Table of Contents
Adenosine is a chemical found in human cells. There are 3 various forms: adenosine, adenosine monophosphate (amp), and adenosine triphosphate (atp).
Adenosine obstructs electrical signals in the heart that cause irregular heart rhythms. Atp might also avoid changes in basal metabolism that trigger weight-loss in people with innovative cancer.
An injectable type of adenosine is a us fda-approved prescription drug for a condition involving quick heart rate (paroxysmal supraventricular tachycardia). It is also utilized as a prescription drug to assist measure blockages in the arteries of the heart. Individuals likewise use adenosine, amp, and atp as supplements for athletic performance, cold sores, and many other purposes, however there is no good proof to support these uses. 
Adenosine is an endogenous purine nucleoside that regulates numerous physiological processes. Cellular signaling by adenosine happens through four recognized adenosine receptor subtypes (a1, a2a, a2b, and a3).
Extracellular adenosine concentrations from regular cells are roughly 300 nm; nevertheless, in reaction 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 mostly that of cytoprotection preventing tissue damage during instances of hypoxia, anemia, and seizure activity. Activation of a2a receptors produces a constellation of responses that in general can be categorized 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 upon their capability to either promote or prevent adenylate cyclase activity. The a1 receptors couple to gi/o and reduces camp levels, while the a2 adenosine receptors couple to gs, which stimulates adenylate cyclase activity. In addition, a1 receptors couple to go, which has been reported to moderate adenosine inhibition of ca2+ conductance, whereas a2b and a3 receptors likewise pair to gq and stimulate phospholipase activity. Scientists 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 transport throughout the bbb of amyloid plaque antibodies and prodrugs related to parkinson’s disease, alzheimer’s, several sclerosis, and cancers of the main nervous system.
Ghrelin/growth hormonal agent secretagogue receptor
Adenosine is an endogenous agonist of the ghrelin/growth hormonal agent secretagogue receptor. However, while it has the ability to increase cravings, unlike other agonists of this receptor, adenosine is not able to induce 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, inhibiting adenylyl cyclase, decreasing camp therefore triggering cell hyperpolarization by increasing k+ efflux through inward rectifier k+ channels, consequently preventing ca2+ current. It likewise triggers endothelial-dependent relaxation of smooth muscle as is discovered inside the artery walls. This triggers dilation of the “typical” sectors of arteries, i.e. Where the endothelium is not separated from the tunica media by atherosclerotic plaque. This feature permits physicians to use adenosine to check for obstructions in the coronary arteries, by exaggerating the distinction in between the normal and unusual sections.
The administration of adenosine likewise minimizes blood circulation to coronary arteries past the occlusion. Other coronary arteries dilate when adenosine is administered while the segment past the occlusion is already maximally dilated, which is a process called coronary steal. This leads to less blood reaching the ischemic tissue, which in turn produces the particular 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 goes through 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, but a diet plan that consists of certain nutrients can assist improve production. The best way to support your body’s capability to make atp is to take in foods which contain:.
Copper– copper is involved in dozens of metabolic procedures and is essential for the synthesis of adenosine triphosphate, for that reason copper deficiency can lead to a slow metabolism, low energy and other signs of bad metabolic health.
Protein (which offer essential amino acids).
Foods that supply these nutrients consist of:.
- 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 legumes (i suggest soaking them initially)
- A variety of vegetables and fruits, including sea veggies like algae and spirulina
A well balanced diet plan is essential for keeping high energy levels due to the fact that each macronutrient has various effects on atp. For example, when you eat carbs, you consume glucose, which is transformed to kept energy inside your muscles in the type of glycogen. Glycogen is then transformed through the procedure of glycolysis into atp. Fat can likewise be used to increase atp production, specifically when carbs are not readily available.
In addition, oxygen is required for atp production. Obviously we obtain oxygen from breathing, specifically when taking deep breaths, doing deep breathing workouts and throughout physical activity when we breathe faster.
Uses in ayurveda and tcm
In conventional systems of medicine, adenosine/atp itself was seldom discussed, but tiredness was a typical health issue that was dealt with. How did traditional medications such as ayurveda and traditional chinese medicine (tcm) aid deal with issues connected to poor energy metabolism and body immune system?
In ayurveda, absence of energy is believed to be brought on by a combination of diet and way of life elements, consisting of not eating the ideal 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 psychological causes need to all be addressed, which helps stabilize the main dosha energies, vata, pitta and kapha.
A healthy diet plan is used in ayurveda to improve poor blood circulation and to bring blood and oxygen to damaged tissues. Nutrient-dense foods are stated to aid the stomach in the digestion process, enabling more energy to be acquired from foods. The most important treatment for tiredness is to consume entire foods that are as near their natural state as possible– particularly butter, ghee, prepared vegetables and quality proteins. Stimulants such as coffee, tea, alcohol and tobacco need to be minimized. Cold and iced drinks ought to also be lessened, while warm water and natural teas are encouraged. Lastly, excessive workout needs to be prevented until somebody feels much better; yoga and breathing workouts ought to be practiced rather.
In tcm, someone is said to experience low energy when the body’s energy flow, called “qi,” ends up being imbalanced, with too much driven “yang” energy in the body and insufficient nurturing “yin” energy. Tcm professionals recommend that anybody suffering from low energy avoid alcohol, foods with sugarcoated, cold foods and processed foods. Warm, nourishing foods and drinks must be taken in to bring energy up. Yin activities like resting, meditation, qigong, acupuncture and deep breathing are also methods to help the body metabolize food better and maintain more energy.
Adenosine vs. Caffeine
How is adenosine impacted by caffeine? The two basically have opposite effects on your energy levels and concentration. When you take in caffeine, it obstructs the results of adenosine in your brain. Caffeine is for that reason considered an “ar villain.”.
Caffeine prevents adenosine from binding to different ar receptors (including a1, a2a, a3 and a2b receptors), reducing its soothing impacts. This is how caffeine makes you feel more energized and alert– and in some cases likewise more pleased and upbeat. Caffeine can likewise block adenosine from binding to a2a receptors, which can increase the release of “feel excellent” chemicals like dopamine and glutamate that boost your state of mind and motivation.
This is also the factor that adenosine must not be taken, or taken very thoroughly, with competitive methylxanthines, consisting of caffeine and theophylline. 
In people with supraventricular tachycardia (svt), adenosine is used to help identify and transform the rhythm.
Certain svts can be successfully terminated with adenosine. This includes any re-entrant arrhythmias that require 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.
Quick 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. Nevertheless, the ventricular action rate is temporarily slowed with adenosine in such cases.
Because of the impacts of adenosine on av node-dependent svts, adenosine is thought about a class v antiarrhythmic representative. When adenosine is utilized to cardiovert an abnormal rhythm, it is typical for the heart to enter ventricular asystole for a few seconds. This can be perturbing to an usually mindful patient, and is connected with angina-like experiences in the chest.
Nuclear stress test
Adenosine is used as an accessory to thallium (ti 201) or technetium (tc99m) myocardial perfusion scintigraphy (nuclear stress test) in patients unable to undergo adequate tension screening with exercise. 
What is it recommended for?
Paroxysmal supraventricular tachycardia
This medicine is used for the treatment of paroxysmal supraventricular tachycardia (irregular, rapid heart rate) including that connected with wolff-parkinson-white syndrome and which is unresponsive to vagal maneuvers.
Heart stress test
This medication is utilized in addition to other medicines during a stress test of the heart in patients who are not able to work out properly. A stress test is done to figure out how well the heart is working throughout exercise (external stress). 
Along with its required effects, a medication might trigger some unwanted effects. Although not all of these side effects might take place, if they do occur they may require medical attention.
Talk to your doctor or nurse instantly if any of the following adverse effects happen:.
- Chest pain
- Hard or labored breathing
- Lightheadedness or lightheadedness
- Throat, neck, or jaw discomfort
- Tightness in the chest
- Less typical
- Chest pain
- Dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
- Quick, sluggish, or irregular heart beat
- Troubled breathing
- Unusual exhaustion or weakness
- Quick, irregular, pounding, or racing heart beat or pulse
- Pounding in the ears
Some side effects may take place that generally do not need medical attention. These side effects might disappear during treatment as your body gets used to the medicine. Likewise, your healthcare professional may be able to inform you about methods to prevent or lower a few of these side effects. Consult your health care expert if any of the following negative effects continue or are annoying or if you have any questions about them:.
- Feeling of heat
- Anorexia nervosa
- Queasiness or throwing up
- Passing of gas
- Soreness of the face, neck, arms, and occasionally, upper chest
- Stomach pain, fullness, or discomfort
- Area of decreased vision
- Pain in the back, ears, or tongue
- Dry mouth
- Metallic taste
- Mood modifications
- Shakiness in the legs, arms, hands, or feet
- Stuffy nose
- Trembling or shaking of the hands or feet
Opposite effects not listed might likewise occur in some patients. If you discover any other impacts, check with your healthcare expert. 
How to take adenosine (adenocard)?
Usage adenosine (adenocard) exactly as directed on the label, or as prescribed by your doctor. Do not utilize in bigger or smaller sized amounts or for longer than suggested.
Before your heart stress test: prevent coffee, tea, soda pop, chocolate, energy beverages or other sources of caffeine. They can interfere with the outcomes of your test.
Adenosine is given as an infusion into a vein. A healthcare provider will offer you this injection.
You might receive only one dosage of this medication. Repeat dosages might be given if needed to bring back typical heartbeats.
Your breathing, blood pressure, oxygen levels, and other essential indications will be seen carefully.
Your heart rate will be constantly kept track of utilizing an electrocardiograph or ecg (sometimes called an.
Ekg). This will assist your physician determine the length of time 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%.
Typical adult dose for:.
- Radionuclide myocardial perfusion study
- Supraventricular tachycardia
- Wolff-parkinson-white syndrome
Usual pediatric dosage for:.
- Supraventricular tachycardia
- Extra dosage information:
- Renal dose modifications
- Liver dosage adjustments
- Safety measures
- Other remarks
Usual adult dosage for radionuclide myocardial perfusion research study
0.14 mg/kg/min infused over 6 minutes (overall dosage of 0.84 mg/kg).
Remarks: administer just as a continuous peripheral iv infusion.
Inject thallium 201 at the infusion midpoint; might inject directly into the adenosine infusion set as close to venous access as possible to prevent unintentional increase in the adenosine dosage (the contents of the intravenous tubing).
Usage: accessory to thallium 201 myocardial perfusion scintigraphy in clients unable to exercise adequately.
Normal adult dose for supraventricular tachycardia
Preliminary dose: 6 mg iv bolus over 1 to 2 seconds.
Repeat dose: 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 second time if required.
Optimum dosage: 12 mg.
Comments: for fast iv bolus just; must be given peripherally.
Administer directly into a vein or, if offered into an iv line, as near to the patient as possible followed by a fast saline flush.
This drug does not convert atrial flutter, atrial fibrillation, or ventricular tachycardia to normal sinus rhythm; when atrial flutter or fibrillation exists, a transient modest slowing of ventricular reaction may happen right away after supervising this drug.
Usage: conversion to sinus rhythm of paroxysmal supraventricular tachycardia (psvt), including that associated with accessory bypass tracts (wolff-parkinson-white syndrome). When scientifically advisable, suitable vagal maneuvers (e.g., valsalva maneuver), should be tried prior to administration of this drug.
Typical adult dose for wolff-parkinson-white syndrome
Initial dosage: 6 mg iv bolus over 1 to 2 seconds.
Repeat dosage: if initial dose stops working to eliminate supraventricular tachycardia within 1 to 2 minutes: 12 mg iv bolus over 1 to 2 seconds; may duplicate a second time if required.
Maximum dose: 12 mg.
Remarks: for rapid iv bolus just; need to be given peripherally.
Administer straight into a vein or, if offered into an iv line, as near the patient as possible followed by a fast saline flush.
This drug does not transform atrial flutter, atrial fibrillation, or ventricular tachycardia to regular sinus rhythm; when atrial flutter or fibrillation is present, a transient modest slowing of ventricular action may happen 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), should be tried prior to administration of this drug.
Usual 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 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, up until sinus rhythm or optimum single dosage achieved.
50 kg or more:.
Preliminary dose: 6 mg iv bolus over 1 to 2 seconds.
Repeat dosage: if initial dose stops working to get rid of supraventricular tachycardia within 1 to 2 minutes: 12 mg iv bolus over 1 to 2 seconds; may repeat a 2nd time if needed.
Optimum dose: 0.3 mg/kg; 12 mg.
Remarks: for quick iv bolus just; might be offered centrally or peripherally.
Administer straight into a vein or, if offered into an iv line, as near the client as possible followed by a fast 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 is present, a transient modest slowing down of ventricular action might occur right away after supervising this drug.
Use: conversion to sinus rhythm of paroxysmal supraventricular tachycardia (psvt). When clinically recommended, appropriate vagal maneuvers (e.g., valsalva maneuver), should be attempted prior to administration of this drug.
Kidney dosage adjustments
No modification advised.
Liver dose adjustments
No adjustment suggested.
Adenoscan( r) safety and effectiveness have actually not been developed in patients younger than 18 years. 
What other drugs connect with adenosine?
If your physician has actually directed you to use this medication, your physician or pharmacist may already understand any possible drug interactions and might be monitoring you for them. Do not begin, stop, or change the dosage of any medication before contacting your physician, healthcare provider, or pharmacist first.
Adenosine has no recognized extreme interactions with other drugs.
Adenosine has no recognized major interactions with other drugs.
Moderate interactions of adenosine include:.
- Green tea
- Nicotine inhaled
- Nicotine intranasal
- Moderate interactions of adenosine include:
- Lily of the valley
This information does not consist of all possible interactions or negative impacts. Therefore, prior to utilizing 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 information with your physician and pharmacist. Contact your health care professional or doctor for extra medical guidance, or if you have health concerns, concerns, or for more information about this medication. 
When not to utilize?
Allergy: this medication is not recommended for use in clients with a known allergy to adenosine or any other inactive component present along with it.
2nd or third-degree atrioventricular block: this medicine is not advised for use in clients experiencing a second or third-degree atrioventricular block and who have actually not gone through pacemaker implantation considering that it might aggravate the client’s condition.
Sick sinus syndrome: this medicine is not advised for use in clients experiencing ill sinus syndrome and who have actually not undergone pacemaker implantation given that it may worsen the client’s condition.
Severe hypotension/shock: this medication is not recommended for usage in clients suffering from an extremely low blood pressure (serious hypotension) or shock due to the increased threat of intensifying of the patient’s condition.
Cardiac arrest: this medicine is not suggested for use in patients struggling with a heart failure considering that it might get worse the patient’s condition.
Asthma: this medicine is not advised for usage in clients experiencing asthma or any other severe breathing disorder due to the increased danger of aggravating of the client’s condition.
Long qt syndrome: this medicine is not advised for usage in patients struggling with a rare heart problem referred to as long qt syndrome considering that it may intensify the patient’s condition.
Warnings for special population.
Pregnancy: this medication is not advised for use in pregnant women unless absolutely essential. All the dangers and advantages must be gone over with the medical professional before receiving this medication.
Breast-feeding: this medicine is not recommended for use in breastfeeding females unless definitely necessary. All the risks and benefits need to be gone over with the medical professional prior to receiving this medicine. Your doctor may encourage you to stop breastfeeding for a specific time period based on your scientific condition.
Other medications: this medication may connect with many other medicines and might trigger serious adverse effects. Thus, it is recommended that you report all your existing medications consisting of any herbs and supplements to the medical professional prior to receiving this medication.
Heart block: administration of this medication might produce a short lasting initially, second, or third-degree heart block. Proper corrective measures should be started based upon the client’s medical condition. If patients establish a top-level heart block after the initial dosage, additional dosages ought to not be provided.
Arrythmias: use of this medication might cause the appearance of a range of short-lasting new heart rhythms on the electrocardiogram. It is advised to continually keep track of the heart rhythm of the client while this medication is being administered.
Bronchoconstriction: use of this medication may make the respiratory tracts leading to the lungs more narrow and trigger getting worse of signs of asthma, copd, and other obstructive lung diseases. It is advised to administer this medicine with extreme caution in clients with obstructive illness of the lungs and the breathing tract. Replacement with an ideal alternative might be needed based on the client’s condition.
Heart diseases: this medication must be utilized with severe caution in clients who have actually had a cardiovascular disease, cardiac arrest, or have had a heart transplant done within the last 1 year. It needs to also be used with extreme caution in clients experiencing constricting of the heart valves, swelling and enhancement of tissues around the heart, or other known heart defects. Close monitoring of heart function, proper dosage adjustments, or replacement with an ideal alternative might be needed based upon the scientific condition of the client.
Low blood volume: this medication needs to be utilized with extreme care in clients with a low blood volume level that has actually not been fixed (hypovolemia) because it might aggravate the patient’s condition. Suitable restorative steps and/or replacement with an ideal option might be necessary based upon the clinical condition of the client.
Seizure disorder: this medicine must be used with caution in patients with a history of seizures or convulsions due to the increased risk of getting worse of the patient’s condition. Close tracking of clinical condition, appropriate dosage adjustments, or replacement with an ideal option might be required sometimes.
Caffeine uptake: use of caffeine and caffeine-containing items ought to be avoided for 12 to 24 hr before the administration of this medicine considering that these items may minimize the efficiency of this medicine. 
Further more caution
- Symptomatic slow heart rate (bradycardia), cardiac arrest, heart block, heart transplant patients, hypertension (hypertension), low blood pressure (hypotension), cardiovascular disease, frequent occurrence of pre-existing arrhythmias (proarrhythmic) events, low blood circulation to the heart (unsteady angina)
- Adenocard: care with bronchoconstrictive or bronchospastic lung illness (asthma)
- Cerebrovascular accident hemorrhagic and ischemic cerebrovascular accidents reported; hemodynamic impacts of adenosine consisting of low high blood pressure or high blood pressure possibly associated with these unfavorable responses
- Nucleoside transportation inhibitors (dipyridamole) and potentiate the vasoactive impacts of adenosine; withhold for 5 half-lives before adenosine administration
- Methylxanthines (caffeine, theophylline) are adenosine receptor antagonists and inhibit adenosine’s vasoactive effects; withhold methylxanthines for 5 half-lives before adenosine administration
- New-onset or recurrence of convulsive seizures reported following adenosine; some seizures are extended and need emergent anticonvulsive management; aminophylline may increase danger of seizures connected with adenosine;
- Methylxanthine use is not recommended in patients who experience seizures in association with adenosine administration
- Difficulty breathing, throat tightness, flushing, reddening of the skin, rash, and chest discomfort reported that may need symptomatic treatment; resuscitative steps might be required if symptoms development; have actually trained personnel and treatment offered throughout treatment
- Arrhythmia sometimes of cardioversion (adenocard): ventricular fibrillation reported following administration, including both resuscitated and fatal events; in a lot of circumstances, these cases were connected with the concomitant use of digoxin and, less regularly with digoxin and verapamil
- Threat for myocardial infarction and death
- Avoid use for cardiac nuclear stress tests in patients with indications or symptoms of intense myocardial anemia (unstable chest discomfort [angina], cardiovascular instability); use may increase the risk of fatal cardiovascular disease (myocardial infarction [mi]
- Screen all nuclear stress test prospects for threats
Pregnancy and lactation
Usage adenosine during pregnancy with caution if the benefits outweigh the threats. Animal studies reveal threat and human studies are not readily available, or neither animal nor human research studies were done.
Adenosine usage when breastfeeding has the capacity for major negative reactions in nursing infants. A decision to interrupt nursing after administration of adenosine should consider the value of the drug to the mom 
In conclusion, adenosine is released in reaction to organ tension or tissue damage and displays cytoprotective impacts, in general, both in the brain and in the periphery. When excessive activity occurs in an offered organ, adenosine functions as an endogenous silencing compound, to either minimize the energy need or increase the energy supply to that organ. Almost every cell type in the body expresses one or more of the ar subtypes, which suggests the main function of this feedback system in protecting organs and tissues and in tissue regeneration. Thus, a common theme to the restorative applications proposed for agonists is that adenosine functions as a cytoprotective modulator in reaction to tension to an organ or tissue.