治療陣發性上心室心搏過速。 輔助診斷QRS波變寬或變窄之複雜性上心室心搏過速。

Antiarrhythmic Agent, Miscellaneous; Diagnostic Agent

Onset of action: Rapid.
Duration: Very brief.
Metabolism: phosphorylated by adenosine kinase to adenosine monophosphate (AMP) which is then incorporated into high-energy pool; intracellular adenosine is also deaminated by adenosine deaminase to inosine; inosine can be metabolized to hypoxanthine, then xanthine and finally to uric acid.
Half-life elimination: <10 seconds.

Hypersensitivity to adenosine or any component of the formulation; second- or third-degree AV block, sick sinus syndrome, or symptomatic bradycardia; known or suspected bronchoconstrictive or bronchospastic lung disease, asthma; severe hypotension.

C; Adenosine is recommended for the acute treatment of SVT in pregnant women.

Adenosine is endogenous in breast milk.

>10%: cardiac arrhythmia (55%), chest pressure (7% to 40%), headache (2% to 18%), dizziness (≤12%), facial flushing (18% to 44%), gastrointestinal distress (13%), neck discomfort (<1% to 15%), dyspnea (12% to 28%).
1% to 10%: atrioventricular block, depression of ST segment on ECG (3%), hypotension (<1% to 2%), chest pain, palpitations, nervousness (2%), paresthesia (≤2%), numbness (1%), apprehension, diaphoresis, nausea (3%), upper extremity discomfort (≤4%), hyperventilation.

1. Paroxysmal supraventricular tachycardia, Tachyarrhythmia, diagnostic aid in hemodynamically stable patients (off-label use) :
IV: Initial: 6 mg over 1 to 2 seconds via a peripheral line, followed immediately by an NS flush; if initial dose does not terminate the arrhythmia or cause AV block within 1 to 2 minutes, administer a second dose of 12 mg using the same procedures; if second dose does not terminate the arrhythmia or cause AV block, may administer a third dose of 12 or 18 mg using the same procedures.
Central line administration: Initial dose should be reduced to 3 mg with subsequent doses of 6 mg, then 9 mg, if needed.
Heart transplant patients: Initial dose should be reduced to 1 mg; may increase subsequent doses up to 3 mg, if needed.
2. Pharmacologic cardiac stress testing, diagnostic aid: Continuous infusion: IV (via peripheral line): 140 mcg/kg/minute for 6 minutes using syringe or volumetric infusion pump; total dose: 840 mcg/kg. Thallium-201 is injected at midpoint (3 minutes) of adenosine infusion.
3. Fractional flow reserve testing, diagnostic aid (off- label use) :
Continuous infusion: IV (via peripheral line): 140 mcg/kg/minute during testing.
Intracoronary: 40 mcg into the right coronary artery or 80 mcg into the left coronary artery; dilute dose in 10 mL of NS and administer rapidly through the guiding catheter.

Supraventricular tachycardia:
1. Hemodynamically unstable: Infants, Children, and Adolescents: Rapid IV, Intraosseous: Initial: 0.1 mg/kg (maximum initial dose: 6 mg/dose); if not effective, increase to 0.2 mg/kg (maximum dose: 12 mg/dose).
2. Hemodynamically stable:
Infants, Children, and Adolescents <50 kg: Rapid IV: Initial dose: 0.05 to 0.1 mg/kg via peripheral or central line; maximum initial dose: 6 mg/dose; if not effective within 1 to 2 minutes, increase dose by 0.05 to 0.1 mg/kg increments every 1 to 2 minutes to a maximum single dose of 0.3 mg/kg or 12 mg (whichever is less).
Children and Adolescents ≥50 kg: Rapid IV: Initial: 6 mg via peripheral line, if not effective within 1 to 2 minutes, 12 mg may be given; may repeat 12 mg bolus if needed; follow each bolus with NS flush.