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Antiarrhythmic (Purinergic) Pregnancy: Use with caution — limited data; used in SVT in pregnancy

Adenosine

Brand names: Adenocor

Adult dose

Dose: 3 mg rapid IV bolus; if no response after 1–2 min: 6 mg; if still no response after 1–2 min: 12 mg
Route: IV rapid bolus into large proximal vein (antecubital or central)
Frequency: Sequential escalating doses
Max: 12 mg per dose
For termination of SVT involving AV node. Must be given as rapid bolus followed by saline flush. Causes transient AV block. Warn patient of chest tightness/flushing. Reduce dose with dipyridamole or cardiac transplant.

Paediatric dose

Dose: 0.1 mg/kg
Route: IV rapid bolus
Frequency: Escalate: 0.1 → 0.2 → 0.3 mg/kg
Max: 12 mg
Concentration: 3 mg/mL mg/ml
Dose 0.1 mg/kg; if no response 0.2 mg/kg; then 0.3 mg/kg. Maximum single dose 12 mg.

Dose adjustments

Renal

No dose adjustment — extremely short half-life (<10 seconds)

Hepatic

No dose adjustment

Paediatric weight-based calculator

Dose 0.1 mg/kg; if no response 0.2 mg/kg; then 0.3 mg/kg. Maximum single dose 12 mg.

Clinical pearls

  • Half-life ~10 seconds — must be injected rapidly then flushed immediately
  • Always have crash trolley available — transient asystole is expected
  • Diagnostic AND therapeutic in SVT — helps distinguish from VT during adenosine administration
  • In AF with WPW, adenosine is relatively contraindicated — may precipitate VF via accessory pathway

Contraindications

  • Second/third degree AV block (unless paced)
  • Sick sinus syndrome (unless paced)
  • Asthma/COPD with bronchospasm
  • Long QT syndrome
  • Atrial flutter/fibrillation with accessory pathway (WPW — may accelerate conduction)

Side effects

  • Chest tightness/pain (very common)
  • Facial flushing
  • Dyspnoea
  • Bradycardia/asystole (transient)
  • Nausea
  • Bronchospasm (in asthmatics — avoid)

Interactions

  • Dipyridamole — potentiates effect (reduce adenosine dose to 1 mg, use with extreme caution)
  • Theophylline/caffeine — antagonises effect (may need higher doses)
  • Carbamazepine — enhanced AV block

Monitoring

  • Continuous ECG monitoring during administration
  • Blood pressure
  • SpO2
  • Be ready for defibrillation

Reference: BNFc; BNF; Resuscitation Council UK ACLS Guidelines 2021; ESC SVT Guidelines 2019. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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