Questions about Atrial Fibrillation? Get answers from our expert.

Adenosine (Systemic)


VA CLASSIFICATION
Primary: CV300
Secondary: DX900

Commonly used brand name(s): Adenocard; Adenoscan.

Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).

Not commercially available in Canada.



Category:


Antiarrhythmic—

diagnostic aid adjunct (ischemic heart disease)—

Indications

Note: Bracketed information in the Indications section refers to uses that are not included in U.S. product labeling.

Accepted

Tachycardia, supraventricular, paroxysmal (treatment)—Adenosine is indicated for conversion to sinus rhythm of paroxysmal supraventricular tachycardia, including those due to atrioventricular (AV) node reentry {52} and associated with accessory bypass tracts (Wolff-Parkinson-White syndrome), after appropriate vagal maneuvers (e.g., Valsalva maneuver) have been attempted {01} {03} {07} {15} {49}.

Myocardial perfusion imaging, radionuclide (adjunct) 1{85}; or
[Stress echocardiography (adjunct) ]1—In patients unable to exercise adequately, adenosine is used to induce coronary artery vasodilation in conjunction with myocardial perfusion imaging (i.e., thallium-201 myocardial perfusion scintigraphy){85} or two-dimensional echocardiography for the detection of perfusion defects or regional contraction abnormalities {56} associated with coronary artery disease. {85}{25} {26} {27} {28} {29} {30} {31} {32} {33}

Acceptance not established
Adenosine has been studied for the diagnosis and treatment of tachyarrhythmias of ventricular origin in neonates{63}{67} and for treatment of pulmonary hypertension of the newborn{81}{82}{83}. More data are needed to assess the place in therapy for adenosine for these indications{80}{84}.

1 Not included in Canadian product labeling.



Pharmacology/Pharmacokinetics

Mechanism of action/Effect:

Antiarrhythmic—Slows impulse formation in the sinoatrial (SA) node, slows conduction time through the atrioventricular (AV) node, and can interrupt reentry pathways through the AV node. {01} {03} {07} {19} {20} {21} {41} Adenosine depresses left ventricular function, but because of its short half-life, the effect is transient, allowing use in patients with existing poor left ventricular function {07}.

Diagnostic aid—The precise mechanism of coronary vasodilation is not completely understood. {34} However, it is speculated that adenosine may have a direct effect on smooth muscle receptors and may influence cellular calcium dynamics. {85}{34} Coronary vasodilation by adenosine contributes to the creation of heterogeneity of myocardial blood flow. {35} {36} The difference in coronary reserve in the vascular bed distal to a critical coronary stenosis versus that supplied by normal coronary arteries accounts for a significantly greater, 3- to 5-fold, increase in regional myocardial blood flow to normal epicardial vessels. {35} {36}


Other actions/effects:

Administration of doses larger than 12 mg by intravenous infusion decreases blood pressure by reducing peripheral vascular resistance {01} {03}. Physiologically, naturally occurring adenosine functions as an intermediate metabolite in a number of processes including regulation of coronary and systemic vascular tone, platelet function, lipolysis in fat cells, and intracardiac conduction {02}.

Biotransformation:

Very rapid, by circulating enzymes {02} in erythrocytes and vascular endothelial cells {01} {09}, by deamination {02} {19}, primarily to inactive inosine (further degraded to hypoxanthine and then to uric acid) {19} and by phosphorylation to adenosine monophosphate (AMP) {01} {03} {09}.

Half-life:

Less than 10 seconds {01} {03} {07} {09} {21} {38} {39}.

Onset of action:

Immediate.

Elimination:
    Principal elimination routes are cellular uptake, primarily by erythrocytes and vascular endothelial cells, and metabolism. {85} {19} Metabolites excreted renally. {19} The predominant final excretory metabolite is uric acid. {19}


Precautions to Consider

Carcinogenicity

Studies have not been done {01} {15}{85}.

Mutagenicity

Mutagenicity tests in the Salmonella/mammalian microsome assay (Ames test) were negative {01} {15}{85}. However, adenosine causes chromosomal alterations {01} {15}{85}.

Pregnancy/Reproduction
Fertility—
In rats and mice, intraperitoneal administration of 50, 100, and 150 mg per kg of body weight (mg/kg) per day for 5 days caused decreased spermatogenesis and increased numbers of abnormal sperm {01} {03} {15}{85}.

Pregnancy—
Studies have not been done in humans. Because adenosine occurs naturally in the body, problems are not expected {01} {04}. Scant reports of adenosine use in pregnant women have not revealed fetal or maternal sequelae. {17} {18} {40} {41}

Studies have not been done in animals. {15}

FDA Pregnancy Category C.

Breast-feeding

Because of rapid removal from circulation, adenosine is not expected to be distributed into breast milk {10}.

Pediatrics

Studies performed to date on adenosine's use as an antiarrhythmic have not demonstrated pediatrics-specific problems that would limit the usefulness of this medication in the pediatric population. {02} {06} {08} {16} {22} {23} {24} {50} {51}

The safety and effectiveness of adenosine, when used as an adjunct to myocardial perfusion imaging, have not been established in patients less than 18 years of age {85}.


Geriatrics


Appropriate studies on the relationship of age to the effects of adenosine have not been performed in the geriatric population. However, geriatrics-specific problems that would limit the usefulness of this medication in the elderly are not expected {11}.

Drug interactions and/or related problems
The following drug interactions and/or related problems have been selected on the basis of their potential clinical significance (possible mechanism in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):


Note: Combinations containing any of the following medications, depending on the amount present, may also interact with this medication.

Carbamazepine    (may increase heart block caused by adenosine {01} {03} {15} {21})


Dipyridamole    (potentiates the effects of adenosine by inhibiting cellular uptake; dosage reduction is recommended {01} {02} {03} {09} {15} {21} {38}{85})


Xanthines, especially caffeine and theophylline    (antagonize the effects of adenosine; larger doses of adenosine may be required or alternative therapy should be used {85}{57} {01} {02} {03} {09} {15} {21} {46})

    (concurrent use with xanthines may invalidate test when adenosine is used as a diagnostic aid {53} {54})


Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).


Except under special circumstances, this medication should not be used when the following medical problem exists:
» Atrioventricular (AV) block, pre-existing second or third degree without pacemaker {01} {03} {35}{85}    (risk of complete heart block)


Risk-benefit should be considered when the following medical problems exist
Angina pectoris, unstable {85}    (may increase risk of developing fatal cardiac arrest, life threatening ventricular arrhythmias, and myocardial infarction)


Asthma {01} {03} {07} {09} {35} {45}{85}    (although problems have not been reported with adenosine injection, inhaled adenosine has been reported to cause bronchoconstriction in asthmatic patients but not in normal individuals)


Hypotension {85}    (patients with autonomic dysfunction, stenotic valvular heart disease, pericarditis or pericardial effusions, stenotic carotid artery disease with cerebrovascular insufficiency, or uncorrected hypovolemia are at a greater risk of hypotensive complications)


Sensitivity to adenosine {01} {03}{85}
» Sick sinus syndrome {01} {03} {09} {35} {42} {49}{85}    (sinus node recovery time prolonged; sinus bradycardia, sinus pause, or sinus arrest may occur)



Patient monitoring
The following may be especially important in patient monitoring (other tests may be warranted in some patients, depending on condition; » = major clinical significance):

» Blood pressure and
» Heart rate    (determinations recommended every 15 to 30 seconds for several minutes {13})


» Electrocardiogram (ECG) {12}    (recommended to confirm efficacy of adenosine)




Side/Adverse Effects

Note: Side/adverse effects are usually transient, generally lasting less than one minute. {01} {07} {09} {48} However, loss of consciousness and prolonged hypotension have been reported rarely. {42}

The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:

Those indicating need for medical attention
Incidence more frequent
    
Arrhythmias, new {01} {02} {04} {05} {06} {07} {09} {44} {47} {48} {49} , including premature ventricular contractions, atrial premature contractions, sinus bradycardia, sinus tachycardia, and skipped beats {01} {09}
    
chest, {01} {03} {05} {21} {44} {48} jaw, throat, or arm pain {54}
    
dyspnea (shortness of breath){01}{02}{03}{04}{05}{06}{07}{09}{44}

Note: New arrhythmias usually last only a few seconds {03} {05} {07}.


Incidence rare
    
Heart block, first-, second-, or third-degree {01} {03} {04} {05} {14} {49}

Note: Heart block is usually of short duration {03} {49} and may occur more frequently in patients who receive a rapid intravenous dose of adenosine {53}. Episodes of transient asystole have been reported {49}.




Those indicating need for medical attention only if they continue or are bothersome
Incidence more frequent
    
Flushing of face {01} {02} {03} {05} {06} {07} {09} {21} {47} {48} {49} {54}
    
gastrointestinal discomfort {85}( abdominal or stomach pain; diarrhea; nausea ; vomiting)
    
headache {01} {03} {05} {06} {09} {54}

Incidence less frequent
    
Cough {09}
    
dizziness or lightheadedness {01} {03}
    
nausea {01} {03} {06} {09}
    
numbness or tingling in arms {01} {03}





General Dosing Information
If high-level heart block occurs after one dose of adenosine, it is recommended that additional doses not be given {01} {03}. The effect usually resolves quickly because of adenosine's short duration of action {01}.

Rapid intravenous administration of adenosine is recommended for the treatment of paroxysmal supraventricular tachycardia in order to achieve the desired negative chronotropic and dromotropic activity {09}. Slow administration may result in an increase in heart rate in response to vasodilation {09}.

During myocardial perfusion imaging, adenosine should be given as a continuous peripheral intravenous infusion {85}. Safety and efficacy of adenosine administered by the intracoronary route have not been established {85}.

For treatment of adverse effects and/or overdose
Because of adenosine's extremely short duration of action, adverse effects are usually self-limiting {01} {03} {15}{85}. Treatment of prolonged adverse effects should be individualized {01} {03}. Xanthines (e.g., caffeine, theophylline) are competitive antagonists of adenosine {01} {03}{85}.


Parenteral Dosage Forms

Note: Bracketed uses in the Dosage Forms section refer to categories of use and/or indications that are not included in U.S. product labeling.

ADENOSINE INJECTION

Usual adult dose
Antiarrhythmic
Intravenous, rapid (over one to two seconds), 6 mg {01} {03} {15}. If the first dose is not effective within one to two minutes, a rapid intravenous dose of 12 mg may be given, and repeated if necessary {01} {03} {15}.

Diagnostic aid adjunct 1
Intravenous, 140 mcg (0.14 mg) per kg of body weight per minute given for six minutes. {85}{26} {27} {28} {29} {30} {31}

Note: The following adenosine infusion nomogram may be used to determine the appropriate infusion rate corrected for total body weight {85}:

Patient Weight kg  Patient Weight lbs  Infusion Rate mL/min 
45  99  2.1 
50  110  2.3 
55  121  2.6 
60  132  2.8 
65  143  3.0 
70  154  3.3 
75  165  3.5 
80  176  3.8 
85  187  4.0 
90  198  4.2 
This nomogram was derived from the following general formula: 0.140 (mg/kg/min) × total body weight (kg) ÷ adenosine concentration (3 mg/mL) = infusion rate (mL/min) {85}.
In patients at increased risk for side/adverse effects, the dose may be titrated from 50 mcg (0.05 mg) per kg of body weight per minute up to 140 mcg (0.14 mg) per kg of body weight per minute at one-minute intervals. {25} {53} {54} {55} If side/adverse effects are severe, the infusion rate may be reduced to a more tolerable level. {35} {53} Doses of 75 and 100 mcg (0.075 and 0.1 mg) per kg of body weight per minute can adequately increase coronary blood flow. {35}
Thallium is physically compatible with adenosine and may be injected directly into the adenosine infusion set{85}; however, it has been suggested that thallium should be injected into a separate vein {53}. Thallium is usually injected at the three- or four-minute mark (midpoint) of the adenosine infusion{85} {26} {29} {30} {53}.



Note: To ensure that adenosine injection reaches the systemic circulation, it should be given directly into a vein or, if given into an intravenous line, be given as proximally as possible and followed by a rapid saline flush {01} {03}{85}.


Usual adult prescribing limits
Up to 12 mg per dose {01}{03}.

Usual pediatric dose
Antiarrhythmic
Intravenous, 50 mcg (0.05 mg) per kg of body weight. Dose may be increased in increments of 50 mcg (0.05 mg) per kg of body weight given every two minutes up to a maximum dose of 250 mcg (0.25 mg) per kg of body weight.{50}
Diagnosis and treatment of supraventricular tachycardia in neonates—Intravenous, 100 mcg (0.1 mg) to 300 mcg (0.3 mg) per kg of body weight{58}{59}{60}{61}{62}{63}{64}{65}{66}{67}{68}{69}{70}{71}{72}{73}{74}{75}{76}{77}{78}{79}{80}

Diagnostic aid adjunct
Safety and effectiveness of adenosine in patients less than 18 years of age have not been established {85}.


Strength(s) usually available
U.S.—


3 mg per mL (Rx) [Adenocard]


3 mg per mL (Rx) [Adenoscan ( 20 mL and 30 mL vials) (sodium chloride (9 mg/mL) ) (water for injection)]

Canada—
Not commercially available.

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Do not refrigerate{01}{85}. Protect from freezing.

Stability:
Because adenosine injection contains no preservatives, any unused portion should be discarded {01}{03}{85}.

Crystallization may occur if adenosine injection is refrigerated. If that occurs, the crystals may be dissolved by warming the injection to room temperature. The solution must be clear before use. {01} {03}{85}.



Revised: 08/21/2000



References
  1. Adenocard package insert (Lyphomed—US), 10/89.
  1. Olin BR, editor. Drug facts and comparisons. St. Louis: Facts and Comparisons Inc, 1989: 809.
  1. Olin BR, editor. Drug facts and comparisons. St. Louis: Facts and Comparisons Inc, 1990: 148m-148n.
  1. Moro C, Lorio N, Nunez A, et al. Dose related efficacy of adenosine triphosphate in spontaneous supraventricular tachyarrhythmias. Int J Cardiol 1989 Nov; 25(2): 207-12.
  1. Rankin AC, Oldroyd KG, Chong E, et al. Value and limitations of adenosine in the diagnosis and treatment of narrow and broad complex tachycardias. Br Heart J 1989 Sep; 62: 195-203.
  1. Till J, Shinebourne EA, Rigby ML, et al. Efficacy and safety of adenosine in the treatment of supraventricular tachycardia in infants and children. Br Heart J 1989 Sep; 62: 204-11.
  1. Garratt C, Linker N, Griffith M. Comparison of adenosine and verapamil for termination of paroxysmal junctional tachycardia. Am J Cardiol 1989 Dec 1; 64: 1310-6.
  1. Clarke B, Till J, Rowland E, et al. Rapid and safe termination of supraventricular tachycardia in children by adenosine. Lancet 1987; 1: 299-301. Cited in reference #7.
  1. Parker RB, McCollam PL. Adenosine in the episodic treatment of paroxysmal supraventricular tachycardia. Clin Pharm 1990 Apr; 9: 261-71.
  1. Reviewers" responses to panel question #2, 1991 revision.
  1. Reviewers" responses to panel question #3, 1991 revision.
  1. Reviewers" responses to panel question #4a, 1991 revision.
  1. Reviewers" responses to panel question #4b, 1991 revision.
  1. Reviewers" responses to panel question #5, 1991 revision—panel agreed that heart block induced by adenosine is rare.
  1. Adenocard package insert (Fujisawa—US), Rev 2/92, Rec 1/93.
  1. Litman RS, Keon TP, Campbell FW. Termination of supraventricular tachycardia with adenosine in a healthy child undergoing anesthesia. Anesth Analg 1991; 73: 665-7.
  1. Podolsky SM, Varon J. Adenosine use during pregnancy. Ann Emerg Med 1991; 20(9): 1027-8.
  1. Propp DA, Broderick K, Pesch D. Adenosine during pregnancy. Ann Emerg Med 1992; 21(4): 453-4.
  1. Pelleg A, Porter RS. The pharmacology of adenosine. Pharmacotherapy 1990; 10(3): 157-74.
  1. Belardinelli L, Lerman BB. Adenosine: cardiac electrophysiology. PACE Pacing Clin Electrophysiol 1991; 14(11): 1672-80.
  1. Faulds D, Chrisp P, Buckley MM. Adenosine. An evaluation of its use in cardiac diagnostic procedures, and in the treatment of paroxysmal supraventricular tachycardia. Drugs 1991; 41(4): 596-624.
  1. Fletcher S, Fyfe DA, Gillette PC, Annibale D. The utility of adenosine to terminate supraventricular tachycardia in a premature hydropic infant. Am Heart J 1991; 121 (6 part 1): 1818-9.
  1. Reyes G, Stanton R, Galvis AG. Adenosine in the treatment of paroxysmal supraventricular tachycardia in children. Ann Emerg Med 1992; 21(12): 1499-1501.
  1. Rossi AF, Steinberg LG, Kipel G, Golinko RJ, Griepp RB. Use of adenosine in the management of perioperative arrhythmias in the pediatric cardiac intensive care unit. Crit Care Med 1992; 20(8): 1107-11.
  1. Mahmarian JJ, Pratt CM, Nishimura S, Abreu A, Verani MS. Quantitative adenosine 20 1Tl single-photon emission computed tomography for the early assessment of patients surviving acute myocardial infarction. Circulation 1993; 87: 1197-210.
  1. O'Keefe JH, Bateman TM, Barnhart CS. Adenosine thallium-201 is superior to exercise thallium-201 for detecting coronary artery disease in patients with left bundle branch block. J Am Coll Cardiol 1993; 21: 1332-8.
  1. Gupta NC, Esterbrooks DJ, Hilleman DE, Mohiuddin SM. Comparison of adenosine and exercise thallium-201 single-photon emission computed tomography (SPECT) myocardial perfusion imaging. J Am Coll Cardiol 1992; 19: 248-57.
  1. Mohiuddin SM, Gupta NC, Esterbrooks DJ, et al. Thallium-201 myocardial imaging in patients with coronary artery disease: comparison of intravenous adenosine and oral dipyridamole. Ann Pharmacother 1992; 26: 1352-7.
  1. Nishimura S, Mahmarian JJ, Boyce TM. Equivalence between adenosine and exercise thallium-201 myocardial tomography: a multicenter, prospective, crossover trial. J Am Coll Cardiol 1992; 20: 265-75.
  1. O'Keefe JH, Bateman TM, Silvestri R, Barnhart C. Safety and diagnostic accuracy of adenosine thallium-201 scintigraphy in patients unable to exercise and those with left bundle branch block. Am Heart J 1992; 124: 614-21.
  1. Heinle S, Hanson M, Gracey L, Coleman E, Kisslo J. Correlation of adenosine echocardiography and thallium scintigraphy. Am Heart J 1993; 125: 1606-13.
  1. Marwick T, Willemart B, D'Hondt AM, et al. Selection of the optimal nonexercise stress for the evaluation of ischemic regional myocardial dysfunction and malperfusion. Circulation 1993; 87: 345-54.
  1. Martin TW, Seaworth JF, Johns JP, Pupa LE, Condos WR. Comparison of adenosine, dipyridamole, and dobutamine in stress echocardiography. Ann Intern Med 1992; 116: 190-6.
  1. van Rugge FP, van der Wall EE, Bruschke AV. New developments in pharmacologic stress imaging. Am Heart J 1992; 124(2): 468-85.
  1. Verani MS. Pharmacological stress with adenosine for myocardial perfusion imaging. Sem Nucl Med 1991; 21(3): 266-72.
  1. Wackers FJ. Adenosine or dipyridamole: which is preferred for myocardial perfusion imaging? Am J Cardiol 1991; 17(6): 1295-6.
  1. Freilich A, Tepper D. Adenosine and its cardiovascular effects. Am Heart J 1992; 123(5): 1324-8.
  1. Klabunde RE. Dipyridamole inhibition of adenosine metabolism in human blood. Eur J Pharmacol 1983; 93: 21-6.
  1. Moser GH, Schrader J, Deussen A. Turnover of adenosine in plasma of human and dog blood. Am J Physiol 1989; 256: C799-C806.
  1. Afridi I, Moise KJ, Rokey R. Termination of supraventricular tachycardia with intravenous adenosine in a pregnant woman with Wolff-Parkinson White syndrome. Obstet Gynecol 1992; 80: 481-3.
  1. DiMarco JP, Sellers TD, Berne RM, West GA, Belardinelli L. Adenosine: electrophysiologic effects and therapeutic use for terminating paroxysmal supraventricular tachycardia. Circulation 1983; 68(6): 1254-63.
  1. Reed R, Falk JL, O'Brien J. Untoward reaction to adenosine therapy for supraventricular tachycardia. Am J Emerg Med 1991; 9: 566-70.
  1. Harrison JK, Greenfield RA, Wharton JM. Acute termination of supraventricular tachycardia by adenosine during pregnancy. Am Heart J 1992; 123(5): 1386-8.
  1. DiMarco JP, Miles W, Akhtar M, et al. Adenosine for paroxysmal supraventricular tachycardia: dose ranging and comparison with verapamil. Ann Intern Med 1990; 113: 104-10.
  1. Bjorck T, Gustafsson LE, Dahlen SE. Isolated bronchi from asthmatics are hyperresponsive to adenosine, which apparently acts indirectly by liberation of leukotrienes and histamine. Am Rev Respir Dis 1992; 145: 1087-91.
  1. Smits P, Schouten J, Thien T. Cardiovascular effects of two xanthines and the relation to adenosine antagonism. Clin Pharmacol Ther 1989; 45: 593-9.
  1. DiMarco JP, Sellers TD, Lerman BB, et al. Diagnostic and therapeutic use of adenosine in patients with supraventricular tachyarrhythmias. J Am Coll Cardiol 1985; 6: 417-25.
  1. Hood MA, Smith WM. Adenosine versus verapamil in the treatment of supraventricular tachycardia: a randomized double-blind crossover trial. Am Heart J 1992; 123: 1543-9.
  1. Rankin AC, Brooks R, Ruskin JN. Adenosine and the treatment of supraventricular tachycardia. Am J Med 1992; 92: 655-64.
  1. Till J, Shinebourne EA, Rigby ML, et al. Efficacy and safety of adenosine in the treatment of supraventricular tachycardia in infants and children. Br Heart J 1989; 62: 204-11.
  1. Till J, Shinebourne EA. Supraventricular tachycardia: diagnosis and current acute management. Arch Dis Child 1991; 66: 647-52.
  1. Panel comment, 2/94.
  1. Panel comment, 3/94
  1. Verani MS, Mahmarian JJ. Myocardial perfusion scintigraphy during maximal coronary artery vasodilation with adenosine. Am J Cardiol 1991; 67: 12D-17D.
  1. Verani MS, Mahmarian JJ, Hixson JB, Boyce TM, Staudacher RA. Diagnosis of coronary artery disease by controlled coronary vasodilation with adenosine and thallium-201 scintigraphy in patients unable to exercise. Circulation 1990; 82: 80-7.
  1. Panelist comment, 2/94.
  1. Panelist comment, 4/94.
  1. Jaeggi E, Chiu C, Hamilton R, et al. Adenosine-induced atrial pro-arrhythmia in children. Can J Cardiol 1999 Feb; 15(2): 169-72.
  1. Losek JD, Endom E, Dietrich A, et al. Adenosine and pediatric supraventricular tachycardia in the emergency department: multicenter study and review. Ann Emerg Med 1999 Feb; 33(2): 185-91.
  1. Sherwood MC, Lau KC, Sholler GF. Adenosine in the management of supraventricular tachycardia in children. J Paediatr Child Health 1998 Feb; 34(1): 53-6.
  1. Bakshi F, Barzilay Z, Paret G. Adenosine in the diagnosis and treatment of narrow complex tachycardia in the pediatric intensive care unit. Heart Lung 1998 Jan-Feb; 27(1): 47-50.
  1. Fitzsimmons CL, Withington DE. Use of adenosine in multiple doses for supraventricular tachycardia in an infant. Pediatr Cardiol 1997 Nov-Dec; 18(6): 432-3.
  1. Fitzsimmons CL, Withington DE. Use of adenosine in multiple doses for supraventricular tachycardia in an infant. Pediatr Cardiol 1997 Nov-Dec; 18(6): 432-3.
  1. Friedman FD. Intraosseous adenosine for the termination of supraventricular tachycardia in an infant. Ann Emerg Med 1996 Sep; 28(3): 356-8.
  1. Paret G, Steinmetz D, Kuint J, et al. Adenosine for the treatment of paroxysmal supraventricular tachycardia in full-term and preterm newborn infants. Am J Perinatol 1996 Aug; 13(6): 343-6.
  1. Mulla N, Karpawich P. Ventricular fibrillation following adenosine therapy for supraventricular tachycardia in a neonate with concealed Wolff-Parkinson-White syndrome treated with digoxin. Pediatr Emerg Care 1995 Aug; 11(4): 238-9.
  1. Crosson JE, Etheridge SP, Milstein S, et al. Therapeutic and diagnostic utility of adenosine during tachycardia evaluation in children. Am J Cardiol 1994 Jul 15; 74(2): 155-60.
  1. Eubanks AP, Artman M. Administration of adenosine to a newborn of 26 weeks' gestation [letter]. Pediatr Cardiol 1994 May-Jun; 15(3): 157-8.
  1. Ralston MA, Knilans TK, Hannon DW, et al. Use of adenosine for diagnosis and treatment of tachyarrhythmias in pediatric patients. J Pediatr 1994 Jan; 124(1): 139-43.
  1. Berul CI. Higher adenosine dosage required for supraventricular tachycardia in infants treated with theophylline. Clin Pediatr (Phila) 1993 Mar; 32(3): 167-8.
  1. Rossi AF, Steinberg LG, Kipel G, et al. Use of adenosine in the management of perioperative arrhythmias in the pediatric cardiac intensive care unit. Crit Care Med 1992 Aug; 20(8): 1107-11.
  1. Stemp LI, Roy WL. Adenosine for the cardioversion of supraventricular tachycardia during general anesthesia and open heart surgery. Anesthesiology 1992 May; 76(5): 849-52.
  1. Ros SP, Fisher EA, Bell TJ. Adenosine in the emergency management of supraventricular tachycardia. Pediatr Emerg Care 1991 Aug; 7(4): 222-3.
  1. Fletcher S, Fyfe DA, Gillette PC, et al. The utility of adenosine to terminate supraventricular tachycardia in a premature hydropic infant. Am Heart J 1991 Jun; 121(6 Pt 1): 1818-9.
  1. Rossi AF, Kipel G, Golinko, RJ, et al. Use of adenosine in postoperative junctional ectopic tachycardia with 1:1 retrograde atrial conduction. Am Heart J 1991 Apr; 121(4 Pt 1): 1237-9.
  1. Rossi AF, Burton DA. Adenosine in altering short- and long-term treatment of supraventricular tachycardia in infants. Am J Cardiol 1989 Sep 15; 64(10): 685-6.
  1. Till J, Shinebourne EA, Rigby ML, et al. Efficacy and safety of adenosine in the treatment of supraventricular tachycardia in infants and children. Br Heart J 1989 Sep; 62(3): 204-11.
  1. Overholt ED, Rheuban KS, Gutgesell HP, et al. Usefulness of adenosine for arrhythmias in infants and children. Am J Cardiol 1988 Feb 1; 61(4): 336-40.
  1. Clarke B, Till J, Rowland E, et al. Rapid and safe termination of supraventricular tachycardia in children by adenosine. Lancet 1987 Feb 7; 1(8528): 299-301.
  1. Panel consensus 12/1999.
  1. Patole S, Lee J, Whitehall J. Adenosine infusion in the management of a micropremi neonate with pulmonary hypertension. Indian Pediatr 1998 Dec; 35(12): 1221-4.
  1. Patole S, Lee J, Buettner P, et al. Improved oxygenation following adenosine infusion in persistent pulmonary hypertension of the newborn. Biol Neonate 1998 Nov; 74(5): 345-50.
  1. Konduri GG, Garcia DC, Kazzi NJ, et al. Adenosine infusion improves oxygenation in term infants with respiratory failure. Pediatrics 1996; Mar 97(3): 295-300.
  1. Panel consensus 2/2000.
  1. Product Information: Adenoscan®, adenosine. Fujisawa Healthcare, Inc., Deerfield, IL, (PI revised 1/1999) reviewed 8/2000.
Hide
(web2)