ADENOSINE (adenosine)

There are 1 contraindications. These drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.

Drug Interaction

Drug Names

Adenosine; Regadenoson/Dipyridamole SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Dipyridamole inhibits cellular transport of adenosine.(1-3) Also, dipyridamole has been shown to increase intrinsic adenosine levels indicating that dipyridamole inhibits the intrinsic metabolism of adenosine.(4) Regadenoson is a derivative of adenosine.(5) CLINICAL EFFECTS: Concurrent dipyridamole may increase serum concentrations and potentiate the cardiovascular effects of adenosine. Conversely, significant bradycardia has occurred following rapid bolus injections of adenosine.(1-8) Dipyridamole may increase the effects of regadenoson.(1,2,5) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The recommendations for concurrent use of adenosine or regadenoson with dipyridamole is dependent on the indication. -For Cardioversion: The Australian manufacturer of adenosine states the use of adenosine for cardioversion is contraindicated in patients receiving dipyridamole. Discontinue the use of dipyridamole 24 hours prior to adenosine bolus dosing.(7) The US manufacturer of adenosine states smaller doses of adenosine may be effective with dipyridamole.(6) Lower the dose of adenosine in patients receiving dipyridamole.(1,2) Monitor for increased effects of adenosine. -For Stress Testing: Clinical practice guidelines from the American Society of Nuclear Cardiology state dipyridamole use within the previous 48 hours is a contraindication to adenosine or regadenoson stress testing.(9,10) The US manufacturer of dipyridamole recommends stopping dipyridamole for 48 hours prior to stress testing with intravenous dipyridamole or other adenosinergic agents (e.g. adenosine or regadenoson).(1) The Australian manufacturer of dipyridamole recommends stopping dipyridamole for 24 hours prior to stress testing with adenosine.(2) The US manufacturer of regadenoson recommends withholding dipyridamole for at least 2 days prior to regadenoson administration.(5) DISCUSSION: In a prospective, placebo-controlled single blinded study in eight healthy subjects, all patients were randomized to receive adenosine infusion on two separate days. Heart rate and skin temperature increased in a dose-related manner following adenosine administration. An increase in heart rate of 15 bpm occurred with 0.005 mg/kg/min of adenosine following administration of dipyridamole but did not change following saline. Blood pressure remained unchanged throughout the study.(11) According to another prospective, non-placebo controlled, non-blinded study, five healthy volunteers received a five-day course of oral dipyridamole 100 mg every 6 hours. Plasma adenosine levels were measured for a five day control period as a baseline and also during the five-day course of dipyridamole. It was found during the baseline studies that adenosine levels vary significantly between individuals but seem to be constant within the same individual. During the five-day course, the average increase in endogenous adenosine concentration was 60%. It was concluded that administration of oral dipyridamole significantly increases plasma adenosine levels in normal human subjects. Also, there was a positive correlation between adenosine and dipyridamole levels (p = 0.001).(12)

ASPIRIN-DIPYRIDAMOLE ER, DIPYRIDAMOLE

Drug contraindication overview.

Known hypersensitivity to adenosine. Second- or third-degree AV block (except in patients with a functioning artificial pacemaker). Sinus node disease, such as sick sinus syndrome or symptomatic bradycardia (except in patients with a functioning artificial pacemaker).

Known or suspected bronchoconstrictive or bronchospastic lung disease (e.g., asthma).

Adverse reaction overview.

Adverse effects reported in at least 1% of patients receiving adenosine for the treatment of PSVT in controlled clinical trials include facial flushing, shortness of breath/dyspnea, chest pressure, nausea, headache, lightheadedness, dizziness, numbness, and tingling in the arms. Adverse effects reported in at least 1% of patients receiving adenosine as an adjunct to thallium stress testing in controlled and uncontrolled clinical trials include facial flushing; chest discomfort; dyspnea or urge to breathe deeply; headache; discomfort in the throat, neck, or jaw; GI discomfort; lightheadedness/dizziness; upper extremity discomfort; ST-segment depression; first-degree AV block; second-degree AV block; paresthesia; hypotension; nervousness; and arrhythmias.

Although the manufacturer states that controlled studies establishing the safety and efficacy of adenosine for treatment of PSVT in pediatric patients are lacking, the drug has been used for the treatment of PSVT in neonates, infants, children, and adolescents, and some clinicians consider it a drug of choice for SVT in pediatric patients. Safety and efficacy as an adjunct to thallium stress testing not established in children 18 years of age or younger.

Contraindicated

None

Severe Precaution

None

Management or Monitoring Precaution

None