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

Dosing Recommendations

Adenosine should be administered by rapid IV bolus over 1–2 seconds. It may be delivered directly into a vein or given through IV access in the port closest to the patient. The dose should be immediately followed by a rapid saline flush.[3,4] In patients without IV access, adenosine may be delivered through an intraosseous catheter.[18,19] Intraosseous administration has been shown in animal models to produce a rate of cardioversion similar to IV administration.[18]

In adults and children weighing 50 kg or more, the recommended initial adenosine dose is 6 mg. If the patient does not convert to normal sinus rhythm, a 12 mg dose may be given within 1–2 minutes. A subsequent 12 mg dose may be administered if needed. In children weighing less than 50 kg, the manufacturer recommends an IV adenosine dose of 0.05 to 0.1 mg/kg. If there is no response, subsequent doses may be increased by 0.5 to 0.1 mg/kg increments up to a maximum single dose of 0.3 mg/kg.[3,4]

Several consensus papers and policy statements, including the 2005 American Heart Association guidelines for pediatric cardiopulmonary resuscitation, recommend an initial adenosine dose of 0.1 mg/kg in infants and children, with an increase to 0.2 mg/kg for subsequent doses.[1,20] This recommendation has been based on the lack of response frequently observed with the 0.05 mg/kg dose.[6,11,12] In their retrospective study of 23 infants, Dixon and colleagues found that a dose of 0.05 mg/kg was effective in only 9% of their patients.[21] The recommended initial dose for intraosseous administration is also 0.1 mg/kg.[19]

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