From the Guidelines
Adenosine is contraindicated in patients with sinus node disease, second- or third-degree atrioventricular block, and pulmonary issues such as bronchoconstrictive or bronchospastic lung disease, as stated in the most recent guideline from 2023 1. When considering the use of adenosine, it is crucial to weigh the potential benefits against the risks, particularly in patients with pre-existing conditions that may be exacerbated by the drug.
- The primary concerns include:
- Sinus node disease: Adenosine can worsen existing conduction abnormalities, leading to potentially severe cardiac complications.
- Second- or third-degree atrioventricular block: The drug's effects on the AV node can further disrupt conduction, resulting in significant morbidity or mortality.
- Pulmonary issues: Bronchoconstrictive or bronchospastic lung disease can be triggered or worsened by adenosine, leading to respiratory distress or failure. Additionally, caution should be exercised in patients with first-degree atrioventricular block, bundle-branch block, or a history of heart transplantation, as well as those with coronary artery disease, due to the potential for adverse cardiac effects 1. It is also worth noting that other studies, such as those from 2010 1 and 2016 1, provide guidance on the management of atrial fibrillation and supraventricular tachycardia, but the most recent and relevant guideline for adenosine contraindications is from 2023 1.
From the FDA Drug Label
4 CONTRAINDICATIONS
Adenosine injection is contraindicated in patients with: • 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) • Known hypersensitivity to adenosine injection
The contraindications to adenosine are:
- 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)
- Known hypersensitivity to adenosine injection 2
From the Research
Contraindications to Adenosine
- Adenosine is contraindicated in asthmatic subjects due to the risk of precipitating severe bronchospasm 3, 4
- The drug should be used with caution in patients with chronic obstructive pulmonary disease (COPD) 3, 5, 6
- Severe bronchospasm can occur even in patients without a history of pulmonary disease 3
- Adenosine may cause bronchoconstriction in subjects with asthma or COPD, although this effect may be dependent on the severity of the disease 6, 7
Special Considerations
- Patients with mild asthma or COPD can undergo adenosine stress testing with pretreatment with an inhaled beta(2)-adrenergic agonist, and the test is generally well-tolerated 6
- Dyspnea and chest pain are common side effects of adenosine, but are usually mild and well-tolerated 6
- Bronchospasm can occur in patients with asthma or COPD, but can be managed with discontinuation of the adenosine infusion and treatment with aminophylline if necessary 3, 6