Adenosine is a chemical discovered in human cells. There are three various kinds: adenosine, adenosine monophosphate (amp), and adenosine triphosphate (atp).

Adenosine obstructs electrical signals in the heart that cause irregular heart rhythms. Atp might likewise avoid changes in energy metabolism that trigger weight-loss in people with advanced cancer.

An injectable kind of adenosine is a us fda-approved prescription drug for a condition including rapid heart rate (paroxysmal supraventricular tachycardia). It is likewise used as a prescription drug to assist measure obstructions in the arteries of the heart. People also use adenosine, amp, and atp as supplements for athletic performance, cold sores, and many other purposes, but there is no good evidence to support these usages. [2]

Pharmacological effects

Adenosine is an endogenous purine nucleoside that regulates numerous physiological processes. Cellular signaling by adenosine happens through 4 known adenosine receptor subtypes (a1, a2a, a2b, and a3).

Extracellular adenosine concentrations from regular cells are approximately 300 nm; nevertheless, in action to cellular damage (e.g., in inflammatory or ischemic tissue), these concentrations are quickly elevated (600– 1,200 nm). Therefore, in regard to stress or injury, the function of adenosine is primarily that of cytoprotection preventing tissue damage during circumstances of hypoxia, anemia, and seizure activity. Activation of a2a receptors produces a constellation of actions that in general can be classified as anti-inflammatory. Enzymatic production of adenosine can be anti-inflammatory or immunosuppressive.

Adenosine receptors

All adenosine receptor subtypes (a1, a2a, a2b, and a3) are g-protein-coupled receptors. The 4 receptor subtypes are further classified based upon their capability to either stimulate or prevent adenylate cyclase activity. The a1 receptors couple to gi/o and decreases camp levels, while the a2 adenosine receptors couple to gs, which promotes adenylate cyclase activity. In addition, a1 receptors couple to go, which has been reported to mediate adenosine inhibition of ca2+ conductance, whereas a2b and a3 receptors also combine to gq and promote phospholipase activity. Researchers at cornell university have recently revealed adenosine receptors to be type in opening the blood-brain barrier (bbb). Mice dosed with adenosine have revealed increased transport throughout the bbb of amyloid plaque antibodies and prodrugs related to parkinson’s illness, alzheimer’s, multiple sclerosis, and cancers of the main nervous system.

Ghrelin/growth hormonal agent secretagogue receptor

Adenosine is an endogenous agonist of the ghrelin/growth hormone secretagogue receptor. However, while it is able to increase hunger, unlike other agonists of this receptor, adenosine is unable to cause the secretion of growth hormone and increase its plasma levels.

Mechanism of action

When it is administered intravenously, adenosine causes short-term heart block in the atrioventricular (av) node. This is moderated via the a1 receptor, inhibiting adenylyl cyclase, minimizing camp and so triggering cell hyperpolarization by increasing k+ efflux via inward rectifier k+ channels, subsequently inhibiting ca2+ current. It likewise causes endothelial-dependent relaxation of smooth muscle as is found inside the artery walls. This triggers dilation of the “regular” sectors of arteries, i.e. Where the endothelium is not separated from the tunica media by atherosclerotic plaque. This feature permits physicians to utilize adenosine to evaluate for blockages in the coronary arteries, by exaggerating the difference between the normal and unusual sections.

The administration of adenosine likewise reduces blood circulation to coronary arteries past the occlusion. Other coronary arteries dilate when adenosine is administered while the section past the occlusion is already maximally dilated, which is a procedure called coronary take. This causes less blood reaching the ischemic tissue, which in turn produces the particular chest pain. [3]


Adenosine can be phosphorylated by adenosine kinase to form adenosine monophosphate. From there, it is phosphorylated once again by adenylate kinase 1 to form adenosine diphosphate, and once again by nucleoside diphosphate kinase a or b to form adenosine triphosphate.

Additionally, adenosine can be deaminated by adenosine deaminase to form inosine. Iosine is phosphorylated by purine nucleoside phosphorylase to form hypoxanthine. Hypoxanthine goes through oxidation by xanthine dehydrogenase twice to form the metabolites xanthine, followed by uric acid. [4]

Foods and sources

Which foods can increase atp? All macronutrients contribute to atp production, however a diet that consists of particular nutrients can assist boost production. The best way to support your body’s ability to make atp is to consume foods which contain:.

Copper– copper is associated with lots of metabolic procedures and is necessary for the synthesis of adenosine triphosphate, therefore copper shortage can lead to a slow metabolism, low energy and other indications of bad metabolic health.

Protein (which provide essential amino acids).

Foods that provide these nutrients include:.

  • Grass-fed meat, pastured poultry and organ meats, such as liver or kidneys
  • Wild-caught fish and seafood, such as salmon, sardines, halibut, orange roughy, tuna, ling, pike, cod, cusk, sunfish, haddock and whitefish
  • Free-range eggs
  • Nuts and seeds
  • One hundred percent whole grains and beans (i advise soaking them initially)
  • A range of veggies and fruits, consisting of sea vegetables like algae and spirulina

A well balanced diet is very important for preserving high energy levels since each macronutrient has various effects on atp. For example, when you consume carbs, you consume glucose, which is converted to saved energy inside your muscles in the form of glycogen. Glycogen is then changed by means of the procedure of glycolysis into atp. Fat can also be used to increase atp production, particularly when carbohydrates are not available.

Furthermore, oxygen is needed for atp production. Undoubtedly we acquire oxygen from breathing, particularly when taking deep breaths, doing deep breathing exercises and throughout physical activity when we breathe faster.

Utilizes in ayurveda and tcm

In traditional systems of medicine, adenosine/atp itself was rarely mentioned, but fatigue was a common illness that was treated. How did standard medicines such as ayurveda and traditional chinese medicine (tcm) assistance treat problems connected to poor energy metabolism and body immune system?

In ayurveda, lack of energy is believed to be caused by a mix of diet plan and lifestyle elements, including not eating the right food for one’s body type/constitution, tension, overwork, sleep deprivation, use of medications, disease and lack of physical activity. To treat tiredness, physical, psychological and emotional causes should all be resolved, which helps balance the main dosha energies, vata, pitta and kapha.

A healthy diet is utilized in ayurveda to enhance bad circulation and to bring blood and oxygen to broken tissues. Nutrient-dense foods are said to aid the stomach in the food digestion process, permitting more energy to be gotten from foods. The most essential remedy for tiredness is to consume whole foods that are as close to their natural state as possible– especially butter, ghee, cooked veggies and quality proteins. Stimulants such as coffee, tea, alcohol and tobacco ought to be decreased. Cold and iced beverages must likewise be reduced, while warm water and natural teas are encouraged. Finally, extreme exercise ought to be prevented until somebody feels better; yoga and breathing exercises must be practiced instead.

In tcm, someone is said to experience low energy when the body’s energy flow, called “qi,” becomes imbalanced, with excessive driven “yang” energy in the body and insufficient supporting “yin” energy. Tcm professionals suggest that anybody struggling with low energy abstain from alcohol, foods with added sugar, cold foods and processed foods. Warm, nourishing foods and drinks need to be consumed to bring energy up. Yin activities like resting, meditation, qigong, acupuncture and deep breathing are also methods to assist the body metabolize food better and keep more energy.

Adenosine vs. Caffeine

How is adenosine affected by caffeine? The two basically have opposite impacts on your energy levels and concentration. When you consume caffeine, it obstructs the impacts of adenosine in your brain. Caffeine is therefore considered an “ar villain.”.

Caffeine prevents adenosine from binding to various ar receptors (including a1, a2a, a3 and a2b receptors), decreasing its relaxing effects. This is how caffeine makes you feel more energized and alert– and in some cases also more pleased and upbeat. Caffeine can likewise obstruct adenosine from binding to a2a receptors, which can increase the release of “feel great” chemicals like dopamine and glutamate that enhance your mood and inspiration.

This is also the factor that adenosine must not be taken, or taken very carefully, with competitive methylxanthines, consisting of caffeine and theophylline. [5]

Medical usages

Supraventricular tachycardia

In individuals with supraventricular tachycardia (svt), adenosine is utilized to help recognize and convert the rhythm.

Certain svts can be successfully ended with adenosine. This includes any re-entrant arrhythmias that need the av node for the re-entry, e.g., av reentrant tachycardia (avrt), av nodal reentrant tachycardia (avnrt). In addition, atrial tachycardia can sometimes be terminated with adenosine.

Fast rhythms of the heart that are confined to the atria (e.g., atrial fibrillation, atrial flutter) or ventricles (e.g., monomorphic ventricular tachycardia) and do not involve the av node as part of the re-entrant circuit are not usually converted by adenosine. Nevertheless, the ventricular reaction rate is briefly slowed with adenosine in such cases.

Because of the effects of adenosine on av node-dependent svts, adenosine is thought about a class v antiarrhythmic representative. When adenosine is utilized to cardiovert an irregular rhythm, it is typical for the heart to enter ventricular asystole for a couple of seconds. This can be perturbing to a typically conscious client, and is associated with angina-like feelings in the chest.

Nuclear stress test

Adenosine is used as an adjunct to thallium (ti 201) or technetium (tc99m) myocardial perfusion scintigraphy (nuclear stress test) in clients not able to undergo appropriate stress testing with exercise. [6]

What is it prescribed for?

Paroxysmal supraventricular tachycardia

This medicine is used for the treatment of paroxysmal supraventricular tachycardia (irregular, rapid heart rate) including that associated with wolff-parkinson-white syndrome and which is unresponsive to vagal maneuvers.

Heart stress test

This medication is used along with other medicines during a stress test of the heart in patients who are not able to exercise adequately. A stress test is done to determine how well the heart is working during workout (external tension). [7]

Side effects

In addition to its required effects, a medicine may cause some undesirable results. Although not all of these side effects may occur, if they do happen they may require medical attention.

Consult your medical professional or nurse instantly if any of the following adverse effects happen:.

More common

  • Chest discomfort
  • Tough or labored breathing
  • Lightheadedness or dizziness
  • Throat, neck, or jaw pain
  • Tightness in the chest
  • Less common
  • Chest pain
  • Confusion
  • Lightheadedness, faintness, or lightheadedness when getting up all of a sudden from a lying or sitting position
  • Fainting
  • Fast, sluggish, or irregular heartbeat
  • Sweating
  • Distressed breathing
  • Unusual tiredness or weakness


  • Quick, irregular, pounding, or racing heart beat or pulse
  • Headache
  • Nervousness
  • Pounding in the ears

Some side effects may occur that typically do not require medical attention. These side effects may go away throughout treatment as your body adjusts to the medicine. Likewise, your healthcare expert may have the ability to tell you about methods to prevent or reduce some of these negative effects. Talk to your healthcare professional if any of the following side effects continue or are bothersome or if you have any questions about them:.

More common

  • Diarrhea
  • Feeling of warmth
  • Indigestion
  • Anorexia nervosa
  • Queasiness or throwing up
  • Passing of gas
  • Soreness of the face, neck, arms, and periodically, upper chest
  • Stomach discomfort, fullness, or pain


  • Area of decreased vision
  • Cough
  • Pain in the back, ears, or tongue
  • Sleepiness
  • Dry mouth
  • Metal taste
  • Mood changes
  • Shakiness in the legs, arms, hands, or feet
  • Stuffy nose
  • Shivering or shaking of the hands or feet

Other side effects not listed may also occur in some clients. If you see any other effects, check with your health care specialist. [8]

How to take adenosine (adenocard)?

Use adenosine (adenocard) precisely as directed on the label, or as prescribed by your medical professional. Do not use in larger or smaller quantities or for longer than advised.

Before your heart stress test: avoid coffee, tea, cola, chocolate, energy beverages or other sources of caffeine. They can interfere with the results of your test.

Adenosine is provided as an infusion into a vein. A doctor will offer you this injection.

You may get only one dose of this medicine. Repeat dosages might be given if required to bring back normal heartbeats.

Your breathing, high blood pressure, oxygen levels, and other vital signs will be enjoyed carefully.

Your heart rate will be continuously kept an eye on utilizing an electrocardiograph or ecg (in some cases called an.

Ekg). This will help your medical professional figure out for how long to treat you with adenosine. [9]

Adenosine dose

Applies to the following strengths: 25 mg/ml; 3 mg/ml; 300 mcg/50 ml-nacl 0.9%; monophosphate; triphosphate; 50 mcg/ml-nacl 0.9%; 1 mg/ml-nacl 0.9%.

Usual adult dosage for:.

  • Radionuclide myocardial perfusion research study
  • Supraventricular tachycardia
  • Wolff-parkinson-white syndrome

Typical pediatric dose for:.

  • Supraventricular tachycardia
  • Extra dose information:
  • Renal dosage changes
  • Liver dosage adjustments
  • Preventative measures
  • Dialysis
  • Other remarks

Typical adult dosage for radionuclide myocardial perfusion study

0.14 mg/kg/min infused over 6 minutes (total dosage of 0.84 mg/kg).

Comments: administer only as a continuous peripheral iv infusion.

Inject thallium 201 at the infusion midpoint; might inject straight into the adenosine infusion set as near to venous access as possible to prevent unintended boost in the adenosine dose (the contents of the intravenous tubing).

Use: accessory to thallium 201 myocardial perfusion scintigraphy in patients unable to work out adequately.

Usual adult dose for supraventricular tachycardia

Preliminary dose: 6 mg iv bolus over 1 to 2 seconds.

Repeat dose: if preliminary dosage stops working to get rid of supraventricular tachycardia within 1 to 2 minutes: 12 mg iv bolus over 1 to 2 seconds; might repeat a second time if required.

Optimum dosage: 12 mg.

Comments: for rapid iv bolus only; should be given peripherally.

Administer straight into a vein or, if provided into an iv line, as close to the patient as possible followed by a quick saline flush.

This drug does not convert atrial flutter, atrial fibrillation, or ventricular tachycardia to normal sinus rhythm; when atrial flutter or fibrillation is present, a transient modest slowing down of ventricular reaction may occur right away after administrating this drug.

Use: conversion to sinus rhythm of paroxysmal supraventricular tachycardia (psvt), consisting of that associated with accessory bypass systems (wolff-parkinson-white syndrome). When scientifically advisable, appropriate vagal maneuvers (e.g., valsalva maneuver), should be tried prior to administration of this drug.

Typical adult dose for wolff-parkinson-white syndrome

Preliminary dosage: 6 mg iv bolus over 1 to 2 seconds.

Repeat dosage: if preliminary dosage stops working to eliminate supraventricular tachycardia within 1 to 2 minutes: 12 mg iv bolus over 1 to 2 seconds; may repeat a 2nd time if required.

Maximum dosage: 12 mg.

Remarks: for quick iv bolus just; must be offered peripherally.

Administer straight into a vein or, if offered into an iv line, as close to the client as possible followed by a quick saline flush.

This drug does not transform atrial flutter, atrial fibrillation, or ventricular tachycardia to typical sinus rhythm; when atrial flutter or fibrillation exists, a short-term modest slowing of ventricular response might take place right away after administrating this drug.

Usage: conversion to sinus rhythm of paroxysmal supraventricular tachycardia (psvt), including that related to accessory bypass tracts (wolff-parkinson-white syndrome). When scientifically suggested, proper vagal maneuvers (e.g., valsalva maneuver), need to be tried prior to administration of this drug.

Typical pediatric dose for supraventricular tachycardia

Less than 50 kg:.

Preliminary dose: 0.05 to 0.1 mg/kg iv bolus over 1 to 2 seconds.

Repeat dosage: if initial dose fails to eliminate supraventricular tachycardia within 1 to 2 minutes, repeat at incrementally higher doses, increasing by 0.05 to 0.1 mg/kg, up until sinus rhythm or maximum single dosage obtained.

50 kg or more:.

Initial dose: 6 mg iv bolus over 1 to 2 seconds.

Repeat dosage: if initial dose stops working to remove supraventricular tachycardia within 1 to 2 minutes: 12 mg iv bolus over 1 to 2 seconds; may duplicate a 2nd time if needed.

Maximum dose: 0.3 mg/kg; 12 mg.

Remarks: for quick iv bolus just; might be given centrally or peripherally.

Administer straight into a vein or, if provided into an iv line, as near to the client as possible followed by a rapid saline flush.

Follow each bolus with a saline flush.

This drug does not transform atrial flutter, atrial fibrillation, or ventricular tachycardia to regular sinus rhythm; when atrial flutter or fibrillation exists, a transient modest slowing of ventricular action may occur instantly after supervising this drug.

Usage: conversion to sinus rhythm of paroxysmal supraventricular tachycardia (psvt). When scientifically advisable, suitable vagal maneuvers (e.g., valsalva maneuver), need to be tried prior to administration of this drug.

Renal dose adjustments

No modification advised.

Liver dosage changes

No change recommended.


Adenoscan( r) safety and effectiveness have actually not been developed in patients more youthful than 18 years. [10]

What other drugs communicate with adenosine?

If your medical professional has directed you to use this medication, your physician or pharmacist might already know any possible drug interactions and may be monitoring you for them. Do not begin, stop, or alter the dose of any medicine prior to checking with your physician, health care service provider, or pharmacist initially.

Adenosine has no known extreme interactions with other drugs.

Adenosine has no recognized major interactions with other drugs.

Moderate interactions of adenosine consist of:.

  • Dipyridamole
  • Dyphylline
  • Green tea
  • Hawthorn
  • Nicotine inhaled
  • Nicotine intranasal
  • Sevelamer
  • Theophylline
  • Moderate interactions of adenosine consist of:
  • Acebutolol
  • Atenolol
  • Betaxolol
  • Bisoprolol
  • Caffeine
  • Carvedilol
  • Celiprolol
  • Esmolol
  • Labetalol
  • Lily of the valley
  • Metoprolol
  • Nadolol
  • Nebivolol
  • Penbutolol
  • Pindolol
  • Propranolol
  • Sotalol
  • Timolol

This info does not contain all possible interactions or unfavorable impacts. For that reason, before using this item, inform your doctor or pharmacist of all the items you use. Keep a list of all your medications with you, and share this info with your medical professional and pharmacist. Consult your healthcare expert or physician for additional medical suggestions, or if you have health concerns, issues, or for more details about this medication. [11]

When not to utilize?

Allergy: this medication is not advised for use in patients with a known allergy to adenosine or any other non-active ingredient present together with it.

Second or third-degree atrioventricular block: this medicine is not advised for use in patients experiencing a 2nd or third-degree atrioventricular block and who have not gone through pacemaker implantation given that it might get worse the patient’s condition.

Sick sinus syndrome: this medicine is not recommended for use in clients struggling with ill sinus syndrome and who have actually not gone through pacemaker implantation since it may aggravate the client’s condition.

Serious hypotension/shock: this medication is not advised for usage in patients suffering from a really low high blood pressure (serious hypotension) or shock due to the increased danger of worsening of the patient’s condition.

Cardiac arrest: this medicine is not suggested for use in clients suffering from a cardiac arrest considering that it might get worse the client’s condition.

Asthma: this medication is not suggested for use in patients struggling with asthma or any other serious breathing condition due to the increased danger of aggravating of the patient’s condition.

Long qt syndrome: this medicine is not recommended for use in clients experiencing an uncommon heart issue known as long qt syndrome given that it may aggravate the client’s condition.


Cautions for special population.

Pregnancy: this medicine is not recommended for use in pregnant females unless definitely needed. All the threats and benefits should be gone over with the physician prior to getting this medicine.

Breast-feeding: this medicine is not suggested for use in breastfeeding ladies unless absolutely required. All the risks and advantages need to be discussed with the medical professional prior to receiving this medicine. Your medical professional might recommend you to stop breastfeeding for a specific period of time based upon your clinical condition.

General cautions

Other medicines: this medicine may connect with lots of other medicines and might cause extreme unfavorable effects. For this reason, it is recommended that you report all your existing medicines including any herbs and supplements to the doctor before getting this medicine.

Heart block: administration of this medicine might produce a short long lasting first, second, or third-degree heart block. Suitable restorative steps must be initiated based on the patient’s clinical condition. If clients establish a high-level heart block after the initial dose, extra doses ought to not be given.

Arrythmias: use of this medicine might cause the look of a range of short-lasting brand-new heart rhythms on the electrocardiogram. It is recommended to continually keep an eye on the heart rhythm of the client while this medication is being administered.

Bronchoconstriction: use of this medicine may make the airways leading to the lungs more narrow and cause getting worse of symptoms of asthma, copd, and other obstructive lung diseases. It is recommended to administer this medicine with severe caution in clients with obstructive disease of the lungs and the breathing system. Replacement with an ideal option may be required based on the patient’s condition.

Cardiovascular disease: this medicine needs to be utilized with severe care in patients who have had a heart attack, heart failure, or have had a heart transplant done within the last 1 year. It must likewise be utilized with severe care in patients suffering from narrowing of the heart valves, swelling and enlargement of tissues around the heart, or other recognized heart flaws. Close monitoring of heart function, proper dose adjustments, or replacement with an appropriate option may be required based upon the clinical condition of the client.

Low blood volume: this medication must be utilized with severe care in patients with a low blood volume level that has not been corrected (hypovolemia) since it might get worse the client’s condition. Proper restorative procedures and/or replacement with an ideal alternative may be essential based upon the scientific condition of the client.

Seizure condition: this medicine needs to be utilized with care in clients with a history of seizures or convulsions due to the increased threat of getting worse of the patient’s condition. Close monitoring of medical condition, suitable dosage adjustments, or replacement with an ideal option may be necessary sometimes.

Caffeine uptake: use of caffeine and caffeine-containing items should be avoided for 12 to 24 hours before the administration of this medication considering that these items might lower the efficiency of this medication. [12]

Further more care

  • Symptomatic sluggish heart rate (bradycardia), cardiac arrest, heart block, heart transplant patients, hypertension (hypertension), low blood pressure (hypotension), heart attack, frequent event of pre-existing arrhythmias (proarrhythmic) occasions, low blood circulation to the heart (unsteady angina)
  • Adenocard: caution with bronchoconstrictive or bronchospastic lung disease (asthma)
  • Cerebrovascular accident hemorrhagic and ischemic cerebrovascular accidents reported; hemodynamic effects of adenosine including low high blood pressure or high blood pressure perhaps related to these adverse reactions
  • Nucleoside transport inhibitors (dipyridamole) and potentiate the vasoactive impacts of adenosine; withhold for 5 half-lives before adenosine administration
  • Methylxanthines (caffeine, theophylline) are adenosine receptor villains and prevent adenosine’s vasoactive effects; withhold methylxanthines for 5 half-lives before adenosine administration
  • New-onset or reoccurrence of convulsive seizures reported following adenosine; some seizures are extended and need emergent anticonvulsive management; aminophylline may increase risk of seizures associated with adenosine;
  • Methylxanthine usage is not suggested in clients who experience seizures in association with adenosine administration
  • Problem breathing, throat tightness, flushing, reddening of the skin, rash, and chest discomfort reported that might require symptomatic treatment; resuscitative measures might be required if signs progress; have trained personnel and treatment readily available throughout treatment
  • Arrhythmia at time of cardioversion (adenocard): ventricular fibrillation reported following administration, consisting of both resuscitated and deadly events; in the majority of instances, these cases were associated with the concomitant use of digoxin and, less regularly with digoxin and verapamil
  • Threat for myocardial infarction and death
  • Prevent use for cardiac nuclear stress tests in patients with signs or symptoms of acute myocardial anemia (unstable chest pain [angina], cardiovascular instability); use may increase the danger of deadly heart attack (myocardial infarction [mi]
  • Screen all nuclear stress test prospects for threats

Pregnancy and lactation

Usage adenosine during pregnancy with care if the benefits exceed the dangers. Animal studies show risk and human studies are not readily available, or neither animal nor human research studies were done.

Adenosine use when breastfeeding has the capacity for serious unfavorable responses in nursing babies. A choice to interrupt nursing after administration of adenosine should consider the significance of the drug to the mom [13]


In conclusion, adenosine is released in reaction to organ stress or tissue damage and displays cytoprotective effects, in general, both in the brain and in the periphery. When extreme activity happens in a provided organ, adenosine acts as an endogenous silencing compound, to either minimize the energy demand or increase the energy supply to that organ. Almost every cell key in the body reveals one or more of the ar subtypes, which suggests the main function of this feedback system in protecting organs and tissues and in tissue regrowth. Therefore, a common theme to the restorative applications proposed for agonists is that adenosine serves as a cytoprotective modulator in reaction to tension to an organ or tissue. [14]


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