adenosine: clinical use

Prescribing considerations

• Use only where continuous ECG monitoring and immediate cardiorespiratory resuscitation are available.
• Review respiratory disease, conduction abnormalities, prolonged QT, recent myocardial infarction, severe heart failure, recent heart transplantation, seizure susceptibility and accessory pathways.
• Injection and infusion products have distinct licensed indications and administration methods.
• The infusion product is licensed for adults; the injection product includes treatment of paroxysmal supraventricular tachycardia in children.
• Renal or hepatic impairment is not expected to materially alter efficacy because exogenous adenosine is not principally cleared by either organ.

Contraindications and cautions

• Hypersensitivity to adenosine or excipients.
• Sick sinus syndrome or second- or third-degree AV block without a functioning pacemaker.
• Long QT syndrome.
• Severe hypotension.
• Decompensated heart failure.
• Obstructive lung disease with active bronchospasm, including bronchial asthma.
• For the infusion product: uncontrolled unstable angina and concomitant dipyridamole.

Monitoring

• Continuous ECG during administration.
• Monitor heart rate, blood pressure, respiratory status and symptom tolerance.
• Stop administration for severe or persistent hypotension, angina, severe bradycardia, high-grade AV block, respiratory failure or cardiac arrest.
• Maintain immediate access to cardiorespiratory resuscitation equipment.

Clinical pharmacology

Adenosine is an endogenous purine nucleoside with an extremely short intravascular lifetime. A1-receptor activity transiently slows AV-nodal conduction; A2-receptor activity contributes to coronary vasodilation. Cellular uptake is followed by rapid phosphorylation or deamination.

Formulation and product differences

• The solution for injection is a clear, colourless, single-use intravenous product licensed for selected supraventricular tachycardias and diagnostic electrophysiology uses.
• The solution for infusion is a clear, colourless, single-use intravenous product licensed as a coronary vasodilator for radionuclide myocardial perfusion imaging in adults.
• Both selected products contain sodium chloride and water for injections and should not be mixed with other medicines when compatibility has not been established.

Solution for infusion

Route: Intravenous

Strengths: 30 mg/10 mL

Injection

Route: Parenteral

Strengths: 3 mg/mL