Drugs List

Therapeutic Indications

Uses

Diagnosis of broad/narrow complex supra-ventricular tachycardia
Paroxysmal supra-ventricular tachyarrhythmias

Rapid conversion to a normal sinus rhythm of paroxysmal supraventricular tachycardias, including those associated with accessory bypass tracts (Wolff-Parkinson-White syndrome).

Aid to diagnosis of broad or narrow complex supraventricular tachycardias where the slowing of AV conduction helps diagnosis of atrial activity.

Sensitisation of intra-cavitary electrophysiological investigations.

Administration

For rapid intravenous bolus injection, directly into a vein or intravenous line.

If given by an intravenous line then give as proximally as possible and followed by a rapid saline flush. If administered into a peripheral vein, it is recommended a large bore cannula is used.

Contraindications

Asthma
Breastfeeding
Chronic obstructive pulmonary disease
Decompensated cardiac failure
Long QT syndrome
Non paced second/third degree AV block
Non-paced sinus node dysfunction
Severe hypotension

Precautions and Warnings

Children under 18 years
Left-to-right cardiovascular shunt
Predisposition to seizures
Restricted sodium intake
Atrial fibrillation
Autonomic neuropathy
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
Hypovolaemia
Left main coronary artery stenosis
Obstructive valvular heart disease
Pericardial effusion
Pericarditis
Pregnancy
Recent myocardial infarction

Sodium content of formulation may be significant
Correct hypovolaemia prior to administration
Not all available brands are licensed for all age groups
Previous/Concurrent medicine consider washout period: See prescribing info
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 severe bradycardia occurs
Discontinue if sustained second or third degree AV block occurs
Discontinue immediately if severe hypotension occurs
Discontinue treatment if angina appears or worsens
Not licensed for all indications in all age groups
Avoid food/drink containing xanthines for 12 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. Severe bradycardia would favour the occurrence of torsades de pointes, especially in patients with prolonged QT interval.

There have been reports of cerebrovascular accident and transient ischaemic attacks secondary to the haemodynamic effects of adenosine. Myocardial infarction shortly after use has also been reported.

Pregnancy and Lactation

Pregnancy

Use adenosine with caution in pregnancy.

Some manufacturers recommend only using adenosine if the physician considers the benefits to outweigh the potential risks.

At the time of writing there is limited published information regarding the use of adenosine during pregnancy. Potential risks are unknown. Animal studies are insufficient with respect to reproductive toxicity.

Briggs (2015) suggests, if indicated the drug should not be withheld during pregnancy. Adenosine has been used during pregnancy without harming the embryo or foetus.

Lactation

Adenosine is contraindicated during breastfeeding.

It is unknown whether adenosine metabolites are excreted in human milk. Manufacturers states that adenosine should not be used during breastfeeding.

Side Effects

Anaphylactic reaction
Angioedema
Apnoea
Apprehension
Arrhythmias
Asthenia
Asystole
Atrial extrasystoles
Atrial fibrillation
Atrioventricular block
Blurred vision
Bradycardia
Bronchospasm
Burning sensation
Cardiac arrest
Chest pain
Convulsions
Dizziness
Drowsiness
Dry mouth
Dyspnoea
Flushing
General discomfort
Headache
Hyperventilation
Hypotension
Impaired consciousness
Injection site reactions
Intracranial hypertension
Light-headedness
Metallic taste
Nasal congestion
Nausea
Nervousness
Pain
Palpitations
Paraesthesia
Rash
Respiratory arrest
Respiratory failure
Sensation of pressure
Sinus pause
Sinus tachycardia
Skipped beat
Sweating
Syncope
Tinnitus
Torsades de pointes
Transient rhythm disturbances
Tremor
Urinary urgency
Urticaria
Ventricular excitability disorders
Ventricular extrasystoles
Ventricular fibrillation
Ventricular tachycardia
Vomiting
Weakness

Presentation

Injections of adenosine.

Drugs List

Therapeutic Indications

Uses

Diagnosis of broad/narrow complex supra-ventricular tachycardia
Paroxysmal supra-ventricular tachyarrhythmias

Rapid conversion to a normal sinus rhythm of paroxysmal supraventricular tachycardias, including those associated with accessory bypass tracts (Wolff-Parkinson-White syndrome).

Aid to diagnosis of broad or narrow complex supraventricular tachycardias where the slowing of AV conduction helps diagnosis of atrial activity.

Sensitisation of intra-cavitary electrophysiological investigations.

Dosage

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

Adults

Children

Neonates

Administration

For rapid intravenous bolus injection, directly into a vein or intravenous line.

If given by an intravenous line then give as proximally as possible and followed by a rapid saline flush. If administered into a peripheral vein, it is recommended a large bore cannula is used.

Contraindications

Asthma
Breastfeeding
Chronic obstructive pulmonary disease
Decompensated cardiac failure
Long QT syndrome
Non paced second/third degree AV block
Non-paced sinus node dysfunction
Severe hypotension

Precautions and Warnings

Children under 18 years
Left-to-right cardiovascular shunt
Predisposition to seizures
Restricted sodium intake
Atrial fibrillation
Autonomic neuropathy
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
Hypovolaemia
Left main coronary artery stenosis
Obstructive valvular heart disease
Pericardial effusion
Pericarditis
Pregnancy
Recent myocardial infarction

Sodium content of formulation may be significant
Correct hypovolaemia prior to administration
Not all available brands are licensed for all age groups
Previous/Concurrent medicine consider washout period: See prescribing info
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 severe bradycardia occurs
Discontinue if sustained second or third degree AV block occurs
Discontinue immediately if severe hypotension occurs
Discontinue treatment if angina appears or worsens
Not licensed for all indications in all age groups
Avoid food/drink containing xanthines for 12 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. Severe bradycardia would favour the occurrence of torsades de pointes, especially in patients with prolonged QT interval.

There have been reports of cerebrovascular accident and transient ischaemic attacks secondary to the haemodynamic effects of adenosine. Myocardial infarction shortly after use has also been reported.

Pregnancy and Lactation

Pregnancy

Use adenosine with caution in pregnancy.

Some manufacturers recommend only using adenosine if the physician considers the benefits to outweigh the potential risks.

At the time of writing there is limited published information regarding the use of adenosine during pregnancy. Potential risks are unknown. Animal studies are insufficient with respect to reproductive toxicity.

Briggs (2015) suggests, if indicated the drug should not be withheld during pregnancy. Adenosine has been used during pregnancy without harming the embryo or foetus.

Lactation

Adenosine is contraindicated during breastfeeding.

It is unknown whether adenosine metabolites are excreted in human milk. Manufacturers states that adenosine should not be used during breastfeeding.

Side Effects

Anaphylactic reaction
Angioedema
Apnoea
Apprehension
Arrhythmias
Asthenia
Asystole
Atrial extrasystoles
Atrial fibrillation
Atrioventricular block
Blurred vision
Bradycardia
Bronchospasm
Burning sensation
Cardiac arrest
Chest pain
Convulsions
Dizziness
Drowsiness
Dry mouth
Dyspnoea
Flushing
General discomfort
Headache
Hyperventilation
Hypotension
Impaired consciousness
Injection site reactions
Intracranial hypertension
Light-headedness
Metallic taste
Nasal congestion
Nausea
Nervousness
Pain
Palpitations
Paraesthesia
Rash
Respiratory arrest
Respiratory failure
Sensation of pressure
Sinus pause
Sinus tachycardia
Skipped beat
Sweating
Syncope
Tinnitus
Torsades de pointes
Transient rhythm disturbances
Tremor
Urinary urgency
Urticaria
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: March 2019

Reference Sources

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

Summary of Product Characteristics: Adenocor 3mg/ml solution for injection. Sanofi. Revised April 2021.

Summary of Product Characteristics: Adenosine 3mg/ml solution for injection. Focus Pharmaceuticals Ltd. Revised February 2014.

Summary of Product Characteristics: Adenosine 3mg/ml solution for injection. Wockhardt UK Ltd. Revised March 2015.

Summary of Product Characteristics: Adenosine 3mg/ml solution for injection pre-filled syringe. Fresenius Kabi Limited. Revised May 2018.

NICE - Evidence Services
Available at: www.nice.org.uk
Last accessed: 08 March 2019