Antiarrhythmic (purine nucleoside, transient AV block)
Preparation: 3 mg/ml (2 ml = 6 mg)
Regular narrow-complex tachycardia (SVT) – adults
- 6 mg i.v. (rapid bolus, immediately flush with 20 ml NaCl 0.9 %)[1]if vagal manoeuvres are unsuccessful · 3 mg/ml (2 ml = 6 mg) · = 2 ml
- 12 mg i.v. (rapid bolus)[1]2nd dose if unsuccessful · 3 mg/ml (2 ml = 6 mg) · = 4 ml
- 18 mg i.v. (rapid bolus)[1]consider 3rd dose · 3 mg/ml (2 ml = 6 mg) · = 6 ml
- Start with 3 mg, then 6 mg, then 9–12 mg (depending on the product) at intervals of 1–2 min; single doses > 12 mg are not provided for. i.v. – regimen of the German SmPCs[320]
Large-bore cannula as close to the heart as possible (antecubital fossa), three-way tap, record a 12-lead ECG. According to ERC 2025 only if the resting ECG shows no pre-excitation. Regimen depending on guideline or product (6 → 12 → 18 mg or 3 → 6 → 9–12 mg) – both are common; the 18 mg step is off-label (according to the SmPC – e.g. the Austrian SmPC of an adenosine product – no further dose after 12 mg) – before giving 18 mg, weigh individual tolerability and adverse effects (ERC 2025).
Supraventricular tachycardia – children
- 0.1–0.2 mg/kg i.v./i.o. (rapid bolus, flush immediately)[2]max. 6 mg · 1st dose · 3 mg/ml (2 ml = 6 mg)
- 0.3 mg/kg i.v./i.o. (rapid bolus)[2]max. 12 mg · 2nd dose after at least 1 min · 3 mg/ml (2 ml = 6 mg)
According to the Austrian SmPC of an adenosine product, first bolus 0.1 mg/kg (max. 6 mg) – the ERC upper limit of 0.2 mg/kg is off-label. According to ERC 2025, further doses are possible every 1–2 min in increments of 0.05–0.1 mg/kg up to max. 0.5 mg/kg single dose. Dilute for small children if necessary (volumes < 0.5 ml are difficult to draw up accurately).
| BW | 0.1–0.2 mg/kg i.v./i.o. (rapid bolus, flush immediately) · 3 mg/ml | 0.3 mg/kg i.v./i.o. (rapid bolus) · 3 mg/ml |
|---|---|---|
| 3 kg | 0.3–0.6 mg 0.1–0.2 ml | 0.9 mg 0.3 ml |
| 5 kg | 0.5–1 mg 0.17–0.33 ml | 1.5 mg 0.5 ml |
| 10 kg | 1–2 mg 0.33–0.67 ml | 3 mg 1 ml |
| 15 kg | 1.5–3 mg 0.5–1 ml | 4.5 mg 1.5 ml |
| 20 kg | 2–4 mg 0.67–1.33 ml | 6 mg 2 ml |
| 25 kg | 2.5–5 mg 0.83–1.67 ml | 7.5 mg 2.5 ml |
| 30 kg | 3–6 mg 1–2 ml | 9 mg 3 ml |
| 40 kg | 4–6 mg 1.33–2 ml max | 12 mg 4 ml |
Contraindications
- Second-/third-degree AV block or sick sinus syndrome without pacemaker
- Atrial fibrillation/flutter with pre-excitation (WPW) – risk of rapid conduction
- Bronchial asthma or obstructive lung disease with bronchospasm
- Long QT syndrome, severe hypotension, decompensated heart failure (SmPC)
Notes
- Half-life of a few seconds – only effective if given as a rapid bolus followed by a flush.
- Transient asystole/pauses, flushing, dyspnoea and chest tightness are common – inform the patient beforehand. Defibrillator ready.
- Reduce the dose with dipyridamole therapy, after heart transplantation and when given via a CVC; theophylline/caffeine attenuate the effect.
- Diagnostic use – unmasking of atrial flutter/atrial tachycardia if the tachycardia does not terminate.
- Broad-complex tachycardia – consider only if regular and monomorphic and SVT with bundle branch block is established (ERC); if in doubt, treat as VT.