# Adenosine

Regular narrow-complex tachycardia: adult treatment and pediatric base-order guidance.

Population: Adult & pediatric guidance. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources..
Canonical page: https://www.ocmedic.com/guides/adenosine/
Official source: [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Check before giving

- Do not use for a wide, irregular rhythm.
- PR-115 specifically identifies IO administration as ineffective for adenosine; this pathway is rapid IV.

## Source documents

- [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=1)
- [I-20 — Pediatric Medication Volume Dose by Weight](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf)
- [SO-C-025 — Narrow Complex QRS Complex Tachycardia](https://www.ochealthinfo.com/sites/hca/files/import/data/files/34670.pdf)
- [PR-115 — Intraosseous Infusion](https://www.ochealthinfo.com/sites/hca/files/import/data/files/12408.pdf)

## Use in OCEMS

- For a regular narrow-complex tachycardia with a pulse. The adult SO-C-025 pathway distinguishes mild symptoms from hemodynamic instability.
- For mild symptoms at a rate of at least 150/min, attempt Valsalva before the medication pathway.

## Adult / adolescent

| Indication / route | Dose & limits |
| --- | --- |
| Regular narrow-complex tachycardia ≥150/min | 12 mg rapid IV. If the rhythm persists, repeat 12 mg once after 3 minutes. |
| Unstable presentation | Follow the synchronized-cardioversion branch of SO-C-025; do not delay urgent electrical treatment to complete a medication sequence. |

## Pediatric

- I-20 marks pediatric adenosine as requiring a base hospital order. It provides separate first- and second-dose rows for each weight band.
- Use the ordered dose and the matching weight-band chart; do not apply the adult 12 mg initial dose to a child. I-20 uses a 3 mg/mL preparation.

## Pediatric weight bands — base-ordered adenosine

- I-20 pages 1–10: base hospital order required. Rapid IV route; preparation 3 mg/mL. PR-115 states adenosine is not effective through an IO site.
- These are the published I-20 band doses, not exact-weight calculations. Confirm the actual order and prepared volume against the linked chart; do not extrapolate outside its listed bands.
| I-20 weight band | First dose — rapid IV | Second dose — rapid IV |
| --- | --- | --- |
| 3–5 kg | 0.4 mg | 0.8 mg |
| 6–7 kg | 0.6 mg | 1.2 mg |
| 8–9 kg | 0.8 mg | 1.6 mg |
| 10–11 kg | 1 mg | 2 mg |
| 12–14 kg | 1.2 mg | 2.4 mg |
| 15–18 kg | 1.5 mg | 3 mg |
| 19–23 kg | 2 mg | 4 mg |
| 24–29 kg | 2.5 mg | 5 mg |
| 30–36 kg | 3.5 mg | 7 mg |
| 37–49 kg | 4.5 mg | 9 mg |

## Preparation & reassessment

- Record the rhythm before and after administration and reassess perfusion and symptoms.
- Confirm the actual syringe concentration and dose. A vial or syringe size is not the ordered dose.