Table of Contents
Adenosine is a chemical found in human cells. There are three various types: adenosine, adenosine monophosphate (amp), and adenosine triphosphate (atp).
Adenosine obstructs electrical signals in the heart that trigger irregular heart rhythms. Atp may likewise avoid changes in energy metabolism that cause weight reduction in individuals with innovative cancer.
An injectable type of adenosine is a us fda-approved prescription drug for a condition including rapid heart rate (paroxysmal supraventricular tachycardia). It is also used as a prescription drug to assist determine blockages in the arteries of the heart. Individuals also utilize adenosine, amp, and atp as supplements for athletic performance, fever blisters, and many other functions, however there is no good proof to support these usages. 
Adenosine is an endogenous purine nucleoside that regulates numerous physiological processes. Cellular signaling by adenosine takes place through four known adenosine receptor subtypes (a1, a2a, a2b, and a3).
Extracellular adenosine concentrations from regular cells are around 300 nm; however, in action to cellular damage (e.g., in inflammatory or ischemic tissue), these concentrations are quickly raised (600– 1,200 nm). Hence, in regard to stress or injury, the function of adenosine is mainly that of cytoprotection preventing tissue damage throughout circumstances of hypoxia, ischemia, 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.
All adenosine receptor subtypes (a1, a2a, a2b, and a3) are g-protein-coupled receptors. The four receptor subtypes are more classified based on their ability to either stimulate or inhibit adenylate cyclase activity. The a1 receptors couple to gi/o and reduces 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 likewise pair to gq and promote phospholipase activity. Researchers at cornell university have actually recently shown adenosine receptors to be key in opening the blood-brain barrier (bbb). Mice dosed with adenosine have revealed increased transportation across the bbb of amyloid plaque antibodies and prodrugs connected with parkinson’s illness, alzheimer’s, numerous sclerosis, and cancers of the main nerve system.
Ghrelin/growth hormonal agent secretagogue receptor
Adenosine is an endogenous agonist of the ghrelin/growth hormonal agent secretagogue receptor. Nevertheless, while it has the ability to increase appetite, 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 triggers short-term heart block in the atrioventricular (av) node. This is mediated by means of the a1 receptor, preventing adenylyl cyclase, lowering camp therefore triggering cell hyperpolarization by increasing k+ efflux by means of inward rectifier k+ channels, consequently inhibiting ca2+ current. It also causes endothelial-dependent relaxation of smooth muscle as is found inside the artery walls. This causes dilation of the “typical” sections of arteries, i.e. Where the endothelium is not separated from the tunica media by atherosclerotic plaque. This feature allows physicians to utilize adenosine to check for clogs in the coronary arteries, by overemphasizing the distinction between the typical 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 sector past the occlusion is already maximally dilated, which is a procedure called coronary steal. This leads to less blood reaching the ischemic tissue, which in turn produces the characteristic chest discomfort. 
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 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 undergoes oxidation by xanthine dehydrogenase two times to form the metabolites xanthine, followed by uric acid. 
Foods and sources
Which foods can increase atp? All macronutrients add to atp production, however a diet that consists of certain nutrients can help enhance production. The best method to support your body’s capability to make atp is to consume foods that contain:.
Copper– copper is involved in dozens of metabolic procedures and is important for the synthesis of adenosine triphosphate, for that reason copper shortage can lead to a slow metabolism, low energy and other signs of poor metabolic health.
Protein (which offer vital amino acids).
- Omega-3 fatty acids
- L methionine (which supports production of very same)
Foods that offer 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 vegetables (i recommend soaking them initially)
- A range of vegetables and fruits, consisting of sea veggies like algae and spirulina
A well balanced diet plan is very important for preserving high energy levels because each macronutrient has different results on atp. For instance, when you eat carbohydrates, you consume glucose, which is converted to kept energy inside your muscles in the form of glycogen. Glycogen is then changed by means of the procedure of glycolysis into atp. Fat can likewise be used to increase atp production, particularly when carbs are not readily available.
Furthermore, oxygen is needed for atp production. Obviously we obtain oxygen from breathing, especially when taking deep breaths, doing deep breathing exercises and during physical activity when we breathe faster.
Utilizes in ayurveda and tcm
In conventional systems of medicine, adenosine/atp itself was hardly ever mentioned, however fatigue was a common health issue that was treated. How did conventional medicines such as ayurveda and traditional chinese medicine (tcm) help treat problems associated with bad basal metabolism and body immune system?
In ayurveda, absence of energy is believed to be triggered by a mix of diet and way of life aspects, consisting of not eating the right food for one’s body type/constitution, stress, overwork, sleep deprivation, use of medications, disease and lack of physical activity. To treat tiredness, physical, mental and emotional causes must all be addressed, which assists balance the main dosha energies, vata, pitta and kapha.
A healthy diet plan is used in ayurveda to improve bad blood circulation and to bring blood and oxygen to broken tissues. Nutrient-dense foods are stated to assist the stomach in the digestion process, enabling more energy to be obtained from foods. The most crucial remedy for fatigue is to eat whole foods that are as near to their natural state as possible– particularly butter, ghee, cooked veggies and quality proteins. Stimulants such as coffee, tea, alcohol and tobacco ought to be lessened. Cold and iced drinks should also be decreased, while warm water and organic teas are motivated. Finally, excessive workout must be avoided up until someone feels much better; yoga and breathing exercises must be practiced rather.
In tcm, someone is said to experience low energy when the body’s energy circulation, called “qi,” becomes imbalanced, with excessive driven “yang” energy in the body and not enough nurturing “yin” energy. Tcm specialists advise that anyone struggling with low energy avoid alcohol, foods with sugarcoated, cold foods and processed foods. Warm, nourishing foods and beverages need to be consumed to bring energy up. Yin activities like resting, meditation, qigong, acupuncture and deep breathing are likewise methods to assist the body metabolize food much better and keep more energy.
Adenosine vs. Caffeine
How is adenosine affected by caffeine? The two essentially have opposite impacts on your energy levels and concentration. When you consume caffeine, it blocks the effects of adenosine in your brain. Caffeine is for that reason thought about an “ar antagonist.”.
Caffeine prevents adenosine from binding to different ar receptors (consisting of a1, a2a, a3 and a2b receptors), reducing its soothing impacts. This is how caffeine makes you feel more energized and alert– and sometimes likewise more happy and upbeat. Caffeine can also block adenosine from binding to a2a receptors, which can increase the release of “feel great” chemicals like dopamine and glutamate that boost your mood and inspiration.
This is likewise the reason that adenosine must not be taken, or taken really thoroughly, with competitive methylxanthines, consisting of caffeine and theophylline. 
In individuals with supraventricular tachycardia (svt), adenosine is utilized to assist recognize and convert the rhythm.
Specific svts can be effectively terminated with adenosine. This consists of 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 in some cases be ended with adenosine.
Fast rhythms of the heart that are restricted to the atria (e.g., atrial fibrillation, atrial flutter) or ventricles (e.g., monomorphic ventricular tachycardia) and do not include the av node as part of the re-entrant circuit are not generally transformed by adenosine. However, the ventricular reaction rate is temporarily slowed with adenosine in such cases.
Because of the results of adenosine on av node-dependent svts, adenosine is considered a class v antiarrhythmic agent. When adenosine is utilized to cardiovert an abnormal rhythm, it is regular for the heart to enter ventricular asystole for a couple of seconds. This can be disconcerting to a typically conscious patient, and is related to angina-like feelings in the chest.
Nuclear stress test
Adenosine is utilized as an accessory to thallium (ti 201) or technetium (tc99m) myocardial perfusion scintigraphy (nuclear stress test) in clients not able to go through sufficient tension screening with workout. 
What is it recommended for?
Paroxysmal supraventricular tachycardia
This medication is utilized for the treatment of paroxysmal supraventricular tachycardia (abnormal, rapid heart rate) including that connected with wolff-parkinson-white syndrome and which is unresponsive to vagal maneuvers.
Heart stress test
This medicine is utilized along with other medications throughout a stress test of the heart in clients who are unable to work out properly. A stress test is done to determine how well the heart is working throughout workout (external tension). 
Together with its required effects, a medication might trigger some undesirable results. Although not all of these adverse effects may take place, if they do occur they may require medical attention.
Consult your doctor or nurse immediately if any of the following adverse effects happen:.
- Chest pain
- Tough or labored breathing
- Lightheadedness or dizziness
- Throat, neck, or jaw discomfort
- Tightness in the chest
- Less common
- Chest discomfort
- Lightheadedness, faintness, or lightheadedness when getting up all of a sudden from a lying or sitting position
- Quick, slow, or irregular heartbeat
- Distressed breathing
- Uncommon exhaustion or weakness
- Quick, irregular, pounding, or racing heartbeat or pulse
- Pounding in the ears
Some adverse effects might take place that typically do not require medical attention. These side effects may go away throughout treatment as your body adapts to the medication. Likewise, your health care specialist may have the ability to inform you about ways to prevent or reduce a few of these side effects. Consult your healthcare professional if any of the following side effects continue or are annoying or if you have any concerns about them:.
- Feeling of heat
- Anorexia nervosa
- Queasiness or throwing up
- Death of gas
- Redness of the face, neck, arms, and periodically, upper chest
- Stomach discomfort, fullness, or pain
- Location of decreased vision
- Pain in the back, ears, or tongue
- Dry mouth
- Metallic taste
- State of mind modifications
- Shakiness in the legs, arms, hands, or feet
- Stuffy nose
- Shivering or shaking of the hands or feet
Opposite results not noted might also occur in some clients. If you notice any other results, consult your health care specialist. 
How to take adenosine (adenocard)?
Usage adenosine (adenocard) exactly as directed on the label, or as prescribed by your doctor. Do not utilize in larger or smaller amounts or for longer than suggested.
Before your heart stress test: prevent coffee, tea, soda, chocolate, energy beverages or other sources of caffeine. They can disrupt the outcomes of your test.
Adenosine is given as an infusion into a vein. A healthcare provider will give you this injection.
You may receive only one dosage of this medication. Repeat doses might be offered if required to bring back normal heartbeats.
Your breathing, high blood pressure, oxygen levels, and other essential indications will be enjoyed carefully.
Your heart rate will be constantly kept track of using an electrocardiograph or ecg (often called an.
Ekg). This will assist your doctor figure out how long to treat you with adenosine. 
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 dose for:.
- Radionuclide myocardial perfusion research study
- Supraventricular tachycardia
- Wolff-parkinson-white syndrome
Typical pediatric dose for:.
- Supraventricular tachycardia
- Extra dosage information:
- Kidney dosage changes
- Liver dosage changes
- Preventative measures
- Other remarks
Usual adult dose for radionuclide myocardial perfusion study
0.14 mg/kg/min infused over 6 minutes (overall dosage of 0.84 mg/kg).
Remarks: administer just as a constant peripheral iv infusion.
Inject thallium 201 at the infusion midpoint; may inject directly into the adenosine infusion set as near venous gain access to as possible to prevent inadvertent boost in the adenosine dosage (the contents of the intravenous tubing).
Usage: adjunct to thallium 201 myocardial perfusion scintigraphy in patients not able to exercise effectively.
Typical adult dosage for supraventricular tachycardia
Preliminary dosage: 6 mg iv bolus over 1 to 2 seconds.
Repeat dosage: if initial dosage 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 required.
Optimum dosage: 12 mg.
Comments: for rapid iv bolus only; must be given peripherally.
Administer directly into a vein or, if provided into an iv line, as near the client as possible followed by a rapid saline flush.
This drug does not convert atrial flutter, atrial fibrillation, or ventricular tachycardia to regular sinus rhythm; when atrial flutter or fibrillation exists, a short-term modest slowing down of ventricular reaction may occur instantly after administrating this drug.
Use: conversion to sinus rhythm of paroxysmal supraventricular tachycardia (psvt), including that related to accessory bypass systems (wolff-parkinson-white syndrome). When clinically recommended, appropriate vagal maneuvers (e.g., valsalva maneuver), ought to be tried prior to administration of this drug.
Normal adult dose for wolff-parkinson-white syndrome
Initial dosage: 6 mg iv bolus over 1 to 2 seconds.
Repeat dosage: if preliminary dose stops working to remove supraventricular tachycardia within 1 to 2 minutes: 12 mg iv bolus over 1 to 2 seconds; might repeat a second time if required.
Maximum dose: 12 mg.
Remarks: for rapid iv bolus just; should be given peripherally.
Administer straight into a vein or, if offered into an iv line, as near the client as possible followed by a rapid 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 transient modest slowing down of ventricular action may occur instantly after supervising this drug.
Use: conversion to sinus rhythm of paroxysmal supraventricular tachycardia (psvt), including that associated with accessory bypass systems (wolff-parkinson-white syndrome). When clinically a good idea, proper vagal maneuvers (e.g., valsalva maneuver), ought to be tried prior to administration of this drug.
Usual pediatric dosage for supraventricular tachycardia
Less than 50 kg:.
Initial dosage: 0.05 to 0.1 mg/kg iv bolus over 1 to 2 seconds.
Repeat dosage: if preliminary dose stops working to eliminate supraventricular tachycardia within 1 to 2 minutes, repeat at incrementally greater dosages, increasing by 0.05 to 0.1 mg/kg, till sinus rhythm or optimum single dose attained.
50 kg or more:.
Preliminary dosage: 6 mg iv bolus over 1 to 2 seconds.
Repeat dose: if preliminary dose 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 dose: 0.3 mg/kg; 12 mg.
Remarks: for fast iv bolus only; may be given centrally or peripherally.
Administer directly into a vein or, if provided into an iv line, as close to the client as possible followed by a quick saline flush.
Follow each bolus with a saline flush.
This drug does not convert atrial flutter, atrial fibrillation, or ventricular tachycardia to regular sinus rhythm; when atrial flutter or fibrillation exists, a short-term modest slowing of ventricular reaction may happen instantly after administrating this drug.
Usage: conversion to sinus rhythm of paroxysmal supraventricular tachycardia (psvt). When medically suggested, appropriate vagal maneuvers (e.g., valsalva maneuver), must be tried prior to administration of this drug.
Renal dosage adjustments
No change advised.
Liver dose changes
No adjustment advised.
Adenoscan( r) safety and efficacy have not been developed in clients more youthful than 18 years. 
What other drugs connect with adenosine?
If your physician has actually directed you to utilize this medication, your physician or pharmacist might currently know any possible drug interactions and may be monitoring you for them. Do not begin, stop, or change the dose of any medication prior to contacting your doctor, health care company, or pharmacist first.
Adenosine has no known serious interactions with other drugs.
Adenosine has no known severe interactions with other drugs.
Moderate interactions of adenosine include:.
- Green tea
- Nicotine inhaled
- Nicotine intranasal
- Moderate interactions of adenosine consist of:
- Lily of the valley
This details does not contain all possible interactions or unfavorable results. For that reason, before using this product, inform your physician or pharmacist of all the products you use. Keep a list of all your medications with you, and share this info with your medical professional and pharmacist. Check with your health care expert or physician for additional medical advice, or if you have health concerns, issues, or to find out more about this medication. 
When not to utilize?
Allergic reaction: this medication is not advised for usage in clients with a known allergy to adenosine or any other inactive ingredient present in addition to it.
Second or third-degree atrioventricular block: this medication is not suggested for usage in clients suffering from a 2nd or third-degree atrioventricular block and who have actually not undergone pacemaker implantation considering that it may get worse the patient’s condition.
Ill sinus syndrome: this medication is not suggested for use in clients experiencing sick sinus syndrome and who have not undergone pacemaker implantation given that it may get worse the client’s condition.
Serious hypotension/shock: this medication is not recommended for usage in clients struggling with a really low high blood pressure (extreme hypotension) or shock due to the increased danger of worsening of the patient’s condition.
Cardiac arrest: this medicine is not advised for usage in patients suffering from a cardiac arrest given that it may aggravate the client’s condition.
Asthma: this medication is not suggested for use in patients experiencing asthma or any other serious breathing condition due to the increased risk of intensifying of the patient’s condition.
Long qt syndrome: this medicine is not recommended for usage in patients struggling with an uncommon heart issue called long qt syndrome considering that it might aggravate the client’s condition.
Warnings for unique population.
Pregnancy: this medicine is not suggested for usage in pregnant ladies unless absolutely needed. All the dangers and advantages should be talked about with the doctor prior to receiving this medicine.
Breast-feeding: this medicine is not advised for use in breastfeeding women unless definitely necessary. All the threats and benefits should be gone over with the doctor before getting this medicine. Your doctor might encourage you to terminate breastfeeding for a specific amount of time based upon your scientific condition.
Other medications: this medicine may connect with lots of other medicines and may cause severe unfavorable impacts. Hence, it is encouraged that you report all your existing medications consisting of any herbs and supplements to the medical professional before getting this medication.
Heart block: administration of this medicine might produce a brief enduring initially, 2nd, or third-degree heart block. Appropriate corrective measures must be initiated based on the patient’s scientific condition. If patients establish a top-level heart block after the initial dosage, additional doses must not be given.
Arrythmias: use of this medication might cause the look of a range of short-lasting new heart rhythms on the electrocardiogram. It is recommended to continually monitor the heart rhythm of the patient while this medicine is being administered.
Bronchoconstriction: use of this medication might make the respiratory tracts leading to the lungs more narrow and trigger worsening of symptoms of asthma, copd, and other obstructive lung illness. It is recommended to administer this medicine with extreme care in patients with obstructive disease of the lungs and the respiratory tract. Replacement with a suitable option might be needed based upon the patient’s condition.
Heart problem: this medicine ought to be utilized with severe caution in clients who have had a cardiac arrest, heart failure, or have had a heart transplant done within the last 1 year. It must also be used with extreme caution in patients suffering from constricting of the heart valves, swelling and enlargement of tissues around the heart, or other recognized heart defects. Close monitoring of heart function, proper dosage changes, or replacement with an appropriate option might be essential based upon the clinical condition of the client.
Low blood volume: this medication must be used with extreme caution in clients with a low blood volume level that has not been corrected (hypovolemia) since it might worsen the patient’s condition. Suitable restorative steps and/or replacement with an ideal alternative might be necessary based upon the medical condition of the client.
Seizure disorder: this medicine should be utilized with care in clients with a history of seizures or convulsions due to the increased danger of intensifying of the client’s condition. Close monitoring of scientific condition, suitable dose modifications, or replacement with an ideal alternative might be required in many cases.
Caffeine uptake: use of caffeine and caffeine-containing products need to be avoided for 12 to 24 hr before the administration of this medication because these products might decrease the efficiency of this medicine. 
Further more caution
- Symptomatic sluggish heart rate (bradycardia), heart attack, heart block, heart transplant clients, hypertension (hypertension), low blood pressure (hypotension), heart attack, regular event of pre-existing arrhythmias (proarrhythmic) events, low blood flow to the heart (unstable angina)
- Adenocard: caution with bronchoconstrictive or bronchospastic lung illness (asthma)
- Cerebrovascular accident hemorrhagic and ischemic cerebrovascular accidents reported; hemodynamic impacts of adenosine including low blood pressure or hypertension potentially associated with these negative reactions
- Nucleoside transportation inhibitors (dipyridamole) and potentiate the vasoactive effects of adenosine; keep for 5 half-lives before adenosine administration
- Methylxanthines (caffeine, theophylline) are adenosine receptor antagonists and inhibit adenosine’s vasoactive impacts; withhold methylxanthines for 5 half-lives prior to adenosine administration
- New-onset or reoccurrence of convulsive seizures reported following adenosine; some seizures are prolonged and need emergent anticonvulsive management; aminophylline may increase danger of seizures connected with adenosine;
- Methylxanthine use is not recommended in clients who experience seizures in association with adenosine administration
- Difficulty breathing, throat tightness, flushing, reddening of the skin, rash, and chest discomfort reported that might need symptomatic treatment; resuscitative procedures may be required if symptoms development; have trained personnel and treatment available during treatment
- Arrhythmia sometimes of cardioversion (adenocard): ventricular fibrillation reported following administration, consisting of both resuscitated and fatal occasions; in a lot of instances, these cases were associated with the concomitant use of digoxin and, less regularly with digoxin and verapamil
- Risk for myocardial infarction and death
- Prevent usage for cardiac nuclear stress tests in clients with indications or signs of severe myocardial anemia (unsteady chest pain [angina], cardiovascular instability); usage might increase the risk of fatal cardiac arrest (myocardial infarction [mi]
- Screen all nuclear stress test prospects for risks
Pregnancy and lactation
Use adenosine during pregnancy with care if the advantages exceed the dangers. Animal research studies show threat and human research studies are not offered, or neither animal nor human research studies were done.
Adenosine use when breastfeeding has the potential for severe negative responses in nursing babies. A decision to interrupt nursing after administration of adenosine must take into consideration the significance of the drug to the mom 
In conclusion, adenosine is released in response to organ stress or tissue damage and shows cytoprotective results, in general, both in the brain and in the periphery. When extreme activity takes place in a provided organ, adenosine serves as an endogenous silencing substance, to either minimize the energy demand or increase the energy supply to that organ. Almost every cell type in the body expresses one or more of the ar subtypes, which shows the central role of this feedback system in safeguarding organs and tissues and in tissue regrowth. Therefore, a typical style to the healing applications proposed for agonists is that adenosine functions as a cytoprotective modulator in response to stress to an organ or tissue.