Drug reference

Adenosine

Endogenous purine nucleoside antiarrhythmic · Anti-arrhythmic

START

PSVT 6 mg rapid IV push + immediate flush (large proximal vein); if no effect 12 mg, repeat 12 mg once

TYPICAL MAX

12 mg per dose (repeat 12 mg once)

STOP IF

Severe/prolonged asystole or bronchospasm — usually self-limited (very short t½); have resuscitation

WATCH

Continuous ECG/rhythm strip during administration, asthma history, transient adverse effects (reassure), resuscitation availability

CDSCO approvedSchedule HATC C01EB10

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 18s · onset (<20 s)
PEAK: 18s · peak (~15 s)
t½: 11s · plasma t½ (<10 s)
DURATION: 36s · effect (<1 min)

EXCRETION

Rapid RBC/endothelial uptake to inosine

route + CYP

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

Use for maternal PSVT termination when needed — short-acting; generally acceptable

FDA category + note

Top interactionssee all 12 →

AcebrophyllineSevereDatabase
AmiodaroneSevereDatabaseDDInter
AmisulprideSevereDatabaseDDInter
AnagrelideSevereDatabaseDDInter

Available in India

11 branded formulations. Look up specific brands in the Drugs workspace.

Mechanism

Activates cardiac A1 adenosine receptors → transient AV-nodal conduction block (and sinus slowing) terminating AV-nodal re-entrant tachycardias; A2 vasodilation underlies pharmacologic stress testing; ultra-short acting (RBC/endothelial uptake).

Indications

Acute termination of paroxysmal supraventricular tachycardia (AV-nodal dependent)Diagnostic aid in wide-complex tachycardia (unmask atrial activity)Pharmacologic myocardial perfusion (stress) imaging

Dosing

Adult: PSVT: 6 mg rapid IV push (proximal large vein) with immediate saline flush; if no response in 1–2 min, 12 mg, may repeat 12 mg once. Stress imaging: continuous infusion per protocol.
Pediatric: 0.1 mg/kg rapid IV (max 6 mg), increase by 0.1 mg/kg (max 12 mg).
Renal adjustment: No adjustment (RBC/endothelial metabolism).
Hepatic adjustment: No adjustment.
Geriatric: Standard doses; cardiac comorbidity awareness.
Max dose: 12 mg per single PSVT dose (may repeat 12 mg once)

Pharmacokinetics

Onset

<20 s (rapid IV)

Peak effect

~10–20 s

Duration

Very brief (effect <1 min)

Half-life

<10 s (plasma)

Bioavailability

IV only

Protein binding

Not relevant (ultra-short)

Metabolism

Rapid uptake into RBC/endothelium → inosine/AMP (adenosine deaminase)

Excretion

Metabolic (not renal/hepatic relevant)

Contraindications

2nd/3rd degree AV block or sick sinus (without pacemaker)
Known severe asthma/bronchospastic disease (bronchoconstriction)
Long-QT syndrome (caution)
Hypersensitivity to adenosine

Side effects

Common

Transient flushingChest pressure/discomfortDyspnoeaTransient sinus pause/bradycardia, AV blockSense of impending doom (brief)

Serious

Transient asystole/prolonged sinus pause
Bronchospasm (asthma/COPD)
Atrial fibrillation induction; proarrhythmia (incl. in WPW, torsades — rare)
Severe bradycardia/heart block

Pregnancy & lactation

Pregnancy

Use for maternal PSVT termination when needed — short-acting; generally acceptable

Lactation

Compatible — ultra-short half-life (single emergency use)

Drug interactions

Acebrophylline

Severe

Database

Reduced efficacy of adenosine in treating supraventricular tachycardia

Avoid concomitant use. If adenosine is required, consider alternative antiarrhythmics or be aware that higher doses of adenosine may be needed and its effect may be blunted.

Amiodarone

Severe

Database

Drug interaction classified as: synergy.

Source: DDInter

Amisulpride

Severe

Database

Drug interaction classified as: synergy

Source: DDInter

Anagrelide

Severe