Adenosine

Adenosine is a fast-acting medication that’s used to control the heart’s rhythm.

Overview

Adenosine is known by other names such as Adenine Nucleoside, Adenosine Phosphate, Adenine Riboside, Adenosine, Adenosine-5-Monophosphate, Acide 5'-adénylique, Adenosine 5'-Triphosphate Disodium, Adenosine Monophosphate, Adenosine Diphosphate, Phosphate d'Adénosine, and Adenosine Triphosphate.

It’s a chemical that’s found in all of our cells. It readily mixes with phosphate to create various chemical compounds such as adenosine triphosphate (ATP) and adenosine monophosphate (ADP). People use adenosine for medicine.

Adenosine monophosphate (AMP) is taken orally to treat herpes zoster infection (shingles) and a blood condition known as porphyria cutanea tarda.

Adenosine triphosphate (ATP) is used below the tongue to boost physical energy. It’s also administered intravenously to treat conditions like multiple organ failure, acute kidney failure, high blood pressure in the arteries of lungs (pulmonary hypertension), lung cancer, cystic fibrosis, and cancer-related weight loss. It’s also used during surgery and anesthesia, as well as for cardiac stress exams.

Doctors administer adenosine intravenously to treat nerve pain and surgical pain, pulmonary hypertension, as well as certain kinds of irregular heartbeat. Adenosine is also administered to control blood pressure during surgery and anesthesia and for heart exams known as cardiac stress tests.

Adenosine is injected into the area close to the spinal cord to help treat nerve pain.

Adenosine phosphate is administered through injection intramuscularly (into the muscle), to treat varicose veins, itchiness, shingles (herpes zoster), swollen and painful tendons (tendonitis), bursitis, multiple sclerosis (MS), neuropathy, genital herpes (herpes simplex infections), poor blood circulation, and cold sores.

Conditions treated:

  • Wolff-Parkinson-White Syndrome
  • Paroxysmal Tachycardia
  • Atrioventricular Nodal Reentry Tachycardia

Type of medicine:

  • Nucleoside

Side effects:

In addition to its useful effects, adenosine can cause a number of undesirable effects. While not all of the following side effects can occur, if they happen they may require medical attention.

Consult your healthcare provider right away if you notice any of these side effects while using adenosine:

More common:

  • Chest discomfort
  • Labored or light breathing
  • Dizziness or lightheadedness
  • Neck, throat, or jaw discomfort
  • Tightness in chest

Less common:

  • Chest pain
  • Confusion
  • Faintness, dizziness, or lightheadedness when suddenly getting up from a sitting or lying position
  • Fainting
  • Slow, fast, or irregular heartbeat
  • Sweating
  • Troubled breathing
  • Unusual weakness or tiredness

Rare:

  • Headache
  • Irregular, fast, racing, pounding pulse or heartbeat
  • Nervousness
  • Pounding in ears

Some adenosine side effects can occur that normally don’t require medical attention. Such side effects may disappear during treatment while your body gets used to the medication. In addition, your healthcare provider may recommend ways to reduce or prevent some of the side effects. Talk to your doctor if any of these side effects persist or are troublesome or if you’ve got any queries about them.

More common:

  • Diarrhea
  • Indigestion
  • Loss of appetite
  • Feeling of warmth
  • Vomiting or nausea
  • Passing of gas
  • Redness of the neck, face, arms, and sometimes upper chest
  • Stomach pain, discomfort, or fullness

Rare:

  • Area of decreased vision
  • Cough
  • Discomfort in the tongue, ears, and back
  • Drowsiness
  • Dry mouth
  • Metallic taste
  • Mood changes
  • Stuffy nose
  • Shakiness in the arms, hands, legs, or feet
  • Shaking/trembling of the feet or hands

Other side effects that have not been listed can also happen in some people. If you notice any other effects not listed above, consult your healthcare provider right away.

Call your healthcare provider for advice about the side effects. You can let the FDA know about the side effects at 1-800-FDA-1088.

Dosage:

Follow your doctor’s prescription before taking adenosine. Follow the instructions on the prescription label carefully.

The dose recommended by your doctor will depend on the following:

  • The disorder being treated
  • Other health disorders you have
  • Other medicines you’re taking
  • Your response to adenosine
  • Your height
  • Your weight
  • Your age
  • Your gender

Adenosine injection (adenocard) should be given intravenously. To ensure that the solution gets to the systemic circulation, your doctor administers it either into an intravenous line, or straight into a vein. It should be administered to the patient as close as possible, followed by a quick saline flush.

Adult patients

The recommended dose is based on studies done with minor venous bolus adenosine dosing. Central venous administration of adenosine injection hasn’t been systematically researched.

Here are the recommended doses for adults:

For the first dose, 6mg is administered in 1-2 seconds as a quick intravenous bolus.

If the initial dose doesn’t do away with supraventricular tachycardia in one or two minutes, 12mg needs to be administered as a quick intravenous bolus. This dose can be repeated one more time if required.

Pediatric patients

The dosages recommended for newborns, infants, kids, and teens were the same as those given to adults on the basis of weight.

Pediatric patients weighing less than 50kg:

For the first dose, administer 0.05-0.1 mg per kg as a quick intravenous bolus given either peripherally or centrally. It should be followed by a saline flush.

If PSVT conversion doesn’t occur within one or two minutes, additional adenosine bolus injections can be given at incrementally larger doses, increasing the dose amounts by 0.05-0.1 mg per kg. Each bolus should be followed by a saline flush. This process needs to continue until a maximum single 0.3 mg per kg dose is used, or sinus rhythm is found.

Pediatric patients weighing at least 50kg should be given the adult dose.

Doses above 12mg aren’t recommended for pediatric and adult patients.

Parenteral drugs like adenosine should be checked for discoloration and particulate matter before administration.

Interactions:

Although certain medications should never be used together, in some cases two separate medications can be combined even if there might be an interaction. In such cases, your healthcare provider may want to alter your dose, or may recommend other precautions.

When you’re receiving adenosine, it’s very important to let your doctor know if you're using any of the medications listed below. These interactions have been chosen based on their possible impact and aren’t necessarily all-inclusive.

Taking adenosine with any of these medications is usually not advised, but may be needed in certain cases. If both medications are prescribed jointly, your doctor may alter the dose or change how often you take both or one of the medications.

  • Carbamazepine
  • Dyphylline
  • Aminophylline
  • Theophylline
  • Pentoxifylline
  • Dimenhydrinate
  • Verapamil

Using adenosine with any of these medications can increase the risk of some side effects, but taking both drugs can be the best remedy for you. If your doctor prescribes both medicines together, he may change your dose or change how often you take both or one of the medicines.

Other interactions:

Certain medications shouldn’t be taken at or close to meal times or before eating certain kinds of food as interactions can occur. Smoking cigarettes or taking alcohol with certain medications can also cause interactions. These interactions have been picked based on their potential impact and aren’t necessarily all-inclusive.

Taking adenosine with any of these is usually not advised, but may be required in certain cases. If taken together, your healthcare provider may change your dose or alter how often you take adenosine, or give you specific instructions about the consumption of food, tobacco, or alcohol.

Warnings:

Adenosine applies its effect by reducing conduction via the AV node and can produce a short-lived first, second or third-degree heart block. The right therapy should be administered as needed. People who develop a high-level block after a single adenosine dose shouldn’t be given extra doses. Due to the very short life of adenosine, such effects are usually self-limiting. Proper resuscitative methods are needed.

Brief or prolonged asystole episodes have been noted with fatal consequences in some cases. In rare cases, there have been incidences of ventricular fibrillation after adenosine use, including both fatal and resuscitated cases. Most of the time, these cases were attributed to the simultaneous digoxin consumption and less often with verapamil and digoxin. While no drug to drug interaction or causal relationship has been found, adenosine should be taken with caution by patients using digoxin or a combination of digoxin and verapamil.

At the time normal sinus rhythm is achieved, various new rhythms can be seen on the electrocardiogram. In general, they last just a few seconds minus intervention, and can be in the form of atrial premature conditions, premature ventricular contractions, atrial fibrillation, sinus tachycardia, sinus bradycardia, skipped beats, and various levels of A to V nodal block. These findings were noted in 55 percent of patients.

Adenosine stimulates the respiratory system and intravenous administration of the medicine has been proven to up minute ventilation and decrease arterial PCO2, leading to respiratory alkalosis.

Adenosine administered through inhalation has been shown to cause bronchoconstriction among asthma patients, probably due to histamine release and cell degranulation. These effects haven’t been seen in healthy patients. Adenosine was administered to a few asthma patients and mild or moderate worsening of their symptoms was reported.

Respiratory compromise occurred during adenosine administration in people with obstructive pulmonary disorder. Adenosine should be carefully used by people with obstructive lung disorder not related to bronchoconstriction (like bronchitis, emphysema, and so on) and shouldn’t be used by those suffering from bronchoconstriction or bronchospasm (like asthma). Any patient who suffers severe respiratory problems should stop taking adenosine.

Storage:

  • Adenosine should be stored at temperatures of between 15 degrees Celsius and 30 degrees Celsius.
  • Do not refrigerate as crystallization may occur. You can dissolve the medicine by warming it to room temperature.
  • Discard adenosine if it’s cloudy, discolored, or has particulate matter.
  • Dispose of unused medicine. Don’t store for future use.
  • Store upright.

Summary:

Adenosine is a nucleoside that occurs naturally in all the body’s cells.

Adenosine injection is recommended for the following problems:

Conversion of PSVT (paroxysmal supraventricular tachycardia) to sinus rhythm, including that related to Wolff-Parkinson-White Syndrome (accessory bypass tracts). When clinically recommended, proper vagal maneuvers (including Valsavia maneuver) must be attempted before adenosine administration.

It’s important to ensure that the adenosine injection actually reaches your systemic circulation.

Adenosine doesn’t convert ventricular tachycardia, atrial fibrillation, or atrial flutter to regular sinus rhythm. When atrial fibrillation or atrial flutter is present, a brief slight delay of ventricular response can occur right after adenosine administration.

Resources
Last Reviewed:
December 10, 2017
Last Updated:
December 22, 2017