Adenosine: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 1: Line 1:
{{DrugProjectFormSinglePage
{{DrugProjectFormSinglePage
|authorTag={{Shankar}}
|authorTag=
|genericName=Adenosine
 
|aOrAn=an
Gerald Chi
|drugClass=Antiarrhythmic
 
|indication=[[paroxysmal supraventricular tachycardia]] ([[PSVT]])
<!--Overview-->
|adverseReactions=facial flushing (18%), shortness of breath/ [[dyspnea]] (12%), chest pressure (7%), and [[nausea]] (3%)
 
|blackBoxWarningTitle=Warning Title
|genericName=
|blackBoxWarningBody=<i><span style="color:#FF0000;">Condition Name:</span></i> (Content)
 
|fdaLIADAdult======Paroxysmal Supraventricular Tachycardia=====
 
 
|aOrAn=
 
a
 
|drugClass=
 


* Dosing Information


For rapid bolus [[intravenous]] use only. Adenosine injection should be given as a rapid bolus by the peripheral [[intravenous]] route. To be certain the solution reaches the [[systemic circulation]], it should be administered either directly into a vein or, if given into an [[IV]] line, it should be given as close to the patient as possible and followed by a rapid saline flush.
|indication=


:*Initial dose: '''Adenosine 6 mg given as a rapid [[intravenous]] bolus''' (administered over a 1 to 2 second period).


:*Repeat administration: If the first dose does not result in elimination of the [[supraventricular tachycardia]] within 1 to 2 minutes, '''Adenosine 12 mg''' should be given as a '''rapid [[intravenous]] bolus'''. This 12 mg dose may be repeated a second time if required.


Doses greater than 12 mg are not recommended for adult patients.
|hasBlackBoxWarning=


'''NOTE''': [[Parenteral]] drug products should be inspected visually for particulate matter and discoloration prior to administration.
Yes
|offLabelAdultGuideSupport======Condition 1=====


* Developed by: (Organisation)
|adverseReactions=


* Class of Recommendation: (Class) (Link)


* Strength of Evidence: (Category A/B/C) (Link)


* Dosing Information/Recommendation
<!--Black Box Warning-->


:* (Dosage)
|blackBoxWarningTitle=
Title


=====Condition 2=====
|blackBoxWarningBody=
<i><span style="color:#FF0000;">ConditionName: </span></i>


* Developed by: (Organisation)
* Content


* Class of Recommendation: (Class) (Link)
<!--Adult Indications and Dosage-->


* Strength of Evidence: (Category A/B/C) (Link)
<!--FDA-Labeled Indications and Dosage (Adult)-->


* Dosing Information/Recommendation
|fdaLIADAdult=


:* (Dosage)
=====Condition1=====
|offLabelAdultNoGuideSupport======Condition 1=====


* Dosing Information
* Dosing Information


:* (Dosage)
:* Dosage


=====Condition 2=====
=====Condition2=====


* Dosing Information
* Dosing Information


:* (Dosage)
:* Dosage


=====Condition 3=====
=====Condition3=====


* Dosing Information
* Dosing Information


:* (Dosage)
:* Dosage
|fdaLIADPed======Paroxysmal Supraventricular Tachycardia=====
 
=====Condition4=====


* Dosing Information
* Dosing Information


The dosages used in [[neonate]]s, [[infant]]s, children and [[adolescent]]s were equivalent to those administered to adults on a weight basis.
:* Dosage
 
<!--Off-Label Use and Dosage (Adult)-->
 
<!--Guideline-Supported Use (Adult)-->
 
|offLabelAdultGuideSupport=
 
=====Condition1=====


Pediatric Patients with a Body Weight < 50 kg:
* Developed by:  


:*Initial dose: Give '''Adenosine 0.05 to 0.1 mg/kg as a rapid [[IV]] bolus''' given either centrally or peripherally. A saline flush should follow.
* Class of Recommendation:  


:*Repeat administration: If conversion of [[PSVT]] does not occur within 1 to 2 minutes, additional bolus [[injection]]s of adenosine can be administered at incrementally higher doses, '''increasing the amount given by 0.05 to 0.1 mg/kg'''. Follow each bolus with a saline flush. This process should continue until [[sinus rhythm]] is established or a '''maximum single dose of 0.3 mg/kg''' is used.
* Strength of Evidence:  


Pediatric Patients with a Body Weight ≥ 50 kg:
* Dosing Information


:*Administer the adult dose.
:* Dosage


Doses greater than 12 mg are not recommended for [[pediatric]] patients.
=====Condition2=====


'''NOTE''': [[Parenteral]] drug products should be inspected visually for particulate matter and discoloration prior to administration.
There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in adult patients.
|offLabelPedGuideSupport======Condition 1=====


* Developed by: (Organisation)
<!--Non–Guideline-Supported Use (Adult)-->


* Class of Recommendation: (Class) (Link)
|offLabelAdultNoGuideSupport=


* Strength of Evidence: (Category A/B/C) (Link)
=====Condition1=====


* Dosing Information/Recommendation
* Dosing Information


:* (Dosage)
:* Dosage


=====Condition 2=====
=====Condition2=====


* Developed by: (Organisation)
There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of {{PAGENAME}} in adult patients.


* Class of Recommendation: (Class) (Link)
<!--Pediatric Indications and Dosage-->


* Strength of Evidence: (Category A/B/C) (Link)
<!--FDA-Labeled Indications and Dosage (Pediatric)-->


* Dosing Information/Recommendation
|fdaLIADPed=


:* (Dosage)
=====Condition1=====
|offLabelPedNoGuideSupport======Condition 1=====


* Dosing Information
* Dosing Information


:* (Dosage)
:* Dosage
 
=====Condition2=====
 
There is limited information regarding <i>FDA-Labeled Use</i> of {{PAGENAME}} in pediatric patients.
 
<!--Off-Label Use and Dosage (Pediatric)-->
 
<!--Guideline-Supported Use (Pediatric)-->
 
|offLabelPedGuideSupport=


=====Condition 2=====
=====Condition1=====
 
* Developed by:
 
* Class of Recommendation:
 
* Strength of Evidence:


* Dosing Information
* Dosing Information


:* (Dosage)
:* Dosage
 
=====Condition2=====
 
There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
 
<!--Non–Guideline-Supported Use (Pediatric)-->


=====Condition 3=====
|offLabelPedNoGuideSupport=
 
=====Condition1=====


* Dosing Information
* Dosing Information


:* (Dosage)
:* Dosage
|contraindications=*[[Second degree AV block|Second]]- or [[Third degree AV block|third-degree A-V block]] (except in patients with a functioning [[artificial pacemaker]]).
 
*[[Sinus node disease]], such as [[sick sinus syndrome]] or symptomatic [[bradycardia]] (except in patients with a functioning [[artificial pacemaker]]).
=====Condition2=====
*Known [[hypersensitivity]] to adenosine.
 
|warnings======[[Heart Block]]=====
There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
 
<!--Contraindications-->
 
|contraindications=
 
* Condition1


*Adenosine [[injection]] exerts its effect by decreasing conduction through the [[AV node|A-V node]] and may produce a short lasting [[first degree AV block|first]]-, [[second degree AV block|second]]- or [[third degree AV block|third-degree heart block]]. Appropriate therapy should be instituted as needed. Patients who develop high-level block on one dose of adenosine should not be given additional doses. Because of the very short [[half-life]] of adenosine, these effects are generally self-limiting. Appropriate [[resuscitation|resuscitative]] measures should be available.
<!--Warnings-->
*Transient or prolonged episodes of [[asystole]] have been reported with fatal outcomes in some cases. Rarely, [[ventricular fibrillation]] has been reported following adenosine administration, including both [[resuscitation|resuscitated]] and fatal events. In most instances, these cases were associated with the concomitant use of [[digoxin]] and, less frequently with [[digoxin]] and [[verapamil]]. Although no causal relationship or drug-drug interaction has been established, adenosine should be used with caution in patients receiving [[digoxin]] or [[digoxin]] and [[verapamil]] in combination.


=====[[Arrhythmia]]s at Time of Conversion=====
|warnings=


*At the time of conversion to normal [[sinus rhythm]], a variety of new rhythms may appear on the [[electrocardiogram]]. They generally last only a few seconds without intervention, and may take the form of [[premature ventricular contraction]]s, [[atrial premature contraction]]s, [[atrial fibrillation]], [[sinus bradycardia]], [[sinus tachycardia]], skipped beats, and varying degrees of [[AV block|A-V nodal block]]. Such findings were seen in 55% of patients.
* Description


=====[[Bronchoconstriction]]=====
====Precautions====


*Adenosine is a [[respiratory stimulant]] (probably through activation of [[carotid body]] [[chemoreceptor]]s) and [[intravenous]] administration in man has been shown to increase [[minute ventilation]] (Ve) and reduce arterial PCO2 causing [[respiratory alkalosis]].
* Description
*Adenosine administered by [[inhalation]] has been reported to cause [[bronchoconstriction]] in [[asthma]]tic patients, presumably due to [[mast cell]] [[degranulation]] and [[histamine]] release. These effects have not been observed in normal subjects. Adenosine has been administered to a limited number of patients with [[asthma]] and mild to moderate exacerbation of their symptoms has been reported. [[Respiratory]] compromise has occurred during adenosine infusion in patients with [[obstructive pulmonary disease]]. Adenosine should be used with caution in patients with [[obstructive lung disease]] not associated with [[bronchoconstriction]] (e.g., [[emphysema]], [[bronchitis]], etc.) and should be avoided in patients with [[bronchoconstriction]] or [[bronchospasm]] (e.g., [[asthma]]). Adenosine should be discontinued in any patient who develops severe [[respiratory]] difficulties.
|clinicalTrials=The following reactions were reported with [[intravenous]] adenosine used in controlled U.S. clinical trials. The [[placebo]] group had a less than 1% rate of all of these reactions.


======Cardiovascular======
<!--Adverse Reactions-->


:Facial flushing (18%), [[headache]] (2%), sweating, [[palpitation]]s, [[chest pain]], [[hypotension]] (less than 1%).
<!--Clinical Trials Experience-->


======Respiratory======
|clinicalTrials=


:Shortness of breath/ [[dyspnea]] (12%), chest pressure (7%), [[hyperventilation]], head pressure (less than 1%).
There is limited information regarding <i>Clinical Trial Experience</i> of {{PAGENAME}} in the drug label.


======Central Nervous System======
=====Body as a Whole=====


:Lightheadedness (2%), dizziness, tingling in arms, numbness (1%), apprehension, blurred vision, burning sensation, heaviness in arms, neck and back pain (less than 1%).


======Gastrointestinal======


:[[Nausea]] (3%), metallic taste, tightness in throat, pressure in groin (less than 1%).
|postmarketing=The following adverse events have been reported from marketing experience with adenosine. Because these events are reported voluntarily from a population of uncertain size, are associated with concomitant diseases and multiple drug therapies and surgical procedures, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Decisions to include these events in labeling are typically based on one or more of the following factors: (1) seriousness of the event, (2) frequency of the reporting, (3) strength of causal connection to the drug, or a combination of these factors.


======Cardiovascular======
=====Cardiovascular=====


:Prolonged [[asystole]], [[ventricular tachycardia]], [[ventricular fibrillation]], transient increase in blood pressure, [[bradycardia]], [[atrial fibrillation]], and [[Torsade de Pointes]].


======Respiratory======


:Bronchospasm


======Central Nervous System======
=====Digestive=====


:[[Seizure]] activity, including [[seizure|tonic clonic (grand mal) seizures]], and loss of consciousness.
|drugInteractions=*[[Intravenous]] adenosine has been effectively administered in the presence of other cardioactive drugs, such as [[quinidine]], [[beta-adrenergic blocking agents]], [[CCB|calcium channel blocking agents]], and [[angiotensin converting enzyme inhibitor]]s, without any change in the adverse reaction profile.
*[[Digoxin]] and [[verapamil]] use may be rarely associated with [[ventricular fibrillation]] when combined with adenosine. Because of the potential for additive or synergistic depressant effects on the [[SA node|SA]] and [[AV node]]s, however, adenosine should be used with caution in the presence of these agents. The use of adenosine in patients receiving [[digitalis]] may be rarely associated with [[ventricular fibrillation]].
*The effects of adenosine are antagonized by [[methylxanthine]]s such as [[caffeine]] and [[theophylline]]. In the presence of these [[methylxanthine]]s, larger doses of adenosine may be required or adenosine may not be effective.
*Adenosine effects are potentiated by [[dipyridamole]]. Thus, smaller doses of adenosine may be effective in the presence of [[dipyridamole]].
*[[Carbamazepine]] has been reported to increase the degree of [[heart block]] produced by other agents. As the primary effect of adenosine is to decrease conduction through the [[AV node|A-V node]], higher degrees of [[heart block]] may be produced in the presence of [[carbamazepine]].
|FDAPregCat=C
|useInPregnancyFDA=Animal reproduction studies have not been conducted with adenosine; nor have studies been performed in pregnant women. As adenosine is a naturally occurring material, widely dispersed throughout the body, no fetal effects would be anticipated. However, since it is not known whether adenosine can cause fetal harm when administered to pregnant women, adenosine should be used during [[pregnancy]] only if clearly needed.
|useInPregnancyAUS=There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Adenosine in women who are pregnant.
|useInLaborDelivery=There is no FDA guidance on use of Adenosine during labor and delivery.
|useInNursing=There is no FDA guidance on use of Adenosine during nursing.
|useInPed=No controlled studies have been conducted in [[pediatric]] patients to establish the safety and [[efficacy]] of adenosine for the conversion of [[paroxysmal supraventricular tachycardia]] ([[PSVT]]). However, [[intravenous]] adenosine has been used for the treatment of [[PSVT]] in [[neonate]]s, [[infant]]s, children and [[adolescent]]s.
|useInGeri=Clinical studies of adenosine did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between elderly and younger patients. In general, adenosine in [[geriatric]] patients should be used with caution since this population may have a diminished cardiac function, nodal dysfunction, concomitant diseases or drug therapy that may alter [[hemodynamic]] function and produce severe [[bradycardia]] or [[AV block]].
|useInGender=There is no FDA guidance on use of Adenosine with respect to specific gender.
|useInRace=There is no FDA guidance on use of Adenosine with respect to specific racial populations.
|useInRenalImpair=There is no FDA guidance on use of Adenosine in patients with renal impairment.
|useInHepaticImpair=There is no FDA guidance on use of Adenosine in patients with hepatic impairment.
|useInReproPotential=There is no FDA guidance on use of Adenosine in females of reproductive potential and males.
|useInImmunocomp=There is no FDA guidance on use of Adenosine in patients who are immunocompromised.
|othersTitle=Others
|useInOthers=(Description)
|administration=For rapid bolus [[intravenous]] use only.


Adenosine [[injection]] should be given as a rapid bolus by the peripheral [[intravenous]] route. To be certain the solution reaches the [[systemic circulation]], it should be administered either directly into a [[vein]] or, if given into an [[IV]] line, it should be given as close to the patient as possible and followed by a rapid saline flush.


*'''Adult Patients'''


The dose recommendation is based on clinical studies with peripheral venous bolus dosing. Central venous ([[CVP]] or other) administration of adenosine has not been systematically studied.
=====Endocrine=====


Initial dose is given as a rapid [[intravenous]] bolus (administered over a 1 to 2 second period). If the first dose does not result in elimination of the [[supraventricular tachycardia]] within 1 to 2 minutes, 12 mg should be given as a rapid [[intravenous]] bolus. This 12 mg dose may be repeated a second time if required.


*'''Pediatric Patients'''


The dosages used in neonates, infants, children and adolescents were equivalent to those administered to adults on a weight basis. For pediatric patients with a body weight < 50 kg, an initial dose of 0.05 to 0.1 mg/kg as a rapid IV bolus is given either centrally or peripherally. A saline flush should follow. If conversion of [[PSVT]] does not occur within 1 to 2 minutes, additional bolus injections of adenosine can be administered at incrementally higher doses, increasing the amount given by 0.05 to 0.1 mg/kg. Follow each bolus with a saline flush. This process should continue until sinus rhythm is established or a maximum single dose of 0.3 mg/kg is used. For [[pediatric]] patients with a body weight ≥ 50 kg, administer the adult dose.


Doses greater than 12 mg are not recommended for adult and pediatric patients.
=====Hematologic and Lymphatic=====


'''NOTE''': [[Parenteral]] drug products should be inspected visually for particulate matter and discoloration prior to administration.
|monitoring======[[Heart Block]]=====


*Adenosine [[injection]] exerts its effect by decreasing conduction through the [[AV node|A-V node]] and may produce a short lasting [[first degree AV block|first]]-, [[second degree AV block|second]]- or [[third degree AV block|third-degree heart block]]. Appropriate therapy should be instituted as needed. Patients who develop high-level block on one dose of adenosine should not be given additional doses. Because of the very short [[half-life]] of adenosine, these effects are generally self-limiting. Appropriate [[resuscitation|resuscitative]] measures should be available.
*Transient or prolonged episodes of [[asystole]] have been reported with fatal outcomes in some cases. Rarely, [[ventricular fibrillation]] has been reported following adenosine administration, including both [[resuscitation|resuscitated]] and fatal events. In most instances, these cases were associated with the concomitant use of [[digoxin]] and, less frequently with [[digoxin]] and [[verapamil]]. Although no causal relationship or drug-drug interaction has been established, adenosine should be used with caution in patients receiving [[digoxin]] or [[digoxin]] and [[verapamil]] in combination.


=====[[Arrhythmia]]s at Time of Conversion=====


*At the time of conversion to normal [[sinus rhythm]], a variety of new rhythms may appear on the [[electrocardiogram]]. They generally last only a few seconds without intervention, and may take the form of [[premature ventricular contraction]]s, [[atrial premature contraction]]s, [[atrial fibrillation]], [[sinus bradycardia]], [[sinus tachycardia]], skipped beats, and varying degrees of [[AV block|A-V nodal block]]. Such findings were seen in 55% of patients.
=====Metabolic and Nutritional=====


=====[[Bronchoconstriction]]=====


*Adenosine is a [[respiratory stimulant]] (probably through activation of [[carotid body]] [[chemoreceptor]]s) and [[intravenous]] administration in man has been shown to increase [[minute ventilation]] (Ve) and reduce arterial PCO2 causing [[respiratory alkalosis]].
 
*Adenosine administered by [[inhalation]] has been reported to cause [[bronchoconstriction]] in [[asthma]]tic patients, presumably due to [[mast cell]] [[degranulation]] and [[histamine]] release. These effects have not been observed in normal subjects. Adenosine has been administered to a limited number of patients with [[asthma]] and mild to moderate exacerbation of their symptoms has been reported. [[Respiratory]] compromise has occurred during adenosine infusion in patients with [[obstructive pulmonary disease]]. Adenosine should be used with caution in patients with [[obstructive lung disease]] not associated with [[bronchoconstriction]] (e.g., [[emphysema]], [[bronchitis]], etc.) and should be avoided in patients with [[bronchoconstriction]] or [[bronchospasm]] (e.g., [[asthma]]). Adenosine should be discontinued in any patient who develops severe [[respiratory]] difficulties.
 
|IVCompat=There is limited information about the compatibility of Adenosine and IV administrations.
=====Musculoskeletal=====
|overdose====Acute Overdose===
 
The [[half-life]] of adenosine [[injection]] is less than 10 seconds. Thus, [[adverse effect]]s are generally rapidly self-limiting.
 
 
 
=====Neurologic=====
 
 
 
 
=====Respiratory=====
 
 
 
 
=====Skin and Hypersensitivy Reactions=====
 
 
 
 
 
=====Special Senses=====
 
 
 
 
 
=====Urogenital=====
 
 
 
 
=====Miscellaneous=====
 
 
 
<!--Postmarketing Experience-->
 
|postmarketing=
 
There is limited information regarding <i>Postmarketing Experience</i> of {{PAGENAME}} in the drug label.
 
=====Body as a Whole=====
 
 
 
=====Cardiovascular=====
 
 
 
=====Digestive=====
 
 
 
=====Endocrine=====
 
 
 
=====Hematologic and Lymphatic=====
 
 
 
=====Metabolic and Nutritional=====
 
 
 
=====Musculoskeletal=====
 
 
 
=====Neurologic=====
 
 
 
=====Respiratory=====
 
 
 
=====Skin and Hypersensitivy Reactions=====
 
 
 
=====Special Senses=====
 
 
 
=====Urogenital=====
 
 
 
=====Miscellaneous=====
 
 
 
<!--Drug Interactions-->
 
|drugInteractions=
 
* Drug
:* Description
 
<!--Use in Specific Populations-->
 
|useInPregnancyFDA=
* '''Pregnancy Category'''
 
|useInPregnancyAUS=
* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''
 
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
 
|useInLaborDelivery=
There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
 
|useInNursing=
There is no FDA guidance on the use of {{PAGENAME}} with respect to nursing mothers.
 
|useInPed=
There is no FDA guidance on the use of {{PAGENAME}} with respect to pediatric patients.
 
|useInGeri=
There is no FDA guidance on the use of {{PAGENAME}} with respect to geriatric patients.
 
|useInGender=
There is no FDA guidance on the use of {{PAGENAME}} with respect to specific gender populations.
 
|useInRace=
There is no FDA guidance on the use of {{PAGENAME}} with respect to specific racial populations.
 
|useInRenalImpair=
There is no FDA guidance on the use of {{PAGENAME}} in patients with renal impairment.
 
|useInHepaticImpair=
There is no FDA guidance on the use of {{PAGENAME}} in patients with hepatic impairment.
 
|useInReproPotential=
There is no FDA guidance on the use of {{PAGENAME}} in women of reproductive potentials and males.
 
|useInImmunocomp=
There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.
 
<!--Administration and Monitoring-->
 
|administration=
 
* Oral
 
* Intravenous
 
|monitoring=
 
There is limited information regarding <i>Monitoring</i> of {{PAGENAME}} in the drug label.
 
=====Condition1=====
 
* Description
 
<!--IV Compatibility-->
 
|IVCompat=
 
There is limited information regarding <i>IV Compatibility</i> of {{PAGENAME}} in the drug label.
 
<!--Overdosage-->
 
|overdose=
 
===Acute Overdose===
 
====Signs and Symptoms====
 
* Description
 
====Management====
====Management====
Treatment of any prolonged [[adverse effect]]s should be individualized and be directed toward the specific effect. [[Methylxanthine]]s, such as [[caffeine]] and [[theophylline]], are [[competitive antagonist]]s of adenosine. If you suspect drug poisoning or overdose, please contact the National Poison Help hotline (1-800-222-1222) immediately.
|drugBox={{Drugbox2
| verifiedrevid =
| IUPAC_name =
| image =
| drug_name =


<!--Clinical data-->
* Description
| tradename =  
 
| MedlinePlus =  
===Chronic Overdose===
| licence_US =  
 
| pregnancy_AU =  
There is limited information regarding <i>Chronic Overdose</i> of {{PAGENAME}} in the drug label.
| pregnancy_US =  
 
| legal_status =  
<!--Pharmacology-->
| routes_of_administration =
 
<!--Drugbox2-->
 
|drugBox=
 
 
 
<!--Mechanism of Action-->
 
|mechAction=
 
*
 
<!--Structure-->
 
|structure=
 
*
 
: [[File:{{PAGENAME}}01.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
 
<!--Pharmacodynamics-->
 
|PD=
 
There is limited information regarding <i>Pharmacodynamics</i> of {{PAGENAME}} in the drug label.
 
<!--Pharmacokinetics-->
 
|PK=
 
There is limited information regarding <i>Pharmacokinetics</i> of {{PAGENAME}} in the drug label.
 
<!--Nonclinical Toxicology-->
 
|nonClinToxic=
 
There is limited information regarding <i>Nonclinical Toxicology</i> of {{PAGENAME}} in the drug label.
 
<!--Clinical Studies-->
 
|clinicalStudies=
 
There is limited information regarding <i>Clinical Studies</i> of {{PAGENAME}} in the drug label.
 
=====Condition1=====
 
* Description
 
<!--How Supplied-->
 
|howSupplied=
 
*
 
<!--Patient Counseling Information-->


<!--Pharmacokinetic data-->
|fdaPatientInfo=
| bioavailability =
| metabolism =
| elimination_half-life =
| excretion =  


<!--Identifiers-->
There is limited information regarding <i>Patient Counseling Information</i> of {{PAGENAME}} in the drug label.
| CAS_number_Ref =
| CAS_number =
| ATC_prefix =
| ATC_suffix =
| PubChem =
| IUPHAR_ligand =
| DrugBank_Ref =
| DrugBank =
| ChemSpiderID_Ref =
| ChemSpiderID =
| UNII_Ref =
| UNII =
| KEGG_Ref =
| KEGG =
| ChEBI_Ref =
| ChEBI =
| ChEMBL_Ref =
| ChEMBL =


<!--Chemical data-->
<!--Precautions with Alcohol-->
| C= | H= | N= | O=  
 
| molecular_weight =  
|alcohol=
| smiles =
 
| InChI =  
* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
| InChIKey =  
 
| StdInChI_Ref =  
<!--Brand Names-->
| StdInChI =  
 
| StdInChIKey_Ref =  
|brandNames=
| StdInChIKey =  
 
| melting_point =  
* ®<ref>{{Cite web | title = | url = }}</ref>
}}
 
|mechAction=Adenosine slows conduction time through the [[AV node|A-V node]], can interrupt the reentry pathways through the [[AV node|A-V node]], and can restore normal [[sinus rhythm]] in patients with [[paroxysmal supraventricular tachycardia]] ([[PSVT]]), including [[PSVT]] associated with [[WPW syndrome|Wolff-Parkinson-White Syndrome]].
<!--Look-Alike Drug Names-->
 
|lookAlike=
 
* A® — B®<ref name="www.ismp.org">{{Cite web  | last = | first = | title = http://www.ismp.org | url = http://www.ismp.org | publisher = | date = }}</ref>


Adenosine is [[competitive antagonist|antagonized competitively]] by [[methylxanthine]]s such as [[caffeine]] and [[theophylline]], and potentiated by blockers of [[nucleoside]] transport such as [[dipyridamole]]. Adenosine is not blocked by [[atropine]].
<!--Drug Shortage Status-->
|structure=(Description with picture)
|PD=(Description)
|PK=[[Intravenous]]ly administered adenosine is rapidly cleared from the circulation via cellular uptake, primarily by [[erythrocyte]]s and vascular [[endothelial cell]]s. This process involves a specific [[transmembrane]] [[nucleoside]] carrier system that is reversible, nonconcentrative, and bidirectionally symmetrical. [[Intracellular]] adenosine is rapidly metabolized either via phosphorylation to [[adenosine monophosphate]] by [[adenosine kinase]], or via [[deamination]] to [[inosine]] by [[adenosine deaminase]] in the [[cytosol]]. Since [[adenosine kinase]] has a lower Km and Vmax than [[adenosine deaminase]], [[deamination]] plays a significant role only when [[cytosol]]ic adenosine saturates the [[phosphorylation]] pathway. [[Inosine]] formed by [[deamination]] of adenosine can leave the cell intact or can be degraded to [[hypoxanthine]], [[xanthine]], and ultimately [[uric acid]]. [[Adenosine monophosphate]] formed by [[phosphorylation]] of adenosine is incorporated into the high-energy [[phosphate]] pool. While [[extracellular]] adenosine is primarily cleared by cellular uptake with a [[half-life]] of less than 10 seconds in whole blood, excessive amounts may be [[deamination|deaminated]] by an ecto-form of [[adenosine deaminase]]. As adenosine requires no [[hepatic]] or [[renal]] function for its activation or inactivation, [[hepatic]] and [[renal]] failure would not be expected to alter its effectiveness or tolerability.
|nonClinToxic=Studies in animals have not been performed to evaluate the [[carcinogenic]] potential of adenosine. Adenosine was negative for [[genotoxic]] potential in the [[Salmonella]] ([[Ames test|Ames Test]]) and Mammalian [[Microsome]] [[Assay]].


Adenosine, however, like other [[nucleoside]]s at millimolar concentrations present for several doubling times of cells in [[culture]], is known to produce a variety of [[chromosomal]] alterations. [[Fertility]] studies in animals have not been conducted with adenosine.
|drugShortage=
|clinicalStudies======Paroxysmal Supraventricular Tachycardia=====
}}
In controlled studies in the United States, bolus doses of 3, 6, 9, and 12 mg were studied. A cumulative 60% of patients with [[paroxysmal supraventricular tachycardia]] had converted to normal [[sinus rhythm]] within one minute after an [[intravenous]] bolus dose of 6 mg Adenosine (some converted on 3 mg and failures were given 6 mg), and a cumulative 92% converted after a bolus dose of 12 mg. Seven to sixteen percent of patients converted after 1-4 placebo bolus [[injection]]s. Similar responses were seen in a variety of patient subsets, including those using or not using [[digoxin]], those with [[WPW syndrome|Wolff-Parkinson-White Syndrome]], males, females, blacks, Caucasians, and Hispanics.


Adenosine is not effective in converting rhythms other than [[PSVT]], such as [[atrial flutter]], [[atrial fibrillation]], or [[ventricular tachycardia]], to normal [[sinus rhythm]].
<!--Pill Image-->
|howSupplied=Adenosine [[injection]] is supplied as a [[sterile]], nonpyrogenic solution in [[normal saline]].


'''NDC 10019-063-03 6 mg/2 mL''' (3 mg/mL) in 2 mL flip-top vials, packaged in shelf packs of ten.
{{PillImage
|fileName=No image.jpg|This image is provided by the National Library of Medicine.
|drugName=
|NDC=
|drugAuthor=
|ingredients=
|pillImprint=
|dosageValue=
|dosageUnit=
|pillColor=
|pillShape=
|pillSize=
|pillScore=
}}


'''NDC 10019-063-08 6 mg/2 mL''' (3 mg/mL) in a 2 mL disposable glass [[syringe]], packaged in shelf packs of ten.
<!--Label Display Image-->
|storage='''Store at 20°-25°C (68°-77°F), excursions permitted to 15°-30°C (59°-86°F). [See USP Controlled Room Temperature.]'''


'''DO NOT REFRIGERATE''' as [[crystallization]] may occur. If crystallization has occurred, dissolve crystals by warming to room temperature. The solution must be clear at the time of use.
{{LabelImage
|fileName={{PAGENAME}}11.png|This image is provided by the National Library of Medicine.
}}


Contains no preservatives. Discard unused portion.
{{LabelImage
|fdaPatientInfo=(Patient Counseling Information)
|fileName={{PAGENAME}}11.png|This image is provided by the National Library of Medicine.
|nlmPatientInfo=(Link to patient information page)
|alcohol=Alcohol-Adenosine interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
|lookAlike=* (Paired Confused Name 1a) — (Paired Confused Name 1b)
* (Paired Confused Name 2a) — (Paired Confused Name 2b)
* (Paired Confused Name 3a) — (Paired Confused Name 3b)
}}
}}


|fileName=}}
<!--Category-->
|fileName=}}
 
|fileName=}}
[[Category:Cardiovascular Drugs]]
|fileName=}}
[[Category:Drug]]
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}
|fileName=}}

Revision as of 20:05, 10 July 2014

Adenosine
Black Box Warning
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Gerald Chi

Disclaimer

WikiDoc MAKES NO GUARANTEE OF VALIDITY. WikiDoc is not a professional health care provider, nor is it a suitable replacement for a licensed healthcare provider. WikiDoc is intended to be an educational tool, not a tool for any form of healthcare delivery. The educational content on WikiDoc drug pages is based upon the FDA package insert, National Library of Medicine content and practice guidelines / consensus statements. WikiDoc does not promote the administration of any medication or device that is not consistent with its labeling. Please read our full disclaimer here.

Black Box Warning

Title
See full prescribing information for complete Boxed Warning.
ConditionName:
  • Content

Overview

Adenosine is a that is FDA approved for the {{{indicationType}}} of . There is a Black Box Warning for this drug as shown here. Common adverse reactions include .

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Condition1
  • Dosing Information
  • Dosage
Condition2
  • Dosing Information
  • Dosage
Condition3
  • Dosing Information
  • Dosage
Condition4
  • Dosing Information
  • Dosage

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

Condition1
  • Developed by:
  • Class of Recommendation:
  • Strength of Evidence:
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Guideline-Supported Use of Adenosine in adult patients.

Non–Guideline-Supported Use

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Non–Guideline-Supported Use of Adenosine in adult patients.

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding FDA-Labeled Use of Adenosine in pediatric patients.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

Condition1
  • Developed by:
  • Class of Recommendation:
  • Strength of Evidence:
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Guideline-Supported Use of Adenosine in pediatric patients.

Non–Guideline-Supported Use

Condition1
  • Dosing Information
  • Dosage
Condition2

There is limited information regarding Off-Label Non–Guideline-Supported Use of Adenosine in pediatric patients.

Contraindications

  • Condition1

Warnings

Title
See full prescribing information for complete Boxed Warning.
ConditionName:
  • Content
  • Description

Precautions

  • Description

Adverse Reactions

Clinical Trials Experience

There is limited information regarding Clinical Trial Experience of Adenosine in the drug label.

Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous

Postmarketing Experience

There is limited information regarding Postmarketing Experience of Adenosine in the drug label.

Body as a Whole
Cardiovascular
Digestive
Endocrine
Hematologic and Lymphatic
Metabolic and Nutritional
Musculoskeletal
Neurologic
Respiratory
Skin and Hypersensitivy Reactions
Special Senses
Urogenital
Miscellaneous

Drug Interactions

  • Drug
  • Description

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA):

  • Pregnancy Category


Pregnancy Category (AUS):

  • Australian Drug Evaluation Committee (ADEC) Pregnancy Category

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Adenosine in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Adenosine during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Adenosine with respect to nursing mothers.

Pediatric Use

There is no FDA guidance on the use of Adenosine with respect to pediatric patients.

Geriatic Use

There is no FDA guidance on the use of Adenosine with respect to geriatric patients.

Gender

There is no FDA guidance on the use of Adenosine with respect to specific gender populations.

Race

There is no FDA guidance on the use of Adenosine with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Adenosine in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Adenosine in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Adenosine in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Adenosine in patients who are immunocompromised.

Administration and Monitoring

Administration

  • Oral
  • Intravenous

Monitoring

There is limited information regarding Monitoring of Adenosine in the drug label.

Condition1
  • Description

IV Compatibility

There is limited information regarding IV Compatibility of Adenosine in the drug label.

Overdosage

Acute Overdose

Signs and Symptoms

  • Description

Management

  • Description

Chronic Overdose

There is limited information regarding Chronic Overdose of Adenosine in the drug label.

Pharmacology

There is limited information regarding Adenosine Pharmacology in the drug label.

Mechanism of Action

Structure

This image is provided by the National Library of Medicine.

Pharmacodynamics

There is limited information regarding Pharmacodynamics of Adenosine in the drug label.

Pharmacokinetics

There is limited information regarding Pharmacokinetics of Adenosine in the drug label.

Nonclinical Toxicology

There is limited information regarding Nonclinical Toxicology of Adenosine in the drug label.

Clinical Studies

There is limited information regarding Clinical Studies of Adenosine in the drug label.

Condition1
  • Description

How Supplied

Storage

There is limited information regarding Adenosine Storage in the drug label.

Images

Drug Images

{{#ask: Page Name::Adenosine |?Pill Name |?Drug Name |?Pill Ingred |?Pill Imprint |?Pill Dosage |?Pill Color |?Pill Shape |?Pill Size (mm) |?Pill Scoring |?NDC |?Drug Author |format=template |template=DrugPageImages |mainlabel=- |sort=Pill Name }}

Package and Label Display Panel

{{#ask: Label Page::Adenosine |?Label Name |format=template |template=DrugLabelImages |mainlabel=- |sort=Label Page }}

Patient Counseling Information

There is limited information regarding Patient Counseling Information of Adenosine in the drug label.

Precautions with Alcohol

  • Alcohol-Adenosine interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

Look-Alike Drug Names

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

  1. ↑ Empty citation (help)
  2. ↑ "http://www.ismp.org". External link in |title= (help)


{{#subobject: 

 |Page Name=Adenosine
 |Pill Name=No image.jpg
 |Drug Name=
 |Pill Ingred=|+sep=;
 |Pill Imprint=
 |Pill Dosage=
 |Pill Color=|+sep=;
 |Pill Shape=
 |Pill Size (mm)=
 |Pill Scoring=
 |Pill Image=
 |Drug Author=
 |NDC=

}}


{{#subobject: 

 |Label Page=Adenosine
 |Label Name=Adenosine11.png

}}


{{#subobject: 

 |Label Page=Adenosine
 |Label Name=Adenosine11.png

}}

Retrieved from "https://www.wikidoc.org/index.php?title=Adenosine&oldid=991510"