ADENOCARD
Clinical safety rating: caution
Comprehensive clinical and safety monograph for ADENOCARD (ADENOCARD).
Adenosine is an endogenous purine nucleoside that acts on A1 and A2 adenosine receptors. It slows conduction through the AV node, interrupts reentry pathways, and can restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardia (PSVT).
| Metabolism | Adenosine is rapidly metabolized intracellularly by adenosine deaminase to inosine and is also taken up by erythrocytes and vascular endothelial cells. It has a very short half-life of <10 seconds. |
| Excretion | Primarily renal excretion of metabolites; adenosine is rapidly metabolized intracellularly to inosine and adenosine monophosphate, with less than 1% excreted unchanged in urine. |
| Half-life | Terminal half-life is less than 10 seconds; clinically, the effect is very transient due to rapid cellular uptake and metabolism. |
| Protein binding | Negligible protein binding; essentially unbound in plasma. |
| Volume of Distribution | Volume of distribution is approximately 0.4 L/kg, indicating distribution into total body water. |
| Bioavailability | Intravenous bioavailability is 100%; negligible oral bioavailability due to extensive first-pass metabolism. |
| Onset of Action | Intravenous bolus: onset in 10-20 seconds. |
| Duration of Action | Duration is approximately 10-20 seconds after IV bolus; the drug is rapidly cleared from the circulation. |
6 mg IV bolus over 1-2 seconds, followed by 20 mL saline flush; if no conversion to sinus rhythm within 1-2 minutes, give 12 mg IV bolus; may repeat 12 mg once more if needed.
| Dosage form | INJECTABLE |
| Renal impairment | No dose adjustment required for renal impairment; adenosine is rapidly metabolized by erythrocytes and vascular endothelium, with minimal renal excretion. |
| Liver impairment | No dose adjustment required for hepatic impairment; adenosine metabolism is not dependent on hepatic function. |
| Pediatric use | First dose 0.1 mg/kg IV (max 6 mg); if ineffective, second dose 0.2 mg/kg (max 12 mg); administer as rapid IV bolus followed by saline flush. |
| Geriatric use | Use standard adult dosing; caution in elderly due to higher prevalence of underlying cardiac disease and potential for higher risk of bradycardia or hypotension; administer with cardiac monitoring. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for ADENOCARD (ADENOCARD).
| Breastfeeding | Adenosine is naturally present in breast milk. Exogenous adenosine likely enters breast milk but has very short half-life (<10 seconds). No adverse effects reported in nursing infants. M/P ratio not established. Consider risk vs benefit; generally considered compatible with breastfeeding. |
| Teratogenic Risk | Adenosine is pregnancy category C. No adequate studies in pregnant women. In animal studies, no teratogenic effects were observed at doses up to 20 mg/kg/day (approximately 100 times the human dose). However, adenosine can cause hemodynamic effects (e.g., hypotension, bradycardia) that may reduce placental perfusion. Use only if clearly needed. Risk to fetus cannot be ruled out. |
■ FDA Black Box Warning
Adenocard must be administered as a rapid intravenous bolus. It should not be given by continuous infusion because of the risk of severe hypotension, bradycardia, and asystole.
| Serious Effects |
["Second- or third-degree AV block (except in patients with a functioning artificial pacemaker)","Sick sinus syndrome (except in patients with a functioning artificial pacemaker)","Known hypersensitivity to adenosine","Concomitant use of dipyridamole (potentiates effects) or methylxanthines (antagonize effects)"]
| Precautions | ["Risk of cardiac arrest, myocardial infarction, and ventricular arrhythmias; use with caution in patients with myocardial ischemia or heart block","May cause significant hypotension, bradycardia, and asystole; monitor ECG and blood pressure","Bronchoconstriction: avoid use in patients with known bronchoconstrictive lung disease (e.g., asthma, COPD) unless clearly necessary","Use with caution in patients receiving dipyridamole, carbamazepine, or methylxanthines (caffeine, theophylline) as these may alter adenosine effects","Seizures have been reported, especially in patients with underlying seizure disorders"] |
| Food/Dietary |
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| Fetal Monitoring | Continuous ECG monitoring during administration. Monitor heart rate, blood pressure, and respiratory rate. Observe for signs of bronchospasm, especially in asthmatic patients. Fetal heart rate monitoring may be considered in late pregnancy if indicated. |
| Fertility Effects | No animal studies on fertility. Adenosine is endogenous and essential for cellular function; no evidence of impaired fertility in humans. |
| Avoid caffeine-containing beverages (coffee, tea, cola, chocolate) for at least 12 hours before administration when used for pharmacologic stress testing. Caffeine antagonizes adenosine effects. |
| Clinical Pearls | Administer as rapid IV push followed by saline flush; use large proximal vein. Adenosine half-life <10 seconds; brief asystole or heart block often seen. Have emergency resuscitation equipment available. Contraindicated in second- or third-degree AV block, sick sinus syndrome (unless paced). Dose reduction with dipyridamole, carbamazepine; avoid in heart transplant recipients (prolonged asystole). |
| Patient Advice | You will feel a brief period of flushing, chest pressure, or shortness of breath after the injection. · These sensations last less than a minute and are expected. · You may feel your heart stop or have a very slow rhythm for a few seconds. · This medication is given to diagnose or treat a rapid heart rhythm. · Tell your healthcare provider if you have asthma, COPD, or low blood pressure. · Avoid caffeine for 12 hours before the test if being used for cardiac scintigraphy. |