Rapid reversion to sinus rhythm of paroxysmal supraventricular tachycardias, including those associated with accessory conducting pathways (e.g. Wolff-Parkinson-White syndrome); aid to diagnosis of broad or narrow complex supraventricular tachycardias.
By rapid intravenous injection into central or large peripheral vein, 6 mg over 2 seconds with cardiac monitoring; if necessary followed by 12 mg after 1–2 minutes, and then by 12 mg after a further 1–2 minutes; increments should not be given if high level AV block develops at any particular dose.
Important: Patients with a heart transplant are very sensitive to effects of adenosine and should receive initial dose of 3 mg over 2 seconds, followed if necessary by 6 mg after 1–2 minutes, and then by 12 mg after a further 1–2 minutes. Also, if essential to give with dipyridamole reduce adenosine dose to a quarter of the usual dose.
Mode of action
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Mode of Action
Slows conduction through AV node and interrupts AV reentry pathways.
lMonitor ECG and have resuscita- tion facilities available; atrial fibrillation or flutter with accessory pathway [conduction down anom- alous pathway may increase]; first-degree AV block; bundle branch block; left main coronary artery stenosis; uncorrected hypovolaemia; ste- notic valvular heart disease; left to right shunt; pericarditis; pericardial effusion; autonomic dysfunction; stenotic carotid artery disease with cerebrovascular insufficiency; recent myocardial infarction; heart failure; heart transplant.
Second- or third-degree AV block and sick sinus syndrome [unless pacemaker fitted]; long QT syndrome; severe hypotension; decompensated heart failure; chronic obstructive lung disease [including asthma].
Nausea; arrhythmia [discontinue if asystole or severe bradycardia occur], sinus pause, AV block, flushing, angina [discontinue], dizziness; dyspnoea; headache; less commonly metallic taste; palpitation, hyperventilation, weakness, blurred vision, sweating; very rarely transient worsening of intracranial hypertension, bronchospasm, injection-site reactions; also reported vomiting, syncope, hypotension [discontinue if severe], cardiac arrest, respiratory failure [discontinue], and convulsions.
Drug interactions: Beta-blockers, theophylline, nicotine.
Treatment of choice for terminating paroxysmal supraventricular tachy- cardia.