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Adenosine
Band Name Adenocor Injection
Drug Type Anti-arrhythmic
Indication Acute management of sustained supra ventricular tachycardia (SVT) in the
compromised infant.
Action Adenosine acts by depressing the sinus node and A-V conduction.
Presentation 6mg / 2ml ampoule. Any portion of the vial not used at once should be discarded.
Storage Store at room temperature. Do not refrigerate as crystallisation will occur. Solution
must be clear at time of use.
Dose Give 100microg/Kg as rapid IV push.
If unsuccessful after 2 minutes, give 200microg/Kg
If again unsuccessful after a further 2 minutes, give 300 microg/Kg.
Dilution Adenosine can be diluted with normal saline for doses < 0.2ml (600µg). Use 1ml
adenosine (3000µg) with 9ml normal saline to make 300µg / ml.
Administration Adenosine is administered by direct IV injection over 1-2 seconds followed by a
rapid sodium chloride 0.9% flush.
Ideally adenosine should be administered via a central venous line or large
peripheral vessel, but can be administered via a peripheral cannula.
Compatible Adenosine is compatible with dextrose 5% & N / saline.
Interactions Use of adenosine is not advised in infants with second or third degree AV block, or
sinus node dysfunction
Caution in patients capable of rapid AV conduction.
Methylxanthines including caffeine are competitive adenosine antagonists and have
the potential to diminish the efficacy of adenosine. An increase in the adenosine dose
may be required.
Side Effects Side effects include flushing; increased respiratory effort and irritability are common
but usually resolve within one minute. Apnoea is rare but has been observed.
Contraindications
Other Considerations Infant must have continuous cardio respiratory monitor (rhythm) and oximeter
insitu. Blood pressure before administration may be indicated. Response (sinus
rhythm) should occur within two minutes of dose. Arrhythmias may occur between
termination of SVT and onset of sinus rhythm.
Ensure resuscitation equipment is available. If emergency defibrillation is required
call paediatric arrest in NICU 222.
For elective defibrillation arrange with CNC (88700/87515) or nurse in charge of
shift (87816) (see SVT protocol). Recurrence of SVT occurs in about 30% of treated
infants. Continue observation of infant and report any change in rhythm. Once the
effects of adenosine have been noted, it may be necessary to institute long term anti
arrhythmic therapy.
arrhythmic therapy.
References 1. Australian Resuscitation Council Guidelines 2010: Guideline 12.5: Management
of specific dysrhythmias in Paediatric advanced life support.
2. National Women’s Hospital Newborn Services (2005). Drug Protocols –
Adenosine. Auckland
http://www.adhb.govt.nz/newborn/DrugProtocols/AdenosinePharmacology.htm
Accesssed June 2011
3. NSW Health (2008) Clinical Information Access Programme MIMS Online
Adenocor Injection. Accessed June 2011.
4. Sherwood M, Lau K, Sholler G. Adenosine in the management of supra
ventricular tachycardia in children J Paediatr Child Health 1998;34:53-56
5. Young TE & Magnum B (2005). Neofax® A Manual of Drugs used in Neonatal
Care (18th ed). Acorn Publishing, Inc