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Adenosine Intravenous for Adults

Who can administer

Administration RESTRICTED - see Appendix 1

Important information

  • See monitoring requirements (below and overleaf)
  • AdenoSCAN is only to be used in the Cardiac Angio laboratory
  • While both preparations (AdenoCOR and AdenoSCAN) contain the same concentration of drug, they are licensed for different indications. See under ' dose' for more information
  • Adenoscan is an unlicensed preparation in Ireland

Available preparations

AdenoCOR 6mg per 2ml vial

AdenoSCAN 30mg per 10ml vial

Reconstitution

Already in solution

Infusion fluids

Not required - product ready for use

Methods of intravenous administration

Intravenous bolus (for all uses except for cardiac angio)

  • Using AdenoCOR, give as a rapid IV bolus over 2 seconds
  • Inject as proximally as possible and follow with a rapid flush of Sodium chloride 0.9%

Intermittent intravenous infusion (in cardiac angio only)(administer using an electronically controlled infusion device)

  • Using AdenoSCAN, administer undiluted, at a rate of 140microgram/kg/minute for six minutes.
  • Give the radionuclide into a separate venous site, after the first 3 minutes of the Adenoscan infusion

Dose in adults

AdenoCOR™

First dose

  • Give 3mg, over two seconds, directly into a vein or an IV line, using the most proximal line available.
  • Inject as proximally as possible and follow with a rapid flush of Sodium chloride 0.9%
  • See under 'Further information' overleaf re dose adjustments required if patient is on dipyridamole

Subsequent doses

  • If first dose of 3mg is ineffective within one to two minutes, a further 6mg dose should be given as a rapid IV bolus
  • If the second dose is ineffective within one to two minutes, a further 12mg dose should be given as a rapid IV bolus
  • Additional or higher doses are not recommended
  • Patients who develop high-level AV block at a particular dose should not be given further dosage increments

AdenoSCAN™ for Cardiac Angio only (use undiluted)

  • Administer 140microgram/kg/minute for six minutes using an infusion pump (give the radionuclide into a separate venous site, after the first three minutes of the Adenoscan™ infusion)
  • Care should be taken if the patient is currently receiving dipyridamole - see under 'further information' overleaf
  • Dose of 140mcg/kg/MINUTE using Adenoscan™ 30mg/10ml solution- rate in ml/HOUR
    Weight 50 55 60 65 70 75 80 85 90 95 100 105 110 115 120 125
    Rate (ml/HOUR) 140 154 168 182 196 210 224 238 252 266 280 294 308 322 336 350

     

Monitoring

  • Heart rate and blood pressure should be monitored very closely
  • Monitor respiratory rate
  • For AdenoSCAN: to avoid an adenosine bolus effect, blood pressure should be measured in arm opposite infusion
  • Continuous ECG monitoring is essential during adenosine administration
  • Cardiorespiratory resuscitation equipment must be available for immediate use

Further information

  • Dipyridamole may markedly potentiate the action of adenosine, and therefore concomitant use should be avoided if possible
  • If dipyridamole cannot be discontinued at least 24 hours before the adenosine (longer for Dipyridamole Slow Release formulations), the initial adenosine dose should be greatly reduced.  (reduced about four-fold)(ref 1)
  • Aminophylline, theophylline and other xanthines can inhibit the effect of adenosine and should be avoided for 24 hours prior to use of adenosine
  • Food and drinks containing xanthines (tea, coffee, chocolate and cola) should be avoided for at least 12 hours prior to use of Adenosine.

Storage

  • Store below 25°C
  • Do not refrigerate

References

Adenocor SPC May 2015

Adenoscan UK SPC 11th August 2021

1. Stockley's Drug interactions - checked online  2nd December 2021

Therapeutic classification

Drugs for arrhythmias