Product Monograph
 Pharmacologic Stress in Myocardial Perfusion Imaging: Adenoscan
Dosing and Administration
Adenoscan is for intravenous infusion only (Figure 4). A syringe or volumetric infusion pump is recommended. Adenoscan should be continuously infused at a rate of 140 mcg/kg/min (total dose: 0.84 mg/kg) for 6 minutes through a peripheral intravenous line as close as possible to the cannula entering the arm. Thallium-201 should be injected at the midpoint of the infusion. Thallium-201 is compatible with Adenoscan and can be administered through the same port, but should be administered as close to the venous access as possible, to prevent an Adenoscan bolus.

FIGURE 4. Adenoscan infusion protocol.


Monitoring the Patient During the Infusion
ECG should be monitored continuously, and blood pressure and heart rate every minute, from the beginning of the infusion until baseline values return after the infusion stops. The blood pressure cuff should be applied on the arm opposite the one receiving Adenoscan. If side effects become serious or persistent, the Adenoscan infusion should be terminated. Theophylline may be administered to terminate side effects if needed (50 mg-125 mg slow intravenous injection).
  • Monitor ECG continuously, and BP and HR every minute, until baseline values return.
  • Administer Adenoscan through a continuous peripheral intravenous infusion.
  • Infuse adults at 140 mcg/kg/min for 6 minutes (total dose of 0.84 mg/kg).
  • Inject thallium-201 at midpoint (3 minutes) of infusion as close to the venous access as possible to prevent an inadvertent increase in the dose of Adenoscan (the contents of the IV tubing).

Table 6. Appropriate Infusion Rates Corrected for Total Body Weight
Patient Weight Infusion Rate Total Volume*
kg lb mL/min mL
45 99 2.1 12.6
50 110 2.3 14.0
55 121 2.6 15.4
60 132 2.8 16.8
65 143 3.0 18.2
70 154 3.3 19.6
75 165 3.5 21.0
80 176 3.8 22.4
85 187 4.0 23.8
90 198 4.2 25.2
*To calculate total volume of infusion (mL) for a specific patient, you may use the following formula: 0.28 mL/kg x total body weight (kg) = total volume (mL).
Dosages both higher and lower than those displayed above have been used clinically and can be calculated using the following formula:

0.140 (mg/kg/min) x total body weight (kg)
Adenoscan concentration (3 mg/mL)
=  infusion rate (mL/min)



Note: Parenteral drug products should be visually inspected for particulate matter and discoloration prior to administration.






IMPORTANT SAFETY INFORMATION

Intravenous Adenoscan® (adenosine injection) is indicated as an adjunct to thallium-201 myocardial perfusion scintigraphy in patients unable to exercise adequately.

Adenoscan is contraindicated in patients with 2nd- or 3rd-degree AV block, sinus node disease, and known or suspected bronchoconstrictive or bronchospastic lung disease.

Approximately 2.6% and 0.8% of patients developed second- and third-degree AV block, respectively. All episodes of AV block have been asymptomatic, transient, and did not require intervention; less than 1% required termination of adenosine infusion.

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.

Side effects that were seen most often included flushing (44%), chest discomfort (40%), and dyspnea (28%). Side effects usually resolve quickly when infusion is terminated and generally do not interfere with test results.

Despite adenosine’s short half-life, 10.6% of the side effects started several hours after the infusion terminated, and 8.4% of the side effects that began during the infusion persisted for up to 24 hours after infusion. In many cases, it is not possible to know whether these late adverse events are the result of Adenoscan infusion.

Please see full prescribing information.
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Imaging Efficacy
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Post-marketing Experience
Dosing and Administration
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