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 →

AmiodaroneSevereDatabaseDDInter
AmisulprideSevereDatabaseDDInter
AnagrelideSevereDatabaseDDInter
ArbutamineSevereDatabaseDDInter

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

Amiodarone

Severe

Database

Drug interaction classified as: synergy.

Source: DDInter

Amisulpride

Severe

Database