Adenosine injection is indicated for the following:Conversion to sinus rhythm of paroxysmal supraventricular tachycardia (PSVT), including that associated with accessory bypass tracts (Wolff-Parkinson-White Syndrome).
When clinically advisable, appropriate vagal maneuvers (e.g., Valsalva maneuver), should be attempted prior to adenosine administration.It is important to be sure the adenosine solution actually reaches the systemic circulation (see DOSAGE AND ADMINISTRATION).Adenosine does not convert atrial flutter, atrial fibrillation, or ventricular tachycardia to normal sinus rhythm.In the presence of atrial flutter or atrial fibrillation, a transient modest slowing of ventricular response may occur immediately following adenosine administration.
Adenosine injection is contraindicated in:Second- or 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).Known hypersensitivity to adenosine.
Adenosine exerts its effect by decreasing conduction through the A-V node and may produce a short lasting first-, second- or 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.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 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.Appropriate resuscitative measures should be available.