Adenosine Side Effects

Not all side effects for adenosine may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to adenosine: intravenous solution

In addition to its needed effects, some unwanted effects may be caused by adenosine. In the event that any of these side effects do occur, they may require medical attention.

If any of the following side effects occur while taking adenosine, check with your doctor or nurse immediately:

More common
  • Chest discomfort
  • difficult or labored breathing
  • lightheadedness or dizziness
  • throat, neck, or jaw discomfort
  • tightness in the chest
Less common
  • Chest pain
  • confusion
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • fainting
  • fast, slow, or irregular heartbeat
  • sweating
  • troubled breathing
  • unusual tiredness or weakness
Rare
  • Fast, irregular, pounding, or racing heartbeat or pulse
  • headache
  • nervousness
  • pounding in the ears

Some of the side effects that can occur with adenosine may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common
  • Diarrhea
  • feeling of warmth
  • indigestion
  • loss of appetite
  • nausea or vomiting
  • passing of gas
  • redness of the face, neck, arms, and occasionally, upper chest
  • stomach pain, fullness, or discomfort
Rare
  • Area of decreased vision
  • cough
  • discomfort in the back, ears, or tongue
  • drowsiness
  • dry mouth
  • metallic taste
  • mood changes
  • shakiness in the legs, arms, hands, or feet
  • stuffy nose
  • trembling or shaking of the hands or feet

For Healthcare Professionals

Applies to adenosine: compounding powder, intravenous solution, sublingual spray

General

Although side effects are common (90% of patients), adenosine 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.[Ref]

Cardiovascular

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 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.[Ref]

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.[Ref]

Respiratory

Hemodynamic measurements during adenosine 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.[Ref]

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.[Ref]

Nervous system

Nervous system side effects are probably related to the vasodilatory properties of adenosine, 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).[Ref]

A case in which a man with a subdural hematoma and documented intracranial hypertension developed increased intracranial pressures after adenosine administration has been reported.[Ref]

Gastrointestinal

Gastrointestinal side effects have included epigastric discomfort or nausea (3%), metallic taste, tightness in throat, and pressure in groin (less than 1%).[Ref]

Psychiatric

Psychiatric complaints are rare. A general feeling of anxiety has been reported in less than 1% of patients.[Ref]

References

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3. Cowell RPW, Paul VE, Ilsley CDJ "Haemodynamic deterioration after treatment with adenosine." Br Heart J 71 (1994): 569-71

4. Houltz E, Ricksten SE, Milocco I, Gustavsson T, Caidahl K "Effects of adenosine infusion on systolic and diastolic left ventricular function after coronary artery bypass surgery: evaluation by computer-assisted quantitative 2-d and doppler echocardiography." Anesth Analg 80 (1995): 47-53

5. Tebbenjohanns J, Pfeiffer D, Schumacher B, Jung W, Manz M, Luderitz B "Intravenous adenosine during atrioventricular reentrant tachycardia: induction of atrial fibrillation with rapid conduction over an accessory pathway." Pacing Clin Electrophysiol 18 (1995): 743-6

6. Garratt CJ, Onunain S, Griffith MJ, Connelly DT, Rowland E, Ward DE, Camm J "Effects of intravenous adenosine in patients with preexcited junctional tachycardias: therapeutic efficacy and incidence of proarrhythmic events." Am J Cardiol 74 (1994): 401-4

7. Dougherty AH, Gilman JK, Wiggins S, Jalal S, Naccarelli GV "Provocation of atrioventricular reentry tachycardia: a paradoxical effect of adenosine." Pacing Clin Electrophysiol 16 (1993): 8-12

8. Conti CR "Adenosine: clinical pharmacology and applications." Clin Cardiol 14 (1991): 91-3

9. DiMarco JP, Miles W, Akhtar M, et al. "Adenosine for paroxysmal supraventricular tachycardia: dose ranging and comparison with verapamil. Assessment in placebo-controlled, multicenter trials. The Adenosine for PSVT Study Group." Ann Intern Med 113 (1990): 104-10

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11. Orebaugh SL, Handy M "Intravenous adenosine therapy accelerating rate of paroxysmal supraventricular tachycardia." Am J Emerg Med 10 (1992): 326-30

12. Kipel G, Rossi AF, Steinberg LG, Gelb B, Fiumecaldo F, Golinko RJ, Griepp RB "Malignant wide complex tachycardia after adenosine administration to a postoperative pediatric patient with congenital heart disease." Pediatr Cardiol 16 (1995): 36-7

13. Lee J, Heo J, Ogilby JD, Cave V, Iskandrian B, Iskandrian AS "Atrioventricular block during adenosine thallium imaging." Am Heart J 123 (1992): 1569-74

14. McCollam PL, Uber WE, Van Bakel AB "Adenosine-related ventricular asystole ." Ann Intern Med 118 (1993): 315-6

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17. Meurer MK "A 21-year-old woman with rapid atrial fibrillation after adenosine administration." J Emerg Nurs 17 (1991): 135-6

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19. Reid PG, Fraser AG, Watt AH, Henderson AH, Routledge PA "Acute haemodynamic effects of intravenous infusion of adenosine in conscious man." Eur Heart J 11 (1990): 1018-28

20. Cerqueira MD, Verani MS, Schwaiger M, Heo J, Iskandrian AS, Alazraki NP, Bean LC, Belardinelli L, Bell M, Berman DS, Botvini "Safety profile of adenosine stress perfusion imaging: results from the adenoscan multicenter trial registry." J Am Coll Cardiol 23 (1994): 384-9

21. diMarco JP, Sellers TD, Lerman BB, Greenberg ML, Berne RM, Belardinelli L "Diagnostic and therapeutic use of adenosine in patients with supraventricular tachyarrhythmias." J Am Coll Cardiol 6 (1985): 417-25

22. Celiker A, Tokel K, Cil E, Ozkutlu S, Ozme S "Adenosine induced torsades de pointes in a child with congenital long QT syndrome." Pacing Clin Electrophysiol 17 (1994): 1814-7

23. O'Keefe JH Jr, 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 124 (1992): 614-21

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25. Strickberger SA, Man KC, Daoud EG, et al. "Adenosine-induced atrial arrhythmia: a prospective analysis." Ann Intern Med 127 (1997): 417-22

26. Korkmaz ME, Mahmarian JJ, Guidry GW, Verani MS "Safety of single-site adenosine thallium-201 scintigraphy." Am J Cardiol 73 (1994): 200-4

27. Camm AJ, Garratt CJ "Adenosine and supraventricular tachycardia." N Engl J Med 325 (1991): 1621-9

28. Sylven C, Jonzon B, Edlund A "Angina pectoris-like pain provoked by i.v. bolus of adenosine: relationship to coronary sinus blood flow, heart rate and blood pressure in healthy volunteers." Eur Heart J 10 (1989): 48-54

29. Engelstein ED, Lerman BB "Adenosine induced intraatrial block." Pacing Clin Electrophysiol 16 (1993): 89-94

30. Silverman AJ, Machado C, Baga JJ, Meissner MD, Lehmann MH, Steinman RT "Adenosine-induced atrial fibrillation." Am J Emerg Med 14 (1996): 300-1

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32. Tomcsanyi J, Tenczer J, Horvath L "Unusual effect of adenosine." Int J Cardiol 49 (1995): 89-91

33. Domanovits H, Laske H, Stark G, Sterz F, Schmidinger H, Schreiber W, Mullner M, Laggner AN "Adenosine for the management of patients with tachycardias - a new protocol." Eur Heart J 15 (1994): 589-93

34. Wesley RC Jr, Turnquest P "Torsades de pointe after intravenous adenosine in the presence of prolonged QT syndrome." Am Heart J 123 (1992): 794-6

35. Ho KY, Wilson NJ, Smith WM "Acute treatment of paroxysmal tachycardia by adenosine." Aust N Z J Med 24 (1994): 176-81

36. Exner DV, Muzyka T, Gillis AM "Proarrhythmia in patients with the Wolff-Parkinson-White Syndrome after standard doses of intravenous adenosine." Ann Intern Med 122 (1995): 351-2

37. Brodsky MA, Allen BJ, Grimes JA, Gold C "Enhanced atrioventricular conduction during atrial flutter after intravenous adenosine." N Engl J Med 330 (1994): 288-9

38. Obel IWP "Emergency treatment of acute sustained tachyarrhythmias." S Afr Med J 85 (1995): 745-6

39. Cave V, Heo J, Cassel D, Iskandrian B, Iskandrian AS "Side effects during adenosine thallium imaging with single-port or double-port infusion protocols." Am Heart J 124 (1992): 610-3

40. Reid PG, Watt AH, Routledge PA, Smith AP "Intravenous infusion of adenosine but not inosine stimulates respiration in man." Br J Clin Pharmacol 23 (1987): 331-8

41. Melcher A, Sylven C "Chest pain and oesophageal pressure relationships in man following an intravenous bolus of adenosine." Clin Physiol 9 (1989): 441-8

42. Keim S, Curtis AB, Belardinelli L, Epstein ML, Staples ED, Lerman BB "Adenosine-induced atrioventricular block: a rapid and reliable method to assess surgical and radiofrequency catheter ablation of accessory atrioventricular pathways." J Am Coll Cardiol 19 (1992): 1005-12

43. McIntosh-Yellin NL, Drew BJ, Scheinman MM "Safety and efficacy of central intravenous bolus administration of adenosine for termination of supraventricular tachycardia." J Am Coll Cardiol 22 (1993): 741-5

44. Bennettguerrero E, Young CC "Bronchospasm after intravenous adenosine administration." Anesth Analg 79 (1994): 386-8

45. Ali S, Mustafa SJ, Metzger WJ "Adenosine-induced bronchoconstriction and contraction of airway smooth muscle from allergic rabbits with late-phase airway obstruction: evidence for an inducible adenosine a(1) receptor." J Pharmacol Exp Ther 268 (1994): 1328-34

46. Aggarwal A, Farber NE, Warltier DC "Intraoperative bronchospasm caused by adenosine." Anesthesiology 79 (1993): 1132-5

47. Thorne JR, Broadley KJ "Adenosine-induced bronchoconstriction in conscious hyperresponsive and sensitized guinea pigs." Am J Respir Crit Care Med 149 (1994): 392-9

48. Drake I, Routledge PA, Richards R "Bronchospasm induced by intravenous adenosine." Hum Exp Toxicol 13 (1994): 263-5

49. Patton JW, Sharma GK "Adenosine-induced respiratory arrest in an asthmatic patient." South Med J 101 (2008): 328-9

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