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Adenosine is a vasodilating agent, which acts on the vascular smooth muscle surface and leads to vasodilation and a considerable increased vascular flow.
NB: This article aims to give a summarized description of adenosine. For detailed and exact information please refer to the information and direction for use or package insert from the pharmaceutical company.
It is commonly used for diagnostic purposes in cardiac stress testing and will accentuate the difference between the normal coronary arteries, which dilate under adenosine administration, and coronary stenoses, which remain fixed and cannot dilate any further 1-3.
It has been also used for diagnostic purposes and treatment in supraventricular tachycardia 3.
Adenosine binds non-selectively to A1, A2A, A2B and A3 receptors of which activation of A2A receptors lead to coronary vasodilation, which is required for the cardiac stress test 1,3.
Activation of A1, A2B and A3 receptors can lead to bronchospasm and atrioventricular block 1.
Adenosine has a half-life of 10-30 seconds.
The usual dosage used on cardiac stress tests is the following 1,2:
infusion of 140 µg/kg for 2-4 minutes
if there is no increase in heart rate by 10 beats per minute (bpm) or drop in blood pressure by ≥10 mmHg after 2-3 min of infusion an increase to 210 µg/kg might be considered subject to local and institutional norms 2.
Contraindications of adenosine include 1,2:
2nd or 3rd-degree atrioventricular block
sinus bradycardia (<40-45 bpm)
systolic blood pressure ≤90 mmHg
severe arterial hypertension (e.g. ≥220/120 mmHg)
acute myocardial infarction
known hypersensitivity to adenosine
active bronchoconstriction, asthma or bronchospastic disease requiring regular inhaler use
xanthines such as aminophylline, theophylline, and caffeine act as competitive antagonists
dipyridamole potentiates its action
Intravenous aminophylline: suggested dose 125 mg in 50 mL normal saline by IV infusion for 5–6 min
- 1. Jo Y, Kim J, Park C et al. Guideline for Cardiovascular Magnetic Resonance Imaging from the Korean Society of Cardiovascular Imaging—Part 1: Standardized Protocol. Korean J Radiol. 2019;20(9):1313. doi:10.3348/kjr.2019.0398 - Pubmed
- 2. Kramer C, Barkhausen J, Bucciarelli-Ducci C, Flamm S, Kim R, Nagel E. Standardized Cardiovascular Magnetic Resonance Imaging (CMR) Protocols: 2020 Update. J Cardiovasc Magn Reson. 2020;22(1):17. doi:10.1186/s12968-020-00607-1 - Pubmed
- 3. Eltzschig H, Warner D, Warner M. Adenosine: An Old Drug Newly Discovered. Anesthesiology. 2009;111(4):904-15. doi:10.1097/aln.0b013e3181b060f2 - Pubmed