U.S. BRAND NAMES — Adenocard®; Adenoscan®
CANADIAN BRAND NAMES — Adenocard®; Adenoscan®; Adenosine Injection, USP
SYNONYMS — 9-Beta-D-ribofuranosyladenine
THERAPEUTIC CATEGORY Antiarrhythmic Agent, Miscellaneous
DOSING — Note: Adequate controlled studies in pediatric patients have not been conducted.
(For additional information see "Adenosine: Drug information")
Manufacturer's recommendations: Rapid I.V.: Neonates, Infants, Children, and Adolescents weighing <50 kg: Initial dose: 0.05-0.1 mg/kg; if not effective within 1-2 minutes, increase dose by 0.05-0.1 mg/kg increments every 1-2 minutes to a maximum single dose of 0.3 mg/kg or until termination of PSVT Children and Adolescents weighing 50 kg and Adults: 6 mg, if not effective within 1-2 minutes, 12 mg may be given; may repeat 12 mg bolus if needed
Alternative pediatric dosing: Neonates: Rapid I.V.: Initial dose: 0.05 mg/kg; if not effective within 2 minutes, increase dose by 0.05 mg/kg increments every 2 minutes to a maximum dose of 0.25 mg/kg or until termination of PSVT Infants and Children: PALS dose for treatment of SVT: Rapid I.V.; I.O.: Initial: 0.1 mg/kg (maximum: 6 mg); if not effective, give 0.2 mg/kg (maximum: 12 mg)
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injection, solution [preservative free]: 3 mg/mL (2 mL, 4 mL) Adenocard®: 3 mg/mL (2 mL, 4 mL) Adenoscan®: 3 mg/mL (20 mL, 30 mL)
GENERIC AVAILABLE — Yes
ADMINISTRATION — Parenteral: For rapid bolus I.V. use, administer over 1-2 seconds at peripheral I.V. site closest to patient's heart (I.V. administration into lower extremities may result in therapeutic failure or requirement of higher doses); follow each bolus with NS flush (infants and children: 5-10 mL; adults: 20 mL); if given peripherally in adults, elevate the extremity for 10-20 seconds after the NS flush. To administer doses <600 mcg (0.2 mL of commercial product), a dilution with NS (final concentration: 300 mcg/mL) may be made. Note: Preliminary results in adults suggest adenosine may be administered via a central line at lower doses (eg, Adults: Initial dose: 3 mg); FDA approved labeling for pediatric patients weighing <50 kg states that doses listed may be administered either peripherally or centrally (further studies are needed)
USE — Treatment of paroxysmal supraventricular tachycardia (PSVT); used in adult ACLS algorithms for narrow-complex tachycardias, stable narrow-complex supraventricular tachycardias, and wide-complex tachycardias that are supraventricular in origin; used in PALS algorithms for probable supraventricular tachycardia; investigationally used as a continuous infusion for the treatment of primary pulmonary hypertension in adults and persistent pulmonary hypertension of the newborn (PPHN) (see Additional Information)
ADVERSE REACTIONS Cardiovascular: Flushing, arrhythmias, palpitations, chest pain, bradycardia, heart block, minimal hemodynamic disturbances, hypotension (<1%)
Central nervous system: Irritability, headaches, lightheadedness, dizziness
Gastrointestinal: Nausea, metallic taste
Respiratory: Dyspnea, hyperventilation, bronchoconstriction in asthmatics
CONTRAINDICATIONS — Hypersensitivity to adenosine or any component; second and third degree A-V block or sick sinus syndrome unless pacemaker placed
PRECAUTIONS — Bronchoconstriction may occur in asthmatics (avoid use in patients with bronchospasm or bronchoconstriction); use with caution in patients with underlying dysfunction of sinus or A-V node, obstructive lung disease, and those taking digoxin or verapamil; initial adenosine dose should be significantly decreased in patients receiving dipyridamole
WARNINGS — Heart block, including transient or prolonged asystole may occur as well as other arrhythmias; episodes of asystole or other arrhythmias may be fatal; if arrhythmia is not due to re-entry pathway through A-V node or sinus node (ie, atrial fibrillation, flutter, or tachycardia or ventricular tachycardia), adenosine will not terminate the arrhythmia but can produce transient ventriculoatrial or A-V block; possible mutagenic effects
DRUG INTERACTIONS — Dipyridamole potentiates effects of adenosine (dose of adenosine should be significantly reduced); methylxanthines (aminophylline, theophylline, caffeine) antagonize adenosine's effects so that larger doses of adenosine or an alternative agent may be required; carbamazepine may increase heart block; digoxin and verapamil may cause ventricular fibrillation (rare cases reported)
PREGNANCY RISK FACTOR — C (show table)
MONITORING PARAMETERS — Continuous EKG, heart rate, blood pressure, respirations
STABILITY — Do not refrigerate, precipitation may occur; contains no preservatives, discard unused portion
MECHANISM OF ACTION — Slows conduction time through the A-V node, interrupting the re-entry pathways through the A-V node, restoring normal sinus rhythm
PHARMACODYNAMICS Onset of action: Rapid
Duration: Very brief
PHARMACOKINETICS Metabolism: Removed from systemic circulation primarily by vascular endothelial cells and erythrocytes (by cellular uptake); rapidly metabolized intracellularly; 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: <10 seconds
NURSING IMPLICATIONS — Be alert for dyspnea, shortness of breath, and possible exacerbation of asthma
ADDITIONAL INFORMATION — Not effective in atrial flutter, atrial fibrillation, or ventricular tachycardia; short duration of action is an advantage as adverse effects are usually rapidly self-limiting; effects may be prolonged in patients with denervated transplanted hearts. Individualize treatment of prolonged adverse effects: Give I.V. fluids for hypotension, aminophylline/theophylline may antagonize effects.
Limited information is available regarding the use of adenosine for the treatment of persistent pulmonary hypertension of the newborn (PPHN); efficacy, optimal dose, and duration of therapy is not established; a randomized, masked, placebo-controlled pilot study of 18 term infants with PPHN used initial doses of 25 mcg/kg/minute (n=9); after 30 minutes, doses were increased to 50 mcg/kg/minute if no improvement in PaO2 was observed; all patients received study drug via central line into the right atrium (inserted via the umbilical vein); significant improvement in oxygenation was observed in 4 of 9 newborns receiving 50 mcg/kg/minute; hypotension or tachycardia were not observed; further studies are needed (Kondur, 1996).
Adenosine is also available as Adenoscan®, which is used in adults as an adjunct to thallium-201 myocardial perfusion scintigraphy; see package insert for further information on this use.
Showing posts with label Adenoscan. Show all posts
Showing posts with label Adenoscan. Show all posts
Thursday, January 31, 2008
Adenosine
U.S. BRAND NAMES — Adenocard®; Adenoscan®
CANADIAN BRAND NAMES — Adenocard®; Adenoscan®; Adenosine Injection, USP
SYNONYMS — 9-Beta-D-ribofuranosyladenine
THERAPEUTIC CATEGORY Antiarrhythmic Agent, Miscellaneous
DOSING — Note: Adequate controlled studies in pediatric patients have not been conducted.
(For additional information see "Adenosine: Drug information")
Manufacturer's recommendations: Rapid I.V.: Neonates, Infants, Children, and Adolescents weighing <50 kg: Initial dose: 0.05-0.1 mg/kg; if not effective within 1-2 minutes, increase dose by 0.05-0.1 mg/kg increments every 1-2 minutes to a maximum single dose of 0.3 mg/kg or until termination of PSVT Children and Adolescents weighing 50 kg and Adults: 6 mg, if not effective within 1-2 minutes, 12 mg may be given; may repeat 12 mg bolus if needed
Alternative pediatric dosing: Neonates: Rapid I.V.: Initial dose: 0.05 mg/kg; if not effective within 2 minutes, increase dose by 0.05 mg/kg increments every 2 minutes to a maximum dose of 0.25 mg/kg or until termination of PSVT Infants and Children: PALS dose for treatment of SVT: Rapid I.V.; I.O.: Initial: 0.1 mg/kg (maximum: 6 mg); if not effective, give 0.2 mg/kg (maximum: 12 mg)
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injection, solution [preservative free]: 3 mg/mL (2 mL, 4 mL) Adenocard®: 3 mg/mL (2 mL, 4 mL) Adenoscan®: 3 mg/mL (20 mL, 30 mL)
GENERIC AVAILABLE — Yes
ADMINISTRATION — Parenteral: For rapid bolus I.V. use, administer over 1-2 seconds at peripheral I.V. site closest to patient's heart (I.V. administration into lower extremities may result in therapeutic failure or requirement of higher doses); follow each bolus with NS flush (infants and children: 5-10 mL; adults: 20 mL); if given peripherally in adults, elevate the extremity for 10-20 seconds after the NS flush. To administer doses <600 mcg (0.2 mL of commercial product), a dilution with NS (final concentration: 300 mcg/mL) may be made. Note: Preliminary results in adults suggest adenosine may be administered via a central line at lower doses (eg, Adults: Initial dose: 3 mg); FDA approved labeling for pediatric patients weighing <50 kg states that doses listed may be administered either peripherally or centrally (further studies are needed)
USE — Treatment of paroxysmal supraventricular tachycardia (PSVT); used in adult ACLS algorithms for narrow-complex tachycardias, stable narrow-complex supraventricular tachycardias, and wide-complex tachycardias that are supraventricular in origin; used in PALS algorithms for probable supraventricular tachycardia; investigationally used as a continuous infusion for the treatment of primary pulmonary hypertension in adults and persistent pulmonary hypertension of the newborn (PPHN) (see Additional Information)
ADVERSE REACTIONS Cardiovascular: Flushing, arrhythmias, palpitations, chest pain, bradycardia, heart block, minimal hemodynamic disturbances, hypotension (<1%)
Central nervous system: Irritability, headaches, lightheadedness, dizziness
Gastrointestinal: Nausea, metallic taste
Respiratory: Dyspnea, hyperventilation, bronchoconstriction in asthmatics
CONTRAINDICATIONS — Hypersensitivity to adenosine or any component; second and third degree A-V block or sick sinus syndrome unless pacemaker placed
PRECAUTIONS — Bronchoconstriction may occur in asthmatics (avoid use in patients with bronchospasm or bronchoconstriction); use with caution in patients with underlying dysfunction of sinus or A-V node, obstructive lung disease, and those taking digoxin or verapamil; initial adenosine dose should be significantly decreased in patients receiving dipyridamole
WARNINGS — Heart block, including transient or prolonged asystole may occur as well as other arrhythmias; episodes of asystole or other arrhythmias may be fatal; if arrhythmia is not due to re-entry pathway through A-V node or sinus node (ie, atrial fibrillation, flutter, or tachycardia or ventricular tachycardia), adenosine will not terminate the arrhythmia but can produce transient ventriculoatrial or A-V block; possible mutagenic effects
DRUG INTERACTIONS — Dipyridamole potentiates effects of adenosine (dose of adenosine should be significantly reduced); methylxanthines (aminophylline, theophylline, caffeine) antagonize adenosine's effects so that larger doses of adenosine or an alternative agent may be required; carbamazepine may increase heart block; digoxin and verapamil may cause ventricular fibrillation (rare cases reported)
PREGNANCY RISK FACTOR — C (show table)
MONITORING PARAMETERS — Continuous EKG, heart rate, blood pressure, respirations
STABILITY — Do not refrigerate, precipitation may occur; contains no preservatives, discard unused portion
MECHANISM OF ACTION — Slows conduction time through the A-V node, interrupting the re-entry pathways through the A-V node, restoring normal sinus rhythm
PHARMACODYNAMICS Onset of action: Rapid
Duration: Very brief
PHARMACOKINETICS Metabolism: Removed from systemic circulation primarily by vascular endothelial cells and erythrocytes (by cellular uptake); rapidly metabolized intracellularly; 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: <10 seconds
NURSING IMPLICATIONS — Be alert for dyspnea, shortness of breath, and possible exacerbation of asthma
ADDITIONAL INFORMATION — Not effective in atrial flutter, atrial fibrillation, or ventricular tachycardia; short duration of action is an advantage as adverse effects are usually rapidly self-limiting; effects may be prolonged in patients with denervated transplanted hearts. Individualize treatment of prolonged adverse effects: Give I.V. fluids for hypotension, aminophylline/theophylline may antagonize effects.
Limited information is available regarding the use of adenosine for the treatment of persistent pulmonary hypertension of the newborn (PPHN); efficacy, optimal dose, and duration of therapy is not established; a randomized, masked, placebo-controlled pilot study of 18 term infants with PPHN used initial doses of 25 mcg/kg/minute (n=9); after 30 minutes, doses were increased to 50 mcg/kg/minute if no improvement in PaO2 was observed; all patients received study drug via central line into the right atrium (inserted via the umbilical vein); significant improvement in oxygenation was observed in 4 of 9 newborns receiving 50 mcg/kg/minute; hypotension or tachycardia were not observed; further studies are needed (Kondur, 1996).
Adenosine is also available as Adenoscan®, which is used in adults as an adjunct to thallium-201 myocardial perfusion scintigraphy; see package insert for further information on this use.
CANADIAN BRAND NAMES — Adenocard®; Adenoscan®; Adenosine Injection, USP
SYNONYMS — 9-Beta-D-ribofuranosyladenine
THERAPEUTIC CATEGORY Antiarrhythmic Agent, Miscellaneous
DOSING — Note: Adequate controlled studies in pediatric patients have not been conducted.
(For additional information see "Adenosine: Drug information")
Manufacturer's recommendations: Rapid I.V.: Neonates, Infants, Children, and Adolescents weighing <50 kg: Initial dose: 0.05-0.1 mg/kg; if not effective within 1-2 minutes, increase dose by 0.05-0.1 mg/kg increments every 1-2 minutes to a maximum single dose of 0.3 mg/kg or until termination of PSVT Children and Adolescents weighing 50 kg and Adults: 6 mg, if not effective within 1-2 minutes, 12 mg may be given; may repeat 12 mg bolus if needed
Alternative pediatric dosing: Neonates: Rapid I.V.: Initial dose: 0.05 mg/kg; if not effective within 2 minutes, increase dose by 0.05 mg/kg increments every 2 minutes to a maximum dose of 0.25 mg/kg or until termination of PSVT Infants and Children: PALS dose for treatment of SVT: Rapid I.V.; I.O.: Initial: 0.1 mg/kg (maximum: 6 mg); if not effective, give 0.2 mg/kg (maximum: 12 mg)
DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injection, solution [preservative free]: 3 mg/mL (2 mL, 4 mL) Adenocard®: 3 mg/mL (2 mL, 4 mL) Adenoscan®: 3 mg/mL (20 mL, 30 mL)
GENERIC AVAILABLE — Yes
ADMINISTRATION — Parenteral: For rapid bolus I.V. use, administer over 1-2 seconds at peripheral I.V. site closest to patient's heart (I.V. administration into lower extremities may result in therapeutic failure or requirement of higher doses); follow each bolus with NS flush (infants and children: 5-10 mL; adults: 20 mL); if given peripherally in adults, elevate the extremity for 10-20 seconds after the NS flush. To administer doses <600 mcg (0.2 mL of commercial product), a dilution with NS (final concentration: 300 mcg/mL) may be made. Note: Preliminary results in adults suggest adenosine may be administered via a central line at lower doses (eg, Adults: Initial dose: 3 mg); FDA approved labeling for pediatric patients weighing <50 kg states that doses listed may be administered either peripherally or centrally (further studies are needed)
USE — Treatment of paroxysmal supraventricular tachycardia (PSVT); used in adult ACLS algorithms for narrow-complex tachycardias, stable narrow-complex supraventricular tachycardias, and wide-complex tachycardias that are supraventricular in origin; used in PALS algorithms for probable supraventricular tachycardia; investigationally used as a continuous infusion for the treatment of primary pulmonary hypertension in adults and persistent pulmonary hypertension of the newborn (PPHN) (see Additional Information)
ADVERSE REACTIONS Cardiovascular: Flushing, arrhythmias, palpitations, chest pain, bradycardia, heart block, minimal hemodynamic disturbances, hypotension (<1%)
Central nervous system: Irritability, headaches, lightheadedness, dizziness
Gastrointestinal: Nausea, metallic taste
Respiratory: Dyspnea, hyperventilation, bronchoconstriction in asthmatics
CONTRAINDICATIONS — Hypersensitivity to adenosine or any component; second and third degree A-V block or sick sinus syndrome unless pacemaker placed
PRECAUTIONS — Bronchoconstriction may occur in asthmatics (avoid use in patients with bronchospasm or bronchoconstriction); use with caution in patients with underlying dysfunction of sinus or A-V node, obstructive lung disease, and those taking digoxin or verapamil; initial adenosine dose should be significantly decreased in patients receiving dipyridamole
WARNINGS — Heart block, including transient or prolonged asystole may occur as well as other arrhythmias; episodes of asystole or other arrhythmias may be fatal; if arrhythmia is not due to re-entry pathway through A-V node or sinus node (ie, atrial fibrillation, flutter, or tachycardia or ventricular tachycardia), adenosine will not terminate the arrhythmia but can produce transient ventriculoatrial or A-V block; possible mutagenic effects
DRUG INTERACTIONS — Dipyridamole potentiates effects of adenosine (dose of adenosine should be significantly reduced); methylxanthines (aminophylline, theophylline, caffeine) antagonize adenosine's effects so that larger doses of adenosine or an alternative agent may be required; carbamazepine may increase heart block; digoxin and verapamil may cause ventricular fibrillation (rare cases reported)
PREGNANCY RISK FACTOR — C (show table)
MONITORING PARAMETERS — Continuous EKG, heart rate, blood pressure, respirations
STABILITY — Do not refrigerate, precipitation may occur; contains no preservatives, discard unused portion
MECHANISM OF ACTION — Slows conduction time through the A-V node, interrupting the re-entry pathways through the A-V node, restoring normal sinus rhythm
PHARMACODYNAMICS Onset of action: Rapid
Duration: Very brief
PHARMACOKINETICS Metabolism: Removed from systemic circulation primarily by vascular endothelial cells and erythrocytes (by cellular uptake); rapidly metabolized intracellularly; 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: <10 seconds
NURSING IMPLICATIONS — Be alert for dyspnea, shortness of breath, and possible exacerbation of asthma
ADDITIONAL INFORMATION — Not effective in atrial flutter, atrial fibrillation, or ventricular tachycardia; short duration of action is an advantage as adverse effects are usually rapidly self-limiting; effects may be prolonged in patients with denervated transplanted hearts. Individualize treatment of prolonged adverse effects: Give I.V. fluids for hypotension, aminophylline/theophylline may antagonize effects.
Limited information is available regarding the use of adenosine for the treatment of persistent pulmonary hypertension of the newborn (PPHN); efficacy, optimal dose, and duration of therapy is not established; a randomized, masked, placebo-controlled pilot study of 18 term infants with PPHN used initial doses of 25 mcg/kg/minute (n=9); after 30 minutes, doses were increased to 50 mcg/kg/minute if no improvement in PaO2 was observed; all patients received study drug via central line into the right atrium (inserted via the umbilical vein); significant improvement in oxygenation was observed in 4 of 9 newborns receiving 50 mcg/kg/minute; hypotension or tachycardia were not observed; further studies are needed (Kondur, 1996).
Adenosine is also available as Adenoscan®, which is used in adults as an adjunct to thallium-201 myocardial perfusion scintigraphy; see package insert for further information on this use.
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