Adenine Deoxy Nucleoside Other names: Adenosine Adenyldeoxyriboside Deoxyadenosine Desoxyadenosine Adenine Deoxyribonucleoside Adenine Deoxyribose Adenine Nucleoside Adenine Riboside

Adenosine should be used with caution in patients with severe heart failure that could be transiently aggravated during infusion.

Adenosine should be used with caution in patients with recent myocardial infarction, severe heart failure, or in patients with minor conduction defects (first degree A-V block, bundle branch block) that could be transiently aggravated during infusion.

Adenosine should be used with caution in patients with atrial fibrillation or flutter and especially in those with an accessory by-pass tract since particularly the latter may develop increased conduction down the anomalous pathway.

Aminophylline, theophylline and other xanthines are competitive adenosine antagonists and should be avoided for 24 hours prior to use of adenosine. Food and drinks containing xanthines (tea, coffee, chocolate and cola) should be avoided for at least 12 hours prior to use of adenosine.

Because it has the potential to cause significant hypotension, adenosine should be used with caution in patients with pericarditis or pericardial effusion.

In patients with recent heart transplantation (less than 1 year) an increased sensitivity of the heart to adenosine has been observed.

Because it has the potential to cause significant hypotension, adenosine should be used with caution in patients with left main coronary stenosis.

Adenosine should be used with caution in patients with recent myocardial infarction that could be transiently aggravated during infusion.

Because it has the potential to cause significant hypotension, adenosine should be used with caution in patients with left main coronary stenosis, uncorrected hypovolemia, stenotic valvular heart disease, left to right shunt.

Because it has the potential to cause significant hypotension, adenosine should be used with caution in patients with stenotic valvular heart disease.

Because it has the potential to cause significant hypotension, adenosine should be used with caution in patients with autonomic dysfunction or stenotic carotid artery disease with cerebrovascular insufficiency.

Because it has the potential to cause significant hypotension, adenosine should be used with caution in patients with uncorrected hypovolemia.

Adenosine may trigger convulsions in patients who are susceptible to convulsions. In patients with history of convulsions/seizures, the administration of adenosine should be carefully monitored.

There are no or limited amount of data from the use of adenosine in pregnant women. Animal studies are insufficient with respect to reproductive toxicity. Adenosine is not recommended during pregnancy unless the physician considers the benefits to outweigh the potential risks.

It is unknown whether adenosine metabolites are excreted in human milk. Adenosine should not be used during breast-feeding.

Not applicable.

Effects related to the known pharmacology of adenosine are frequent, but usually self-limiting and of short duration. Discontinuation of infusion may be necessary if the effect is intolerable.

Methylxanthines, such as IV aminophylline or theophylline have been used to terminate persistent side effects (50–125 mg by slow intravenous injection).

Adverse events are ranked under the heading of the frequency: Very common (>1/10), common (≥1/100 to <1/10), uncommon (≥1/1000 to <1/100), rare (≥1/10000 to <1/1000), very rare (<1/10000), not known (cannot be estimated from available data).

Immune system disorders

Not known: anaphylactic reaction (including angioedema and skin reactions such as urticaria and rash).

Cardiac disorders

Common: ST segment depression, sustained or non-sustained ventricular tachycardia, AV block

If sustained second- or third-degree AV block develops the infusion should be discontinued. If first-degree AV block occurs, the patient should be observed carefully as a quarter of patients will progress to a higher degree of block.

Uncommon: bradycardia sometimes severe

Not known: asystole/cardiac arrest (sometimes fatal, especially in patients with underlying ischemic heart disease/cardiac disorders), sinus tachycardia, atrial fibrillation, ventricular fibrillation

Nervous system disorders

Very common: headache

Common: dizziness, light-headedness, paraesthesia

Rare: tremor, drowsiness

Not known: loss of consciousness/syncope, convulsions, especially in predisposed patients

Eye disorders

Rare: blurred vision

Ear and labyrinth disorders

Rare: tinnitus

Respiratory, thoracic and mediastinal disorders

Very common: dyspnea (or the urge to breathe deeply)

Rare: bronchospasm, nasal congestion

Very rare: respiratory failure

Not known: apnoea/respiratory arrest

Cases with fatal outcome of respiratory failure, of bronchospasm, and of apnoea/respiratory arrest have been reported.

Gastrointestinal disorders

Very common: abdominal discomfort

Common: dry mouth

Uncommon: metallic taste

Not known: nausea, vomiting

Renal and urinary disorders

Rare: urinary urgency

Vascular disorders

Very common: flushing

Common: hypotension, sometimes severe

General disorders and administration site conditions

Very common: chest pain or pressure, feeling of thoracic constriction/oppression

Common: throat, neck and jaw discomfort

Uncommon: sweating, discomfort in the leg, arm or back, feeling of general discomfort, weakness/pain

Very rare: injection site reactions

Reproductive system and breast disorders

Rare: nipple discomfort

Psychiatric disorders

Uncommon: nervousness