Adenosine

ADENOSINE — adenosine injection, solution
AuroMedics Pharma LLC

1 INDICATIONS AND USAGE

Adenosine injection, USP is indicated as an adjunct to thallium-201 myocardial perfusion scintigraphy in patients unable to exercise adequately.

2 DOSAGE AND ADMINISTRATION

The recommended adenosine injection, USP dose is 0.14 mg/kg/min infused over six minutes (total dose of 0.84 mg/kg) (Table 1).

  • Administer adenosine injection, USP only as a continuous peripheral intravenous infusion
  • Inject Thallium-201 at the midpoint of the adenosine infusion (i.e., after the first three minutes of adenosine injection, USP)
  • Thallium-201 is physically compatible with adenosine injection, USP and may be injected directly into the adenosine infusion set
  • Inject Thallium-201 as close to the venous access as possible to prevent an inadvertent increase in the dose of adenosine injection, USP (the contents of the intravenous tubing) being administered

Visually inspect adenosine injection, USP for particulate matter and discoloration prior to administration. Do not administer adenosine injection, USP if it contains particulate matter or is discolored. There are no data on the safety or efficacy of alternative adenosine infusion protocols. The safety and efficacy of adenosine injection, USP administered by the intracoronary route have not been established.

Table 1 Dosage Chart for Adenosine Injection, USP
Patient Weight (kilograms) Infusion Rate (mL per minute over 6 minutes for total dose of 0.84 mg/kg)
452.1
502.3
552.6
602.8
653
703.3
753.5
803.8
854
904.2

The nomogram displayed in Table 1 was derived from the following general formula:

General Formula
(click image for full-size original)

3 DOSAGE FORMS AND STRENGTHS

Adenosine injection, USP is supplied as 20 mL and 30 mL single-dose vials containing a sterile, nonpyrogenic, clear colorless solution of adenosine USP 3 mg/mL.

4 CONTRAINDICATIONS

Adenosine injection is contraindicated in patients with:

5 WARNINGS AND PRECAUTIONS

5.1 Cardiac Arrest, Ventricular Arrhythmias, and Myocardial Infarction

Fatal and nonfatal cardiac arrest, sustained ventricular tachycardia (requiring resuscitation), and myocardial infarction have occurred following adenosine infusion. Avoid use in patients with symptoms or signs of acute myocardial ischemia, for example, unstable angina or cardiovascular instability; these patients may be at greater risk of serious cardiovascular reactions to adenosine injection. Appropriate resuscitative measures should be available [see Overdosage (10)].

5.2 Sinoatrial and Atrioventricular Nodal Block

Adenosine injection exerts a direct depressant effect on the SA and AV nodes and may cause first-, second- or third-degree AV block, or sinus bradycardia. In clinical trials, approximately 6% of patients developed AV block following adenosine injection administration (first-degree heart block developed in 3%, second-degree in 3%, and third-degree in 0.8% of patients) [see Clinical Trials Experience (6.1)].

Use adenosine injection with caution in patients with pre-existing first-degree AV block or bundle branch block. Do not use in patients with high-grade AV block or sinus node dysfunction (except in patients with a functioning artificial pacemaker). Discontinue adenosine injection in any patient who develops persistent or symptomatic high-grade AV block.

5.3 Bronchoconstriction

Adenosine injection administration can cause dyspnea, bronchoconstriction, and respiratory compromise. Adenosine injection should be used with caution in patients with obstructive lung disease not associated with bronchoconstriction (e.g., emphysema, bronchitis). Do not use in patients with bronchoconstriction or bronchospasm (e.g., asthma). Discontinue adenosine injection in any patient who develops severe respiratory difficulties. Resuscitative measures should be available prior to adenosine injection administration [see Clinical Trials Experience (6.1), Overdosage (10), and Clinical Pharmacology (12.2)].

5.4 Hypotension

Adenosine injection is a potent peripheral vasodilator and can induce significant hypotension. The risk of serious hypotension may be higher in patients with autonomic dysfunction, hypovolemia, stenotic valvular heart disease, pericarditis or pericardial effusions, or stenotic carotid artery disease with cerebrovascular insufficiency. Discontinue adenosine injection in any patient who develops persistent or symptomatic hypotension.

5.5 Cerebrovascular Accident

Hemorrhagic and ischemic cerebrovascular accidents have occurred. Hemodynamic effects of adenosine injection including hypotension or hypertension can be associated with these adverse reactions. [see Warnings and Precautions (5.4) and (5.9)].

5.6 Seizures

New-onset or recurrence of convulsive seizures has occurred following adenosine injection. Some seizures are prolonged and require emergent anticonvulsive management. Aminophylline may increase the risk of seizures associated with adenosine injection. Methylxanthine use is not recommended in patients who experience seizures in association with adenosine injection administration [see Overdosage (10)].

5.7 Hypersensitivity

Dyspnea, throat tightness, flushing, erythema, rash, and chest discomfort have occurred. Symptomatic treatment may be required. Have personnel and appropriate treatment available. Resuscitative measures may be necessary if symptoms progress. [see Post-Marketing Experience (6.2)].

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