detailed ultrasound should be offered. Adenosine is not recommended during pregnancy unless the physician considers the benefits to outweigh the potential risks.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use adenosine with caution in breastfeeding.

Adenosine is used only by intravenous injection in acute situations, therefore it is doubtful that any reports will be located describing the use of adenosine during breastfeeding. It is unknown whether adenosine metabolites are excreted in human milk, however due to its short half-life it is unlikely that any of the drug will pass into milk. The manufacturer states that adenosine should not be used during breastfeeding. Schaefer (2007) concludes that because of its extremely short half-life, and the very brief time for which it is used, adenosine should not be considered a cause for concern during breastfeeding. Weaning is not necessarily required.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Abdominal discomfort
Angina
Apnoea
Apprehension
Arrhythmias
Asystole
Atrial extrasystoles
Atrial fibrillation
Atrioventricular block
Blurred vision
Bradycardia
Bronchospasm
Burning sensation
Cardiac arrest
Chest pain
Convulsions
Discomfort in back
Discomfort in limb
Dizziness
Drowsiness
Dry mouth
Dyspnoea
Flushing
Headache
Hyperventilation
Hypotension
Impaired consciousness
Injection site reactions
Intracranial hypertension
Light-headedness
Metallic taste
Nasal congestion
Nausea
Neck and jaw discomfort
Nervousness
Nipple discomfort
Pain
Palpitations
Paraesthesia
Reflex tachycardia
Respiratory arrest
Respiratory failure
Sensation of pressure
Sinus pause
Sinus tachycardia
Skipped beat
ST segment depression
Sweating
Syncope
Throat discomfort
Tinnitus
Torsades de pointes
Transient rhythm disturbances
Tremor
Urinary urgency
Ventricular excitability disorders
Ventricular extrasystoles
Ventricular fibrillation
Ventricular tachycardia
Vomiting
Weakness

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: June 2014

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press https://www.medicinescomplete.com Accessed on June 16th, 2014.

Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

Summary of Product Characteristics: Adenoscan. Sanofi. Revised November 2013.

Summary of Product Characteristics: Adenosine 30mg/10ml solution for infusion. Focus Pharmaceuticals Ltd. Revised April 2014.

Summary of Product Characteristics: Adenosine 30mg/10ml solution for infusion. Wockhardt UK Ltd. Revised December 2012.