Product Monograph
 Pharmacologic Stress in Myocardial Perfusion Imaging: Adenoscan
References

1. Iskandrian AS. Cardiac imaging: which test, when, and why? Am J Card Imaging. 1991;5(suppl 1):2-6.

2. Weissman IA, Dickinson CZ, Dworkin HJ, O'Neill WW, Juni JE. Cost-effectiveness of myocardial perfusion imaging with SPECT in the emergency department evaluation of patients with unexplained chest pain. Radiology. 1996;199:353-357.

3. Verani MS, Mahmarian JJ. Myocardial perfusion scintigraphy during maximal coronary artery vasodilation with adenosine. Am J Cardiol. 1991;67:12D-17D.

4. Klabunde RE. Dipyridamole inhibition of adenosine metabolism in human blood. Eur J Pharmacol. 1983;93:21-26.

5. Moser GH, Schrader J, Deussen A. Turnover of adenosine in plasma of human and dog blood. Am J Physiol. 1989;256(4 Pt 1):C799-C806.

6. Wilson RF, Wyche K, Christensen BV, Zimmer S, Laxson DD. Effects of adenosine on human coronary arterial circulation. Circulation. 1990;82:1595-1606.

7. Verani MS, Mahmarian JJ, Hixson JB, Boyce TM, Staudacher RA. Diagnosis of coronary artery disease by controlled coronary vasodilation with adenosine and thallium-201 scintigraphy in patients unable to exercise. Circulation. 1990;82:80-87.

8. Cerqueira MD, Verani MS, Schwaiger M, Heo J, Iskandrian AS. Safety profile of adenosine stress perfusion imaging: results from the Adenoscan Multicenter Trial Registry. J Am Coll Cardiol. 1994;23:384-389.

9. DiMarco JP, Sellers TD, Lerman BB, Greenberg ML, Berne RM, Belardinelli L. Diagnostic and therapeutic use of adenosine in patients with supraventricular tachyarrhythmias. J Am Coll Cardiol. 1985;6:417-425.

10. Rossen JD, Quillen JE, Lopez AG, Stenberg RG, Talman CL, Winniford MD. Comparison of coronary vasodilation with intravenous dipyridamole and adenosine. J Am Coll Cardiol. 1991;18:485-491.

11. Siffring PA, Gupta NC, Mohiuddin SM, et al. Myocardial uptake and clearance of Tl-201 in healthy subjects: comparison of adenosine-induced hyperemia and exercise stress. Radiology. 1989;173:769-774.

12. Lee J, Chae SC, Lee K, Heo J, Iskandrian AS. Biokinetics of thallium-201 in normal subjects: comparison between adenosine, dipyridamole, dobutamine and exercise. J Nucl Med. 1994;35:535-541.

13. Adenoscan [package insert]. Deerfield, Ill: Astellas Pharma US, Inc.; 2005.

14. Nishimura S, Mahmarian JJ, Boyce TM, Verani MS. Equivalence between adenosine and exercise thallium-201 myocardial tomography: a multicenter, prospective, crossover trial. J Am Coll Cardiol. 1992;20:265-275.

15. Gupta NC, Esterbrooks DJ, Hilleman DE, Mohiuddin SM. Comparison of adenosine and exercise thallium-201 single-photon emission computed tomography (SPECT) myocardial perfusion imaging. J Am Coll Cardiol. 1992;19:248-257.

16. Nishimura S, Mahmarian JJ, Boyce TM, Verani MS. Quantitative thallium-201 single-photon emission computed tomography during maximal pharmacologic coronary vasodilation with adenosine for assessing coronary artery disease. J Am Coll Cardiol. 1991;18:736-745.

17. Ogilby JD, Iskandrian AS, Untereker WJ, Heo J, Nguyen TN, Mercuro J. Effect of intravenous adenosine infusion on myocardial perfusion and function: Hemodynamic/angiographic and scintigraphic study. Circulation. 1992;86:887-895.

18. Coyne EP, Belvedere DA, Vande Streek PR, Weiland FL, Evans RB, Spaccavento LJ. Thallium-201 scintigraphy after intravenous infusion of adenosine compared with exercise thallium testing in the diagnosis of coronary artery disease. J Am Coll Cardiol. 1991;17:1289-1294.

19. Nguyen T, Heo J, Ogilby JD, Iskandrian AS. Single photon emission computed tomography with thallium-201 during adenosine-induced coronary hyperemia: correlation with coronary arteriography, exercise thallium imaging and two-dimensional echocardiography. J Am Coll Cardiol. 1990;16:1375-1383.

20. Hachamovitch R, Berman DS, Kiat H, et al. Incremental prognostic value of adenosine stress myocardial perfusion single-photon emission computed tomography and impact on subsequent management in patients with or suspected of having myocardial ischemia. Am J Cardiol. 1997;80:426-433.

21. Watt AH, Reid PG, Stephens MR, Routledge PA. Adenosine-induced respiratory stimulation in man depends on site of infusion. Evidence for an action on the carotid body? Br J Clin Pharmacol. 1987;23:486-490.

22. Cushley MJ, Tattersfield AE, Holgate ST. Inhaled adenosine and guanosine on airway resistance in normal and asthmatic subjects. Br J Clin Pharmacol. 1983;15:161-165.





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.
Product Monograph
Overview
Pharmacology
Imaging Efficacy
Safety
Post-marketing Experience
Dosing and Administration
References
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