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

Drug Interactions

In several of the fatalities reported after adenosine administration in adults, the patients were receiving digoxin and/or verapamil prior to being treated with adenosine. Although no definitive drug interaction has been identified, there may be an additive or synergistic effect on slowing AV node conduction. Adenosine should be used with caution in patients receiving either digoxin or verapamil. In addition, patients given adenosine who are already taking carbamazepine may be at greater risk of heart block.[3,4]

Dipyridamole potentiates the effects of adenosine by blocking its degradation.[3,4] Some resources consider adenosine contraindicated in patients receiving dipyridamole, due to the increased risk of heart block.[1] If adenosine is attempted in these patients, the dose should be reduced.

Methylxanthines (caffeine, aminophylline, and theophylline) antagonize the effects of adenosine. Larger adenosine doses may be required in order to achieve cardioversion in infants receiving a methylxanthine for apnea or in children receiving theophylline for asthma.[3,4] Berui described a premature infant being treated with aminophylline for apnea of prematurity and bronchopulmonary dysplasia who required high-dose adenosine.[17] When she developed SVT on day of life 16, the patient was treated with adenosine, with an initial dose of 0.05 mg/kg and subsequent dose titration to achieve response. Conversion to sinus rhythm did not occur until a dose of 0.4 mg/kg was given. Subsequent episodes of tachycardia required doses of 0.4 to 0.8 mg/kg for termination.

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