Adenosine is an endogenous purine nucleoside that is formed inside the body. It affects many biochemical pathways and acts on many systems in the body, inter alia, by connecting with its characteristic adenosine receptors located on the surface of cells.

Action and indications for the use of adenosine

Adenosine is involved:

  • in energy transport via ATP and ADP,
  • in transmitting genetic information as a building block of RNA and DNA
  • and in the control of nerve impulse transmission as a neurotransmitter that inhibits the central nervous system.

The binding of adenosine to the adenosine receptor has an effect on:

  • pain sensation control,
  • regulation of blood flow through the brain,
  • sleep and respiratory functions,
  • may have an immunosuppressive and immunostimulating effect on the immune system.

Adenosine blocks calcium channels, which affects its antiarrhythmic and vasodilating properties and has a negative dromotropic effect on the atrioventricular node (reducing the conduction velocity in the heart muscle).

The indications for the use of adenosine are:

  • symptomatic paroxysmal supraventricular tachycardia,
  • recurrent nodal tachycardia,
  • Recurrent atrioventricular tachycardia,
  • Wolff-Parkinson-White syndrome,
  • differential diagnosis of supraventricular tachycardia with wide or narrow QRS complexes.

Adenosine is not effective in treating atrial flutter, atrial fibrillation, or ventricular tachycardia.

Adenosine dosage

Adenosine is used as an injection solution only in hospital conditions with intensive medical supervision, under constant ECG monitoring. Dosing is by intravenous injection either directly into a vein or through a venous catheter.

The starting dose for an adult is 3 mg, in the case of no effect after 1-2 minutes, the dose is 6 mg, the maximum dose after another 1-2 minutes without effect is 12 mg.

In children, the starting dose is 0.1 mg per kg body weight (maximum 6 mg) and the dose may be increased by 0.1 mg per kg body weight each time(up to 12 mg).

In case of overdose, administration of aminophylline or theophylline may be necessary.

Contraindications for use and interactions

We can divide contraindications into two groups:

  • absolute
  • and relative.

The first ones are:

  • 2nd and 3rd degree atrioventricular block,
  • sick sinus syndrome,
  • atrial fibrillation,
  • atrial flutter,
  • obstructive pulmonary disease (e.g. bronchial asthma),
  • extended QT interval,
  • WPW team (delta wave in EKG).

You should also be especially careful in the case of relative contraindications (requiring additional consultations with a specialist), such as:

  • decompensated heart failure,
  • unstable angina,
  • sleep apnea,
  • severe hypertension,
  • right-left blood leak.

Adenosine should not be used in pregnant and breastfeeding people .

Adenosine should not be administered to patients taking dipyridamole. There is a potential for interactions also in patients taking β-blockers and β-sympathomimetics.

Substances such as caffeine, theophylline or other xanthines weaken the effect of adenosine. It should be remembered that they may be present in the patient's diet (coffee, tea, chocolate, cola).

Adenosine side effects

The use of adenosine is associated with the risk of side effects. The duration of side effects is usually not more than 1 minute due to the short half-life of adenosine. We distinguish among them:

  • facial flushing,
  • shortness of breath,
  • bronchospasm,
  • hyperventilation,
  • chest pains,
  • nausea,
  • dizziness,
  • sweats,
  • daze,
  • bradycardia,
  • Asystolia,
  • pressure drop.

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