Page 99 - 2026 SMOG

ADENOSINE (ADENOCARD)
Class/Mechanism of Action
• Antiarrhythmic Agent
Slows conduction time through the AV node, inhibits re-entry pathways through the AV node,
restoring normal sinus rhythm. The half-life of under 10 seconds allows for rapid repeat dosing.
Indications
• Labeled Indications
˚ For paroxysmal supraventricular tachycardia (PSVT), when clinically advisable, attempt vagal
maneuvers first. Not effective for conversion of atrial fibrillation, atrial flutter, or ventricular
tachycardia
• Off-Label Indications
˚ ALS/PALS Guidelines (2020): Stable, narrowcomplex regular tachycardias; unstable
narrowcomplex regular tachycardias while preparations are made for synchronized directcurrent
cardioversion; stable regular monomorphic, widecomplex tachycardia as a therapeutic (if SVT)
and diagnostic maneuver
Contraindications
• Hypersensitivity to adenosine or any component of the formulation
• Second- or third-degree AV block, sick sinus syndrome, or symptomatic bradycardia (except in
patients with a functioning artificial pacemaker)
• Use in patients with atrial fibrillation/flutter with underlying Wolff-Parkinson-White (WPW) syndrome
• Known or suspected bronchoconstrictive (asthma) or bronchospastic lung disease
Adverse Reactions/Precautions
• May cause transient asystole and new arrhythmia after cardioversion (PACs, AF, PVCs), chest
discomfort
• Headache, dizziness, flushing, GI upset
• Dyspnea, bronchospasm in asthmatics
• Pregnancy: Category C
• Lactation: Use caution
Dose/Administration
PEDIATRIC
ADULT
(Always reference Broselow Tape)
Paroxysmal Supraventricular Tachycardia Paroxysmal Supraventricular Tachycardia
(PSVT) (PSVT)
• IV/IO • IV/IO
˚ Rapid push over 1–2sec, via proximal ˚ As close to the core as possible, rapid push
over 1–2sec, followed immediately by a
peripheral line (forearm or above, large
bore), followed immediately by a normal normal saline flush.
saline flush ■ Initial: 0.1mg/kg (max INITIAL dose:
■ Initial: 6mg; if not effective within 6mg); if not effective within 1–2min,
1–2min, administer 12mg (max SINGLE administer 0.2mg/kg (max SINGLE dose:
dose: 12mg). Immediately follow each 12mg). Immediately follow each dose
dose with a 10–20mL normal saline flush. with a 5–10mL normal saline flush.
Note: Reduce the initial dose of adenosine to 3mg
if the patient is currently receiving carbamazepine
or dipyridamole, has a transplanted heart, or if
adenosine is administered via a central line
Note: Caffeine and theophylline antagonize the
effects of adenosine, and patients may require
higher doses
2026 Standard Medical Operating Guidelines (SMOG) • 91