Description and indication for use
Adenosine is a purine nucleoside endogenous to all cells of the body. It slows impulse generation in the sinoatrial node (negative chronotropic effect), impairs conduction through the atrioventricular node (negative dromotropic effect) and dilates the coronary arteries.
Adenosine activates specific receptors on the cell membrane.
Adenosine has a rapid onset and a short duration of action, effect usually lasting seconds to minutes. It is used
in the treatment of sustained paroxysmal supraventricular tachycardia (SVT). Consultation with a Paediatric Cardiologist is always sought when Adenosine is being considered for use in the retrieval environment.
Dose
IV
0.05 mg/kg (50 micrograms/kg).
Dose may be increased by 0.05 mg/kg (50 micrograms/kg) every 2 minutes until tachycardia is terminated to a maximum dose of 0.25 mg/kg.1, 2
Reconstitution/Dilution
Ampoule = 6 mg in 2 mL (3 mg/mL).
Store vial at room temperature, do not refrigerate (single use vial).
For IV use
Can be administered undiluted (3 mg/mL) or as a 1 mg/mL solution.2, 3
To
prepare 1 mg/mL solution:
Withdraw 1 mL of 3 mg/mL solution and add to 2 mL of sodium chloride 0.9% in a 5 mL syringe = 3 mg in 3 mL = 1 mg/mL.
Discard excess volume to obtain dose required or withdraw dose using another syringe.
Route and method of administration
IV
Medical staff to be present when administered.
Give by rapid IV push into a large peripheral vein over 1-2 seconds3.
Infuse as close to IV site as possible.
Flush line immediately with 2 - 3 mL of sodium chloride 0.9% (to push into central circulation).1-3
Side effects:
Adenosine has a very short duration of effect (half-life is less than 10 seconds) meaning that any adverse effects are generally rapidly reversible.4
Flushing.
Dyspnoea.
Transient arrhythmias - may occur between termination of SVT and onset of normal sinus rhythm.
Irritability.
Bradycardia (minimal) may occur.
Special precautions
Contraindications
Second or third degree AV block or sick sinus syndrome.
Known sensitivity to Adenosine.
Compatibilities
Limited information.
Compatible fluids: sodium chloride 0.9%, glucose 5%, Hartman’s solution.3,5
Otherwise administer alone or contact pharmacy for further information.
Drug interactions
|
Carbamazepine
|
Higher degrees of heart block may be produced in the presence of both agents. |
| Dipyridamole |
Protects against degradation and can potentiate the clinical effects of Adenosine. Lower doses of Adenosine may be adequate. |
| Theophylline (and caffeine) |
May reduce effectiveness of Adenosine due to antagonistic pharmacologic effects. |
| Verapamil |
Possibility of prolonged bradycardia occurring if Aadenosine is used together with high doses of Verapamil. |
Nursing responsibilities
Continuous cardiorespiratory monitor.
Monitor blood pressure.
References:
1. RCH Paediatric Pharmacopoeia, 13th ed. 2002.
2. RWH Neonatal Pharmacopoeia, 2nd ed. 2005.
3. RCH Paediatric Injectable Guidelines, 4th ed. 2011 (
http://ww2.rch.org.au/pharmacy/intranet/PIG.pdf- accessed 03/10/2013).
4. Australian Injectables Handbook, SHPA, 5th ed. 2011.
5. Lawrence Trissel, Handbook on Injectable Drugs, 17th ed. 2013.