Adenosine for the Management of Neonatal and Pediatric Supraventricular Tachycardia

Contributing Editor: Marcia L. Buck, Pharm.D.; Editorial Board: Kristi N. Hofer, Pharm.D.; Michelle W. McCarthy, Pharm.D.

Disclosures

Pediatr Pharm. 2008;14(8) 

In This Article

Precautions

Administration of adenosine is contraindicated in patients with pre-existing second or third degree heart block or sinus node disease (including sick sinus syndrome and symptomatic bradycardia). All patients receiving adenosine should be closely monitored for the development of first, second, or third-degree heart block, asystole, or torsades de pointes immediately after dose administration. Although these arrhythmias are generally transient and require no treatment, there are reports of patients developing prolonged arrhythmias.[3,4]

Fatalities have occurred in adult patients who developed prolonged asytole or ventricular fibrillation after receiving adenosine.[3,4] Serious arrhythmias have also been reported in children treated with adenosine. In 1995, Kipel and colleagues reported a case of malignant wide complex tachycardia in a 10 year old boy who received adenosine two days after he had undergone a Fontan procedure.[15]

Adenosine is a respiratory stimulant and may produce severe bronchoconstriction and bronchospasm as a result of mast cell degradation and histamine release.[16] It should be used with caution in patients with obstructive lung disease and should be avoided in those with severe asthma or bronchospasm. Administration of adenosine should be immediately discontinued in patients who develop respiratory compromise.

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