Intravenous Differential diagnosis of supraventricular tachycardias
Adult: As an aid to diagnosis of broad or narrow complex cases: Initially, 3 mg via rapid IV bolus inj over 2 seconds; if ineffective within 1-2 minutes, administer 6 mg, followed by 12 mg if still ineffective after another 1-2 minutes. Doses are injected into an IV line and as proximally as possible, followed by a rapid saline flush. If doses are injected through a peripheral vein, a large bore cannula must be used. Dosage and treatment recommendations may vary among individual products and between countries (refer to specific product guidelines).
Adult: Rapid conversion to normal sinus rhythm: Initially, 3 mg via rapid IV bolus inj over 2 seconds; if ineffective within 1-2 minutes, administer 6 mg, followed by 12 mg if still ineffective after another 1-2 minutes. Alternatively, an initial dose of 6 mg via rapid IV bolus inj over 1-2 seconds may be given, followed by 2 further doses of 12 mg at 1-2 minute intervals if necessary. Doses are injected into an IV line and as proximally as possible, followed by a rapid saline flush. If doses are injected through a peripheral vein, a large bore cannula must be used. Dosage and treatment recommendations may vary among individual products and between countries (refer to specific product guidelines). Child: Rapid conversion to normal sinus rhythm: <50 kg: Initially, 0.05-0.1 mg/kg; if not effective within 1-2 minutes, may increase dose by 0.05-0.1 mg/kg every 1-2 minutes up to a Max single dose of 0.3 mg/kg or 12 mg (whichever is less); ≥50 kg: Initially, 6 mg via rapid IV bolus inj. If initial dose is not effective within 1-2 minutes, administer 12 mg. May repeat the 12 mg dose once, if necessary. Doses are given via rapid IV bolus inj either centrally or peripherally and followed by a saline flush. Dosage and treatment recommendations may vary among individual products and between countries (refer to specific product guidelines).
Intravenous Myocardial imaging
Adult: As adjunct to thallium-201 myocardial perfusion scintigraphy in patients unable to exercise adequately: 140 mcg/kg/min via continuous IV infusion for 6 minutes using an infusion pump (total dose: 0.84 mg/kg). Treatment recommendations may vary among individual products and between countries (refer to specific product guidelines).
What are the brands available for Adenosine in Thailand?
Sick sinus syndrome, 2nd or 3rd degree AV block (except in patients with a functioning artificial pacemaker), chronic obstructive lung disease with evidence of bronchospasm (e.g. asthma bronchiale), long QT syndrome, severe hypotension, decompensated states of heart failure.
Special Precautions
Patient with left main coronary stenosis, uncorrected hypovolaemia, stenotic valvular heart disease, left to right shunt, pericarditis or pericardial effusion, autonomic dysfunction or stenotic carotid artery disease with cerebrovascular insufficiency; recent MI, severe heart failure, minor conduction defects (e.g. 1st degree AV block, bundle branch block), atrial fibrillation or flutter, irregular or polymorphic wide-complex tachycardias; accessory bypass tract; recent heart transplantation (<1 year); history of convulsions or seizures; prolonged QT interval. Neonates, children, and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: CVA (haemorrhagic and ischaemic), TIA, MI, sustained ventricular tachycardia; angina, severe hypotension; new-onset or exacerbation of bronchospasm; atrial fibrillation or flutter, heart block; hypersensitivity reactions (e.g. dyspnoea, pharyngeal oedema, erythema, flushing, rash, chest discomfort); hypertension, new-onset or recurrent seizures. Rarely, severe bradycardia. Cardiac disorders: Sinus pause, skipped beats, atrial extrasystoles, ventricular excitability disorders (e.g. ventricular extrasystoles, non-sustained ventricular tachycardia), chest pain or pressure, feeling of thoracic constriction/oppression. Gastrointestinal disorders: Nausea. Nervous system disorders: Headache, dizziness, lightheadedness, paraesthesia. Psychiatric disorders: Nervousness. Potentially Fatal: Respiratory failure, transient or prolonged episodes of asystole, cardiac arrest.
Monitor ECG (particularly during treatment), heart rate, and blood pressure. Assess for signs and symptoms of proarrhythmic effects.
Overdosage
Symptoms: Severe hypotension, bradycardia, asystole. Management: Administration of IV aminophylline or theophylline may be necessary.
Drug Interactions
Concomitant use with dipyridamole may potentiate the effects of adenosine; withhold dipyridamole-containing medications for at least 48 hours prior to pharmacologic stress testing. Concurrent use with aminophylline, theophylline and other xanthines may decrease the therapeutic effect of adenosine; avoid using aminophylline, theophylline and other xanthines 24 hours prior to using adenosine. Increased risk of heart block with carbamazepine. Potentially Fatal: Increased risk of ventricular fibrillation with digoxin and verapamil.
Food Interaction
Foods and drinks containing xanthines (e.g. tea, coffee, chocolate, cola) may decrease the therapeutic effect of adenosine.
Action
Description: Mechanism of Action: Adenosine is a purine nucleoside present in all cells of the body. It slows conduction via the AV node, interrupting the re-entry pathways and thereby restoring the normal sinus rhythm. Additionally, it causes coronary vasodilation and increases blood flow in normal coronary arteries with little to no increase in the stenotic coronary arteries. Onset: Rapid. Duration: Very brief. Pharmacokinetics: Metabolism: Rapidly metabolised intracellulary via phosphorylation by adenosine kinase into adenosine monophosphate (AMP) which is then incorporated into high-energy pool; intracellular adenosine also undergoes deamination by adenosine deaminase into inosine, which can be metabolised into hypoxantine, then xanthine, and finally to uric acid. Excretion: Elimination half-life: <10 seconds.
Chemical Structure
Adenosine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 60961, Adenosine. https://pubchem.ncbi.nlm.nih.gov/compound/Adenosine. Accessed June 26, 2025.
C01EB10 - adenosine ; Belongs to the class of other cardiac preparations.
References
Adenocor 3 mg/mL Solution for Injection (Aventis Pharma Limited). MHRA. https://products.mhra.gov.uk. Accessed 05/05/2025.Adenorythm Solution for Injection 3 mg/mL (MMS Pharma [Malaysia] Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 05/05/2025.Adenoscan 30 mg/10 mL, Solution for Infusion (Aventis Pharma Limited). MHRA. https://products.mhra.gov.uk. Accessed 05/05/2025.Adenosine 3 mg/mL Solution for Injection in Pre-filled Syringe (Fresenius Kabi Limited). MHRA. https://products.mhra.gov.uk. Accessed 05/05/2025.Adenosine Injection (Mylan Institutional LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 05/05/2025.Adenosine Injection, Solution (Mylan Institutional LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 05/05/2025.Adenosine. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 05/05/2025.Adenosine. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 05/05/2025.Adenosine. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 07/05/2025.Adenosine. UpToDate Lexidrug, Pediatric and Neonatal Lexi-Drugs Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 07/05/2025.Baxter Healthcare Ltd. Adenosine Baxter 30 mg/10 mL Solution for Infusion data sheet 11 January 2024. Medsafe. http://www.medsafe.govt.nz. Accessed 05/05/2025.Brayfield A, Cadart C (eds). Adenosine. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/05/2025.Joint Formulary Committee. Adenosine. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 05/05/2025.Paediatric Formulary Committee. Adenosine. BNF for Children [online]. London. BMJ Group, Pharmaceutical Press, and RCPCH Publications. https://www.medicinescomplete.com. Accessed 07/05/2025.Pharmacy Retailing (NZ) Ltd t/a Healthcare Logistics. Adenocor 6 mg/2 mL Solution for Intravenous Infusion data sheet 02 September 2022. Medsafe. http://www.medsafe.govt.nz. Accessed 05/05/2025.
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