Adenosine

Adenosine
Adenosin.svg
Adenosine-3D-balls.png
Clinical data
Trade namesAdenocard; Adenocor; Adenic; Adenoco; Adeno-Jec; Adenoscan; Adenosin; Adrekar; Krenosin
SynonymsSR-96225 (developmental code name)
AHFS/Drugs.comMonograph
Pregnancy
category
  • C

(adenosine may be safe to the fetus in pregnant women)

Routes of
administration
Intravenous
ATC code
Legal status
Legal status
  • In general: ℞ (Prescription only)
Pharmacokinetic data
BioavailabilityRapidly cleared from circulation via cellular uptake
Protein bindingNo
MetabolismRapidly converted to inosine and adenosine monophosphate
half-lifecleared plasma <30 seconds – half-life <10 seconds
Excretioncan leave cell intact or can be degraded to hypoxanthine, xanthine, and ultimately uric acid
Identifiers
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
ECHA InfoCard100.000.354 Edit this at Wikidata
Chemical and physical data
FormulaC10H13N5O4
Molar mass267.241 g/mol
3D model (JSmol)
 ☒N☑Y (verify)

Adenosine is both a chemical found in many living systems and a medication. As a medication it is used to treat certain forms of supraventricular tachycardia that do not improve with vagal maneuvers.[1] Common side effects include chest pain, feeling faint, shortness of breath along with tingling of the senses.[1] Serious side effects include a worsening dysrhythmia and low blood pressure.[1] It appears to be safe in pregnancy.[1]

It is a purine nucleoside composed of a molecule of adenine attached to a ribose sugar molecule (ribofuranose) moiety via a β-N9-glycosidic bond.[2][3][4] Derivatives of adenosine are widely found in nature and play an important role in biochemical processes, such as energy transfer—as adenosine triphosphate (ATP) and adenosine diphosphate (ADP)—as well as in signal transduction as cyclic adenosine monophosphate (cAMP). Adenosine itself is a neuromodulator, believed to play a role in promoting sleep and suppressing arousal. Adenosine also plays a role in regulation of blood flow to various organs through vasodilation.[5][6][7]

Medical uses

Supraventricular tachycardia

In individuals with supraventricular tachycardia (SVT), adenosine is used to help identify and convert the rhythm.

Certain SVTs can be successfully terminated with adenosine.[8] This includes any re-entrant arrhythmias that require the AV node for the re-entry, e.g., AV reentrant tachycardia (AVRT), AV nodal reentrant tachycardia (AVNRT). In addition, atrial tachycardia can sometimes be terminated with adenosine.

Fast rhythms of the heart that are confined to the atria (e.g., atrial fibrillation, atrial flutter) or ventricles (e.g., monomorphic ventricular tachycardia) and do not involve the AV node as part of the re-entrant circuit are not typically converted by adenosine. However, the ventricular response rate is temporarily slowed with adenosine in such cases.

Because of the effects of adenosine on AV node-dependent SVTs, adenosine is considered a class V antiarrhythmic agent. When adenosine is used to cardiovert an abnormal rhythm, it is normal for the heart to enter ventricular asystole for a few seconds. This can be disconcerting to a normally conscious patient, and is associated with angina-like sensations in the chest.[9]

Nuclear stress test

Adenosine is used as an adjunct to thallium (TI 201) or technetium (Tc99m) myocardial perfusion scintigraphy (nuclear stress test) in patients unable to undergo adequate stress testing with exercise.[10]

Dosage

When given for the evaluation or treatment of a supraventricular tachycardia (SVT), the initial dose is 6 mg to 12 mg, depending on standing orders or provider preference,[11] given as a rapid parenteral infusion. Due to adenosine's extremely short half-life, the IV line is started as proximal (near) to the heart as possible, such as the antecubital fossa. The IV push is often followed with an immediate flush of 10-20 ccs of saline. If this has no effect (i.e., no evidence of transient AV block), a dose of 12 mg can be given 1–2 minutes after the first dose. Some clinicians may prefer to administer a higher dose (typically 18 mg), rather than repeat a dose that apparently had no effect.[dubious ] When given to dilate the arteries, such as in a "stress test", the dosage is typically 0.14 mg/kg/min, administered for 4 or 6 minutes, depending on the protocol.

The recommended dose may be increased in patients on theophylline, since methylxanthines prevent binding of adenosine at receptor sites. The dose is often decreased in patients on dipyridamole (Persantine) and diazepam (Valium) because adenosine potentiates the effects of these drugs. The recommended dose is also reduced by half in patients presenting congestive heart failure, myocardial infarction, shock, hypoxia, and/or hepatic or renal insufficiency, and in elderly patients.

Other Languages
العربية: أدينوزين
تۆرکجه: آدنوزین
беларуская: Адэназін
български: Аденозин
bosanski: Adenozin
català: Adenosina
čeština: Adenosin
Cymraeg: Adenosin
dansk: Adenosin
Deutsch: Adenosin
eesti: Adenosiin
Ελληνικά: Αδενοσίνη
español: Adenosina
Esperanto: Adenozino
فارسی: آدنوزین
français: Adénosine
Gaeilge: Adanóisín
galego: Adenosina
한국어: 아데노신
հայերեն: Ադենոզին
hrvatski: Adenozin
Bahasa Indonesia: Adenosin
italiano: Adenosina
עברית: אדנוזין
қазақша: Аденозин
Кыргызча: Аденозин
lietuvių: Adenozinas
magyar: Adenozin
മലയാളം: അഡിനോസിൻ
Nederlands: Adenosine
日本語: アデノシン
norsk: Adenosin
occitan: Adenosina
oʻzbekcha/ўзбекча: Adenozin
polski: Adenozyna
português: Adenosina
русский: Аденозин
Scots: Adenosine
slovenčina: Adenozín
српски / srpski: Adenozin
srpskohrvatski / српскохрватски: Adenozin
suomi: Adenosiini
svenska: Adenosin
Tagalog: Adenosine
тоҷикӣ: Аденозин
українська: Аденозин
中文: 腺苷