Adenosine "Ebeve"

Adenosine "ebeve" is a drug from the group of purine nucleotides. The use of the drug leads to stabilization of coronary blood flow and normalization of blood clotting. The drug has a metabolic, antiarrhythmic and arteriodilating effect. Adenosine "ebeve" is a drug from the group of purine nucleotides. The use of the drug leads to stabilization of coronary blood flow and normalization of blood clotting. The drug has a metabolic, antiarrhythmic and arteriodilating effect.

Indications Adenosine "Ebeve"

The drug is prescribed to patients for the rapid prevention of SVT (AV nodal reentrant, as well as ventricular reentrant), which are symptomatic and require therapy. It should be prescribed to patients only if vagal maneuvers have failed.

Release form

It is available in the form of an injection solution.

Pharmacodynamics

Adenosine has a dose-dependent negative dromo-, chrono-, and inotropic effect on the heart. Since the drug has a short half-life, the negative inotropic effect is not critical.

The antiarrhythmic effect occurs after rapid intravenous administration of adenosine, due to the dromotropic effect. It inhibits AV conduction, reduces the chemical reaction of calcium cellular channels, and increases the permeability of cardiomyocyte cells to potassium ions. At the same time, it prevents the action of cyclic AMP in cardiomyocytes, as a result of which normal cardiac rhythm is restored in patients with paroxysmal SVT (with the inclusion of the AV node in the mechanism of repeated impulse entry).

A negative chronotropic effect can cause the development of temporary sinus bradycardia, which then develops into sinus tachycardia.

Adenosine has no effect in cases of atrial flutter or atrial fibrillation, since in these cases the AV node is not involved in the re-entry mechanism.

At a dosage of 6-12 mg, it does not have a systemic hemodynamic effect. If the infusion is performed in large doses, the drug may cause a decrease in blood pressure.

Pharmacokinetics

Endothelial cells and red blood cells facilitate rapid removal of adenosine from the blood – the half-life is 10 seconds. The process of nucleoside metabolization converts adenosine into uric acid, which is excreted through the kidneys.

Dosing and administration

Adenosine is only permitted for use in hospital settings using equipment used for cardiopulmonary resuscitation. During the use of adenosine, ECG must be continuously monitored, as there is a risk of arrhythmia.

The first dose is 3 mg; if tachycardia continues after 1-2 minutes, a second dose (6 mg) is administered; if no improvement is observed after another 1-2 minutes, a third dose (9 mg) is administered; if tachycardia does not stop after 1-2 minutes, a fourth dose (12 mg) is administered.

Since the first dose (3 mg) has poor efficacy, adenosine therapy usually begins with the 2nd dose (6 mg).

If the 4th dose (12 mg) did not give the desired result, the solution can be administered again in the same dosage, or increased to 18 mg. After this, it is not recommended to administer the drug in the same dose or higher.

All the above dosages should be reduced if the treatment is carried out after a heart transplant or in combination with dipyridamole. However, when treating in combination with methylxanthine, the dosage of adenosine should be increased.

Adenosine is administered by bolus injection, which lasts 1-2 seconds. It should be administered into large peripheral veins, and then it is recommended to immediately administer a 0.9% NaCl solution (10 ml).

Use of adenosine in the diagnosis of cardiac ischemia.

Radioisotopes and Adenosine should be infused into different veins - this is necessary to avoid a bolus effect.

In the thallium-201 SPECT procedure, adenosine is injected intravenously over 6 min (at a rate of 140 μg/kg/min). Thallium-201 should be rapidly injected intravenously 3 min after adenosine administration has begun.

To avoid a bolus effect, blood pressure in the other arm should be monitored while adenosine is being administered.

Use Adenosine "Ebeve" during pregnancy

Since adenosine is a natural component present in all cells of the body, and its half-life is very short, the drug should not have a negative effect on the baby. However, since there is not enough information about the consequences of therapy with this drug, its use during pregnancy is recommended only for vital indications.

Contraindications

Among the contraindications to the use of the drug:

• Hypersensitivity to adenosine;
• AV block 2-3 degrees, as well as Short's syndrome (with the exception of patients with pacemakers);
• Obstructive pulmonary pathologies (eg, bronchial asthma);
• Long QT syndrome.

The drug is prescribed with caution in the following cases:

• In severe cases of CHF;
• Unstable angina;
• After a recent myocardial infarction;
• TP and AF (in patients with additional cardiac conduction pathways, transient increase in conduction is possible);
• After a recent heart transplant;
• Severe hypotension;
• If there is a history of sleep apnea;
• When shunting blood from left to right;
• Concomitant treatment with dipyridamole (in this case, adenosine can be prescribed in small doses, and only when there is a threat to the patient's life).

Side effects Adenosine "Ebeve"

Common side effects of the drug include shortness of breath, flushing of the face, bronchospasm, nausea, a feeling of tightness in the chest, and dizziness.

In addition, the following symptoms are possible: sweating, discomfort, increased heart rate, dizziness, increased intracranial pressure, hyperventilation, "blindness before the eyes", bradycardia, headache, asystole. In addition, there may be pain in the chest, paresthesia, drowsiness, back and neck pain, metallic taste in the mouth, and pharyngeal symptoms.

Most of these side effects are short-lived – less than 1 minute.

In rare cases, adenosine administration may result in a decrease in blood pressure and AF.

Rarely, side effects can be more prolonged and potentially life-threatening (ventricular fibrillation, ventricular flutter, and asystole). In such cases, electrotherapeutic intervention is sometimes required.

Overdose

Manifestations of drug overdose may be observed in case of taking in combination with dipyridamole. However, since adenosine has a very short half-life, the symptoms of overdose disappear quite quickly.

But there are also severe cases in which persistent bradycardia in a severe form may occur, as well as AF and asystole, for the elimination of which a temporary pacemaker or electrical cardioversion is required (this depends on the type of arrhythmia).

Interactions with other drugs

Dipyridamole reduces the strength of cellular uptake of adenosine, so it can enhance its effects. As a result, when treating with dipyridamole, adenosine is prescribed in small doses and only in cases of life-threatening conditions.

Caffeine, as well as theophylline and other xanthine derivatives, are adenosine antagonists, which reduce the strength of its effects on the body.

Carbamazepine enhances the negative dromotropic effect of adenosine.

Adenosine effectively interacts with other substances that affect AV conduction - these are ß-blockers, sodium channel modulators, CCBs, Digitalis drugs, as well as propanorm amiodarone.

Storage conditions

The medicine should be kept in a place closed to light and out of reach of small children. The temperature should not exceed 25°C. Freezing the solution is prohibited, as the active component is subject to crystallization.

Shelf life

Adenosine "ebeve" can be used for 3 years from the date of manufacture.