What is the appropriate dose of adenosine for supraventricular tachycardia (SVT) with a heart rate of tachycardia and hypotension?

From the Guidelines

For supraventricular tachycardia (SVT) with a heart rate of tachycardia and hypotension, the recommended initial dose of adenosine is 6 mg given as a rapid IV push over 1-2 seconds, followed immediately by a saline flush, as supported by the most recent guidelines 1. The dose of adenosine for SVT is crucial in managing the condition effectively.

• The initial dose of 6 mg is recommended, with a possible second dose of 12 mg if the first dose is ineffective after 1-2 minutes, and a third dose of 12 mg can be given if necessary, as outlined in the guidelines 1.
• It is essential to use the most proximal IV access possible and elevate the extremity to ensure rapid delivery to the central circulation.
• Adenosine causes a brief period of asystole, which can be alarming but is expected, and the low blood pressure is concerning, so having vasopressors ready and considering alternative treatments like synchronized cardioversion if adenosine fails or if the patient becomes hemodynamically unstable is crucial.
• The mechanism of action of adenosine involves temporarily blocking AV node conduction, interrupting the reentry circuit that maintains most SVTs, allowing the heart to reset to normal sinus rhythm, as explained in the guidelines 1.
• The guidelines also highlight the importance of being aware of potential adverse effects, such as transient AV block, flushing, chest pain, hypotension, or dyspnea, and taking necessary precautions, such as avoiding the use of adenosine in patients with asthma or those taking certain medications like dipyridamole or carbamazepine, as noted in the guidelines 1.

From the FDA Drug Label

The recommended adenosine injection dose is 0.14 mg/kg/min infused over six minutes (total dose of 0.84 mg/kg) Recommended dose is 0.14 mg/kg/min infused over six minutes as a continuous peripheral intravenous infusion (total dose of 0. 84 mg/kg)

The appropriate dose of adenosine for supraventricular tachycardia (SVT) with a heart rate of tachycardia and hypotension is 0.14 mg/kg/min infused over six minutes as a continuous peripheral intravenous infusion, with a total dose of 0.84 mg/kg 2 2.

From the Research

Appropriate Dose of Adenosine for SVT

• The appropriate dose of adenosine for supraventricular tachycardia (SVT) with a heart rate of tachycardia and hypotension is not explicitly stated in the provided studies, but the standard dosing regimen is 6 mg, 12 mg, and 12 mg 3, 4, 5, 6.
• In cases where the standard dosing regimen fails to terminate SVT, higher doses of adenosine may be considered, as seen in a case report where a patient received 24 mg and 36 mg of adenosine 3.
• The efficacy of adenosine in converting SVT to sinus rhythm is high, with success rates ranging from 86.5% to 98% 4, 6.
• Adenosine is generally considered safe and effective for the treatment of SVT, even in patients with hypotension, with minimal risk of major adverse effects 5, 6.

Alternative Treatments

• Calcium channel blockers, such as verapamil and diltiazem, are alternative treatments for SVT and may be considered in patients who do not respond to adenosine or have contraindications to its use 4, 7.
• Slow infusion of calcium channel blockers has been shown to be effective and safe in the treatment of SVT, with a lower risk of hypotension compared to rapid bolus infusions 4.
• The choice of treatment for SVT should be individualized based on the patient's specific clinical presentation and medical history 3, 6.