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Adenosine

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Version Jan 2023

Patients may feel terrible for 20-30 seconds which is always transient but keep reassuring that the feeling will pass. Do not use in Asthmatics.

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Purine nucleotide useful to treat SVTs. Adenosine receptor agonist

Mode of action

Causes hyperpolarisation of purinergic receptors at the SAN and AVN
This is mediated via the A1 receptor, inhibiting adenyl cyclase
This reduces cAMP causing cell hyperpolarization by increasing outward K⁺ flux

Actions

Causes transient heart block, bradycardia and even asystole
It will not usually cardiovert AF or flutter but will slow the rate transiently
Also acts as a vasodilator and causes flushing
Half life less than 10 seconds
Need to get to the AV nodal branch of the RCA before it is metabolised

Dose Administration: Warn patients that they may feel terrible for 20-30 seconds but the feeling will pass.

Name	Starting Dose	Frequency	Route
Adenosine	1-3 mg if on Dipyridamole or Carbamazepine or Heart Transplant or into central line	stat	Fast IV with 20 ml NS flush into large or central vein
Adenosine	6 mg Standard 1st dose	stat	Fast IV with 20 ml NS flush* into large or central vein. If fails then give 12 mg
Adenosine	12 mg and may be repeated	stat	Fast IV width flush into large or central vein with 20 ml flush

Indications

Treatment of reentry tachyarrhythmia
AVRT, AVNRT, show flutter waves in A Flutter
Also used in myocardial perfusion imaging

Contraindications

Significant Asthma or COPD can get bronchospasm so avoid (Consider Verapamil for SVT)
Prolonged action in combination with dipyridamole, Long QTc, 2nd/3rd-degree heart block, sick sinus syndrome
Heart transplant patients very sensitive

Side effects

Prolonged action in combination with dipyridamole
Reduced action in combination with Theophylline
Nausea, Feels awful, Flushing, Bronchospasm
Transient uncomfortable feeling in the chest
Transient bradyarrhythmia including complete heart block

Interactions

Dipyridamole enhances the effects of Adenosine so start with the lowest dose even down to 1 mg
Theophyllines/Aminophylline reduced effects of Adenosine

References

Adenosine in BNF

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. The official launch will be at the end of 2018. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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