Adenoscan
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Questions & Answers
Side Effects & Adverse Reactions
Fatal Cardiac Arrest, Life Threatening Ventricular Arrhythmias, and Myocardial Infarction
Fatal cardiac arrest, sustained ventricular tachycardia (requiring resuscitation), and nonfatal myocardial infarction have been reported coincident with Adenoscan infusion. Patients with unstable angina may be at greater risk. Appropriate resuscitative measures should be available.
Sinoatrial and Atrioventricular Nodal Block
Adenoscan (adenosine injection) exerts a direct depressant effect on the SA and AV nodes and has the potential to cause first-, second- or third-degree AV block, or sinus bradycardia. Approximately 6.3% of patients develop AV block with Adenoscan, including first-degree (2.9%), second-degree (2.6%), and third-degree (0.8%) heart block. Adenoscan can cause sinus bradycardia. Adenoscan should be used with caution in patients with pre-existing first-degree AV block or bundle branch block and should be avoided in patients with high-grade AV block or sinus node dysfunction (except in patients with a functioning artificial pacemaker). Adenoscan should be discontinued in any patient who develops persistent or symptomatic high-grade AV block. Sinus pause has been rarely observed with adenosine infusions.
Hypotension
Adenoscan (adenosine injection) is a potent peripheral vasodilator and can cause significant hypotension. Patients with an intact baroreceptor reflex mechanism are able to maintain blood pressure and tissue perfusion in response to Adenoscan by increasing heart rate and cardiac output. However, Adenoscan should be used with caution in patients with autonomic dysfunction, stenotic valvular heart disease, pericarditis or pericardial effusions, stenotic carotid artery disease with cerebrovascular insufficiency, or uncorrected hypovolemia, due to the risk of hypotensive complications in these patients. Adenoscan should be discontinued in any patient who develops persistent or symptomatic hypotension.
Hypertension
Increases in systolic and diastolic pressure have been observed (as great as 140 mm Hg systolic in one case) concomitant with Adenoscan infusion; most increases resolved spontaneously within several minutes, but in some cases, hypertension lasted for several hours.
Bronchoconstriction
Adenoscan (adenosine injection) is a respiratory stimulant (probably through activation of carotid body chemoreceptors) and intravenous administration in man has been shown to increase minute ventilation (Ve) and reduce arterial PCO2 causing respiratory alkalosis. Approximately 28% of patients experience breathlessness (dyspnea) or an urge to breathe deeply with Adenoscan. These respiratory complaints are transient and only rarely require intervention.
Adenosine administered by inhalation has been reported to cause bronchoconstriction in asthmatic patients, presumably due to mast cell degranulation and histamine release. These effects have not been observed in normal subjects. Adenoscan has been administered to a limited number of patients with asthma and mild to moderate exacerbation of their symptoms has been reported. Respiratory compromise has occurred during adenosine infusion in patients with obstructive pulmonary disease. Adenoscan should be used with caution in patients with obstructive lung disease not associated with bronchoconstriction (e.g., emphysema, bronchitis, etc.) and should be avoided in patients with bronchoconstriction or bronchospasm (e.g., asthma). Adenoscan should be discontinued in any patient who develops severe respiratory difficulties.
Atrial fibrillation
Atrial fibrillation has been reported in patients (with and without a history of atrial fibrillation) undergoing myocardial perfusion imaging with adenosine infusion. In these cases, atrial fibrillation began 1.5 to 3 minutes after initiation of adenosine, lasted for 15 seconds to 6 hours, and spontaneously converted to normal sinus rhythm.
Legal Issues
There is currently no legal information available for this drug.
FDA Safety Alerts
There are currently no FDA safety alerts available for this drug.
Manufacturer Warnings
There is currently no manufacturer warning information available for this drug.
FDA Labeling Changes
There are currently no FDA labeling changes available for this drug.
Uses
Intravenous Adenoscan is indicated as an adjunct to thallium-201 myocardial perfusion scintigraphy in patients unable to exercise adequately (See WARNINGS).
History
There is currently no drug history available for this drug.
Other Information
Adenosine is an endogenous nucleoside occurring in all cells of the body. It is chemically 6-amino-9-beta-D-ribofuranosyl-9-H-purine and has the following structural formula:
C10H13N5O4 267.24
Adenosine is a white crystalline powder. It is soluble in water and practically insoluble in alcohol. Solubility increases by warming and lowering the pH of the solution.
Each Adenoscan vial contains a sterile, non-pyrogenic solution of adenosine 3 mg/mL and sodium chloride 9 mg/mL in Water for Injection, q.s. The pH of the solution is between 4.5 and 7.5.
Sources
Adenoscan Manufacturers
-
Remedyrepack Inc.
![Adenoscan (Adenosine) Solution [Remedyrepack Inc. ]](/wp-content/themes/bootstrap/assets/img/loading2.gif)
Adenoscan | Remedyrepack Inc.
For intravenous infusion only.
Adenoscan should be given as a continuous peripheral intravenous infusion.
The recommended intravenous dose for adults is 140 mcg/kg/min infused for six minutes (total dose of 0.84 mg/kg).
The required dose of thallium-201 should be injected at the midpoint of the Adenoscan infusion (i.e., after the first three minutes of Adenoscan). Thallium-201 is physically compatible with Adenoscan and may be injected directly into the Adenoscan infusion set.
The injection should be as close to the venous access as possible to prevent an inadvertent increase in the dose of Adenoscan (the contents of the IV tubing) being administered.
There are no data on the safety or efficacy of alternative Adenoscan infusion protocols.
The safety and efficacy of Adenoscan administered by the intracoronary route have not been established.
The following Adenoscan infusion nomogram may be used to determine the appropriate infusion rate corrected for total body weight:
Patient Weight Infusion Rate kg lbs mL/min 45 99 2.1 50 110 2.3 55 121 2.6 60 132 2.8 65 143 3.0 70 154 3.3 75 165 3.5 80 176 3.8 85 187 4.0 90 198 4.2This nomogram was derived from the following general formula:
Note: Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration.
-
Remedyrepack Inc.
Adenoscan | Remedyrepack Inc.
For intravenous infusion only.
Adenoscan should be given as a continuous peripheral intravenous infusion.
The recommended intravenous dose for adults is 140 mcg/kg/min infused for six minutes (total dose of 0.84 mg/kg).
The required dose of thallium-201 should be injected at the midpoint of the Adenoscan infusion (i.e., after the first three minutes of Adenoscan). Thallium-201 is physically compatible with Adenoscan and may be injected directly into the Adenoscan infusion set.
The injection should be as close to the venous access as possible to prevent an inadvertent increase in the dose of Adenoscan (the contents of the IV tubing) being administered.
There are no data on the safety or efficacy of alternative Adenoscan infusion protocols.
The safety and efficacy of Adenoscan administered by the intracoronary route have not been established.
The following Adenoscan infusion nomogram may be used to determine the appropriate infusion rate corrected for total body weight:
Patient Weight Infusion Rate kg lbs mL/min 45 99 2.1 50 110 2.3 55 121 2.6 60 132 2.8 65 143 3.0 70 154 3.3 75 165 3.5 80 176 3.8 85 187 4.0 90 198 4.2This nomogram was derived from the following general formula:
Note: Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration.
-
Remedyrepack Inc.
Adenoscan | Remedyrepack Inc.
For intravenous infusion only.
Adenoscan should be given as a continuous peripheral intravenous infusion.
The recommended intravenous dose for adults is 140 mcg/kg/min infused for six minutes (total dose of 0.84 mg/kg).
The required dose of thallium-201 should be injected at the midpoint of the Adenoscan infusion (i.e., after the first three minutes of Adenoscan). Thallium-201 is physically compatible with Adenoscan and may be injected directly into the Adenoscan infusion set.
The injection should be as close to the venous access as possible to prevent an inadvertent increase in the dose of Adenoscan (the contents of the IV tubing) being administered.
There are no data on the safety or efficacy of alternative Adenoscan infusion protocols.
The safety and efficacy of Adenoscan administered by the intracoronary route have not been established.
The following Adenoscan infusion nomogram may be used to determine the appropriate infusion rate corrected for total body weight:
Patient Weight Infusion Rate kg lbs mL/min 45 99 2.1 50 110 2.3 55 121 2.6 60 132 2.8 65 143 3.0 70 154 3.3 75 165 3.5 80 176 3.8 85 187 4.0 90 198 4.2This nomogram was derived from the following general formula:
Note: Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration.
-
Astellas Pharma Us, Inc.
Adenoscan | Astellas Pharma Us, Inc.
The recommended Adenoscan dose is 0.14 mg/kg/min infused over six minutes (total dose of 0.84 mg/kg) (Table 1).
• Administer Adenoscan only as a continuous peripheral intravenous infusion • Inject Thallium-201 at the midpoint of the Adenoscan infusion (i.e., after the first three minutes of Adenoscan) • Thallium-201 is physically compatible with Adenoscan and may be injected directly into the Adenoscan infusion set • Inject Thallium-201 as close to the venous access as possible to prevent an inadvertent increase in the dose of Adenoscan (the contents of the intravenous tubing) being administeredVisually inspect Adenoscan for particulate matter and discoloration prior to administration. Do not administer Adenoscan if it contains particulate matter or is discolored.
There are no data on the safety or efficacy of alternative Adenoscan infusion protocols. The safety and efficacy of Adenoscan administered by the intracoronary route have not been established.
Table 1. Dosage Chart for AdenoscanPatient Weight
(kilograms)
Infusion Rate
(mL per minute over 6
minutes for total dose of
0.84 mg/kg)45
2.1
50
2.3
55
2.6
60
2.8
65
3
70
3.3
75
3.5
80
3.8
85
4
90
4.2
The nomogram displayed in Table 1 was derived from the following general formula:
0.14 (mg/kg/min) x
total body weight (kg) = Infusion rate
Adenoscan concentration (mL/min)
(3 mg/mL)
![Adenoscan (Adenosine) Solution [Remedyrepack Inc. ]](http://dailymed.nlm.nih.gov/dailymed/image.cfm?setid=cba928b6-605a-4ca8-b6dc-cf478e9ad4f4&name=MM3.jpg)
![Adenoscan (Adenosine) Solution [Remedyrepack Inc. ]](http://dailymed.nlm.nih.gov/dailymed/image.cfm?setid=8d14be75-5d52-4ff3-9124-6c2f06efef0f&name=MM3.jpg)
![Adenoscan (Adenosine) Solution [Astellas Pharma Us, Inc.]](http://dailymed.nlm.nih.gov/dailymed/image.cfm?setid=e49090c7-8968-405f-85d4-17a0ec5bfc58&name=36f7843e-e092-4cec-962e-f4a4f6081baa-03.jpg)
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