Adenosine Adenocard and monophosphate
September 14 2017 by Ray Sahelian, M.D.

Adenosine is a nucleoside made of adenine attached to a ribose. Adenosine plays an important role in energy transfer - as adenosine triphosphate (ATP) and diphosphate (ADP) - as well as in signal transduction as cyclic adenosine monophosphate, cAMP. Adenosine is now a pharmaceutical drug with the product name Adenocard. Caffeine acts as a potent antagonist of central and peripheral nervous system adenosine receptors.

How adenosine works
Adenosine slows conduction time through the A-V node. This nucleoside can interrupt the reentry pathways through the A-V node, and can restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardia (PSVT),

Intravenous adenosine Adenocard
Intravenous adenosine is indicated for conversion to sinus rhythm of paroxysmal supraventricular tachycardia (PSVT), including that associated with accessory bypass tracts (Wolff-Parkinson-White Syndrome). Adenocard adenosine does not convert atrial flutter, atrial fibrillation, or ventricular tachycardia to normal sinus rhythm. In the presence of atrial flutter or atrial fibrillation.

Adenosine for heart attack
Adjunctive administration of adenosine along with early reperfusion therapy improves outcomes after acute myocardial infarction (MI). Dr. Robert A. Kloner from Good Samaritan Hospital, Los Angeles, California investigated the efficacy of high-dose intravenous adenosine in relation to reperfusion time and modality in patients presenting with ST-segment elevation anterior acute MI. Compared with those who received placebo, patients who started reperfusion therapy within 3.1 hours of symptom onset and who received adenosine had significantly lower mortality at both 1 month (9% vs 5%) and 6 months (11% vs 7%). Adenosine did not improve clinical outcomes in patients reperfused later than 3 hours after onset of chest pain. European Heart Journal 2006.

Adenosine is sold as a raw material to vitamin companies.

Effect on erectile function
Andrology 2013. A randomized, double-blind, crossover, placebo-controlled comparative clinical trial of arginine aspartate plus adenosine monophosphate for the intermittent treatment of male erectile dysfunction. Efficacy and safety of l-arginine aspartate 8 grams combined with 200 mg of adenosine monophosphate (AA) with placebo alone for intermittent treatment of mild-to-moderate erectile dysfunction (ED) were compared. ED patients demonstrated significant improvements in all IIEF International Index of Erectile Function domains with the exception of the Sexual Desire and Orgasmic Domains when treated with AA compared with placebo. This pilot phase II study showed that the on-demand oral administration at a high dosage of l-arginine aspartate-adenosine monophosphate combination may be effective in patients with mild-to-moderate erectile dysfunction ED, is very well tolerated and could be tested as a safe first-line therapy in a larger size phase III study.

Studies, research
Molecular Imaging Radionuclide Therapy 2014. Predictors and Diagnostic Significance of the Adenosine Related Side Effects on Myocardial Perfusion SPECT/CT Imaging. The aim of this study was to investigate the relationship between patient characteristics and adenosine-related side-effects during stress myocard perfusion imaging (MPI). The effect of presence of adenosine-related side-effects on the diagnostic value of MPI with integrated SPECT/CT system for coronary artery disease (CAD), was also assessed in this study. Methods: Total of 281 patients (109 M, 172 F; mean age:62.6±10) who underwent standard adenosine stress protocol for MPI, were included in this study. All symptoms during adenosine infusion were scored according to the severity and duration. For the estimation of diagnostic value of adenosine MPI with integrated SPECT/CT system, coronary angiography (CAG) or clinical follow-up were used as gold standard. Results: Total of 173 patients (61.6%) experienced adenosine-related side-effects (group 1); flushing, dyspnea, and chest pain were the most common. Other 108 patients completed pharmacologic stress (PS) test without any side-effects (group 2). Test tolerability were similar in the patients with cardiovascular or airway disease to others, however dyspnea were observed significantly more common in patients with mild airway disease. Body mass index (BMI) ≥30 kg/m2 and age ≤45 years were independent predictors of side-effects. The diagnostic value of MPI was similar in both groups. Sensitivity of adenosine MPI SPECT/CT was calculated to be 86%, specificity was 94% and diagnostic accuracy was 92% for diagnosis of CAD. Conclusion: Adenosine MPI is a feasible and well tolerated method in patients who are not suitable for exercise stress test as well as patients with cardiopulmonary disease. However age ≤45 years and BMI ≥30 kg/m2 are the positive predictors of adenosine-related side-effects, the diagnostic value of adenosine MPI SPECT/CT is not affected by the presence of adenosine related side-effects.