Adenoscan Side Effects
Generic name: adenosine
Note: This document contains side effect information about adenosine. Some of the dosage forms listed on this page may not apply to the brand name Adenoscan.
Some side effects of Adenoscan may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.
For the Consumer
Applies to adenosine: parenteral injection
Side effects include:
For termination of PSVT: Facial flushing, shortness of breath/dyspnea, chest pressure, nausea, headache, lightheadedness, dizziness, numbness, tingling in the arms.
As an adjunct to thallium stress test: Facial flushing, chest discomfort, dyspnea or urge to breathe deeply, headache, throat/neck/jaw discomfort, GI discomfort, lightheadedness/dizziness, upper extremity discomfort, ST-segment depression, first- or second-degree AV block, paresthesia, hypotension, nervousness, arrhythmias.
For Healthcare Professionals
Applies to adenosine: compounding powder, intravenous solution, sublingual spray
Although side effects are common (90% of patients), adenosine (the active ingredient contained in Adenoscan) is considered a very safe drug because of the mild intensity and short duration of side effects. Side effects usually occur within 2 minutes of adenosine administration, and last only seconds to minutes because of its short half-life and rapid plasma clearance.
Data have shown that lower esophageal sphincter pressure is not increased during adenosine-induced chest pain, but coronary sinus blood flow is, indicating a probable cardiac origin. Electrocardiographically, ST segment changes may accompany this chest pain, but there is no other evidence for an ischemic etiology. The chest pain may mimic angina pectoris of cardiac origin, but may occur in patients with normal coronary arteries.
Arrhythmias at the time of conversion generally last only a few seconds without intervention and may take the form of premature atrial fibrillation.
Rare cases of torsades de pointes and nonsustained polymorphic ventricular tachycardia have been reported. In one case the patient was found to have preexisting prolonged QT syndrome.
Three cases of ventricular asystole after central venous administration and a single case of ventricular fibrillation after peripheral administration of adenosine (the active ingredient contained in Adenoscan) have been reported.
After administration of adenosine 6 mg to one patient with atrial flutter and a ventricular response of 140, the ventricular rate varied from 60 to 240. There was no prior evidence of an accessory pathway, leading the investigators to theorize that adenosine may enhance sympathetic tone.
Cardiovascular side effects have occurred in up to 90% of patients. The most serious cardiac side effects have been sinoatrial (SA) or (more commonly) atrioventricular (AV) nodal block (first-, second-, or third-degree) in 8% of patients. Other arrhythmias have included asystole, ventricular tachyarrhythmias (including rare cases of ventricular fibrillation), and torsades de pointes. The ventricular rate may decrease immediately after adenosine infusion.
Although adenosine is indicated for the treatment of supraventricular tachycardia (SVT) due to an accessory pathway, cases of worsened SVT (increased rate) have been reported in some patients with preexcitation syndromes and mitral valve prolapse. Rare cases of atrial fibrillation related to adenosine administration in patients with a documented history of SVT and rare cases of enhanced ventricular rate after adenosine administration to patients with atrial flutter and without a history of a preexcitation syndrome have been reported. In one study, the incidence of new atrial fibrillation associated with the administration of 12 mg of adenosine into the femoral vein to patients with a history of paroxysmal supraventricular tachycardia averaged 12%.
Chest pain has occurred in up to 10% to 80% of patients and has been dose-related. Other general cardiovascular complaints have included facial flushing in 10% to 50%, sweating, headache (2%), palpitations, and hypotension in 1% of patients.
Hemodynamic measurements during adenosine (the active ingredient contained in Adenoscan) administration show that pulmonary vascular resistance is decreased, while pulmonary capillary wedge pressure, pulmonary artery pressure, minute ventilation, and cardiac index are increased.
A 57-year-old man with chronic obstructive pulmonary disease was scheduled for radiofrequency ablation for treatment of Wolff-Parkinson-White syndrome. Adenosine was used intraoperatively to abolish an isoproterenol-induced atrial tachycardia. After injection of adenosine, the peak airway pressure increased from 22 to 50 cm of water, and, on auscultation, diffuse bilateral inspiratory and expiratory wheezes were heard. The patient's respiratory condition persisted and the patient developed acute respiratory acidosis despite two doses of albuterol. The peak airway pressures, wheezing, and arterial blood gases resolved or returned to normal after an aminophylline infusion was begun.
Animal data indicate specific adenosine receptors in the lungs of allergic rabbits, but not in the lungs of nonallergic rabbits. These data imply a specific pharmacologic action of adenosine through cell surface receptors.
Respiratory system side effects include dyspnea in up to 60% of patients. Rare reports of bronchoconstriction have been reported. This may be important in some patients with reactive airways disease. Hyperventilation, chest pressure, head pressure and respiratory arrest have also been reported.
Nervous system side effects are probably related to the vasodilatory properties of adenosine (the active ingredient contained in Adenoscan) and include headache (8% to 25%), lightheadedness (20%), dizziness, numbness (1%), blurred vision, burning sensation, heaviness in arms, back pain, neck pain, and paresthesias (in less than 1% of patients).
A case in which a man with a subdural hematoma and documented intracranial hypertension developed increased intracranial pressures after adenosine administration has been reported.
Gastrointestinal side effects have included epigastric discomfort or nausea (3%), metallic taste, tightness in throat, and pressure in groin (less than 1%).
Psychiatric complaints are rare. A general feeling of anxiety has been reported in less than 1% of patients.
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