Adenocard

Name: Adenocard

Dosing & Uses

Dosage Forms & Strengths

injectable solution

  • 6mg/2mL prefilled syringe
  • 12mg/4mL prefilled syringe

Paroxysmal Supraventricular Tachycardia

Indicated for conversion to sinus rhythm of paroxysmal supraventricular tachycardia (PSVT), including that associated with accessory bypass tracts (Wolff-Parkinson-White Syndrome)

Adenocard: 6 mg IVP over 1-3 seconds (maybe given IO) followed by rapid flush with 20 mL NS, if no conversion within 1-2 minutes give 12 mg IVP, repeat a second time if necessary (30 mg total)

Dosing considerations

  • When clinically advisable for PSVT, appropriate vagal maneuvers (eg, Valsalva maneuver), should be attempted prior to adenosine administration

Stress Testing (Diagnostic)

Indicated as an adjunct to thallium-201 myocardial perfusion scintigraphy in patients unable to exercise adequately

Adenoscan: 140 mcg/kg/min IV infusion for 6 min  

Other Indications & Uses

Off-label: Sustained ventricular tachycardia (SVT)

Dosage Forms & Strengths

injectable solution

  • 6mg/2mL prefilled syringe
  • 12mg/4mL prefilled syringe

Paroxysmal Superventricular Tachycardia (per ACLS)

5 mL 0.9% NaCl  

If necessary may give 2nd dose of 0.2 mg/kg IVP/IO, not to exceed cumulative dose of 12 mg

Elderly may experience more adverse effects from adenosine; they may be more sensitive

PSVT (Adenocard)

6 mg IVP over 1-3 seconds (maybe given IO) followed by rapid flush with 20 mL NS, if no conversion within 1-2 minutes give 12 mg IVP, repeat a second time if necessary (30 mg total)

Adenoscan (Diagnostic)

Stress testing (Adenoscan): 140 mcg/kg/min IV infusion for 6 min

Adverse Effects

>10%

Flushing (18%)

Dyspnea (12%)

1-10%

Chest pressure (7%)

HA (2%)

Lightheadedness (2%)

Dizziness (1%)

Tingling in arms (1%)

Numbness (1%)

Nausea (3%)

Warnings

Contraindications

Hypersensitivity

2nd or 3rd degree AV block (except those on pacemakers)

Sinus node disease, such as sick sinus syndrome or symptomatic bradycardia (except in patients with a functioning artificial pacemaker)

Adenoscan: Contraindicated in bronchoconstrictive or bronchospastic lung disease (eg, asthma)

Cautions

Symptomatic bradycardia, cardiac arrest, heart block, heart transplant patients, HTN, hypotension, MI, proarrhythmic events, unstable angina

Adenocard: Caution with bronchoconstrictive or bronchospastic lung disease (eg, asthma)

Cerebrovascular accident hemorrhagic and ischemic cerebrovascular accidents reported; hemodynamic effects of adenosine including hypotension or hypertension possibly associated with these adverse reactions

Nucleoside transport inhibitors (eg, dipyridamole) and potentiate the vasoactive effects of adenosine; withhold for 5 half-lives before adenosine administration

Methylxanthines (eg, caffeine, theophylline) are adenosine receptor antagonists and inhibit adenosine’s vasoactive effects; withhold methylxanthines for 5 half-lives before adenosine administration

New-onset or recurrence of convulsive seizures reported following adenosine; some seizures are prolonged and require emergent anticonvulsive management; aminophylline may increase risk of seizures associated with adenosine; methylxanthine use not recommended in patients who experience seizures in association with adenosine administration

Dyspnea, throat tightness, flushing, erythema, rash, and chest discomfort reported that may require symptomatic treatment; resuscitative measures may be necessary if symptoms progress; have trained personnel and treatment available during treatment

Arrhythmia at time of cardioversion (Adenocard): Ventricular fibrillation reported following administration, including both resuscitated and fatal events; in most instances, these cases were associated with the concomitant use of digoxin and, less frequently with digoxin and verapamil

Risk for myocardial infarction and death

  • Avoid use for cardiac nuclear stress tests in patients with signs or symptoms of acute myocardial ischemia (eg, unstable angina, cardiovascular instability); use may increase risk of fatal MI
  • Screen all nuclear stress test candidates for risks

Administration

IV Compatibilities

Solution: dextrose 5% in LR, D5W, LR, NS

IV Administration

Adenocard: given as a rapid injection (1-3 sec) by peripheral IV route directly into vein or into IV line close (proximal) to patient and is followed by rapid NS flush after each injection (20 mL for adults, 5 mL or more for pediatrics)

Place patient in mild reverse Trendelenburg position before giving drug

Record rhythm strip during administration

Draw up (separate syringes)

  • Adenosine dose
  • Flush
  • Attach both syringes to IV injection port nearest to patient

Clamp IV tubing above injection port

Avoid drug traveling retrograde

Push adenosine as fast as possible (1-3 sec)

While keeping pressure on adenosine syringe plunger, push NS flush as fast as possible

Unclamp IV tubing

Preferred method using a stopcock

  • Have adenosine in one port and NS flush in other port
  • Simply open stopcock to adenosine and push
  • Close stopcock and open port to NS and push
  • Eliminates possibility of adenosine traveling retrograde

May be given via central line or intraosseus

Adenoscan: given by continuous peripheral IV infusion for 6 minutes

Storage

Store at controlled room temperature of 15-30°C

Do not refrigerate; possible crystal formation

Solution must be clear prior to administration

Patient Handout

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