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Adenosine

    Adenosine is a chemical found in human cells. There are 3 different types: adenosine, adenosine monophosphate (amp), and adenosine triphosphate (atp).

    Adenosine blocks electrical signals in the heart that cause irregular heart rhythms. Atp might also prevent modifications in energy metabolism that trigger weight-loss in individuals with advanced cancer.

    An injectable form of adenosine is a us fda-approved prescription drug for a condition including fast heart rate (paroxysmal supraventricular tachycardia). It is also 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 efficiency, fever blisters, and numerous other functions, but there is no good evidence to support these usages. [2]

    Pharmacological impacts

    Adenosine is an endogenous purine nucleoside that modulates many physiological procedures. Cellular signaling by adenosine occurs through 4 known adenosine receptor subtypes (a1, a2a, a2b, and a3).

    Extracellular adenosine concentrations from regular cells are approximately 300 nm; nevertheless, in response to cellular damage (e.g., in inflammatory or ischemic tissue), these concentrations are quickly raised (600– 1,200 nm). Therefore, in regard to tension or injury, the function of adenosine is mostly that of cytoprotection avoiding tissue damage throughout circumstances of hypoxia, ischemia, and seizure activity. Activation of a2a receptors produces a constellation of actions that in general can be categorized 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 four receptor subtypes are additional classified based upon their ability to either stimulate or hinder adenylate cyclase activity. The a1 receptors pair to gi/o and decreases camp levels, while the a2 adenosine receptors couple to gs, which stimulates adenylate cyclase activity. In addition, a1 receptors couple to go, which has actually been reported to moderate adenosine inhibition of ca2+ conductance, whereas a2b and a3 receptors likewise pair to gq and stimulate phospholipase activity. Researchers at cornell university have recently shown adenosine receptors to be type in opening the blood-brain barrier (bbb). Mice dosed with adenosine have actually shown increased transport across 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 hormone secretagogue receptor. However, while it has the ability to increase cravings, unlike other agonists of this receptor, adenosine is not able to cause the secretion of development hormonal agent and increase its plasma levels.

    System of action

    When it is administered intravenously, adenosine causes transient heart block in the atrioventricular (av) node. This is moderated via the a1 receptor, inhibiting adenylyl cyclase, minimizing camp and so causing cell hyperpolarization by increasing k+ efflux via inward rectifier k+ channels, subsequently hindering ca2+ present. It likewise causes endothelial-dependent relaxation of smooth muscle as is discovered inside the artery walls. This triggers dilation of the “typical” sections of arteries, i.e. Where the endothelium is not separated from the tunica media by atherosclerotic plaque. This function permits physicians to utilize adenosine to test for obstructions in the coronary arteries, by exaggerating the difference between the regular and abnormal segments.

    The administration of adenosine likewise reduces blood flow 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 causes less blood reaching the ischemic tissue, which in turn produces the particular chest discomfort. [3]

    Metabolism

    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.

    Alternatively, 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. [4]

    Foods and sources

    Which foods can increase atp? All macronutrients add to atp production, but a diet plan that consists of certain nutrients can help enhance production. The best way 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 vital for the synthesis of adenosine triphosphate, therefore copper deficiency can lead to a sluggish metabolic process, low energy and other signs of bad metabolic health.

    Protein (which provide essential amino acids).

    Foods that offer 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 beans (i recommend soaking them initially)
    • A range of veggies and fruits, consisting of sea veggies like algae and spirulina

    A well balanced diet is important for maintaining high energy levels since each macronutrient has different effects on atp. For instance, when you eat carbohydrates, you consume glucose, which is converted to kept energy inside your muscles in the type of glycogen. Glycogen is then transformed via the procedure of glycolysis into atp. Fat can also be utilized to increase atp production, particularly when carbs are not readily available.

    In addition, oxygen is needed for atp production. Clearly we obtain oxygen from breathing, specifically when taking deep breaths, doing deep breathing workouts and throughout physical activity when we breathe faster.

    Utilizes in ayurveda and tcm

    In standard systems of medication, adenosine/atp itself was hardly ever discussed, but tiredness was a common health issue that was treated. How did traditional medications such as ayurveda and traditional chinese medicine (tcm) aid deal with issues associated with bad energy metabolism and body immune system?

    In ayurveda, lack of energy is thought to be caused by a combination of diet and lifestyle aspects, consisting of not eating the right food for one’s body type/constitution, tension, overwork, sleep deprivation, use of medications, illness and lack of physical activity. To deal with tiredness, physical, mental and psychological causes need to all be addressed, which helps balance the primary dosha energies, vata, pitta and kapha.

    A healthy diet plan is used in ayurveda to enhance poor flow and to bring blood and oxygen to broken tissues. Nutrient-dense foods are stated to help the stomach in the digestion procedure, permitting more energy to be obtained from foods. The most essential solution for tiredness is to consume entire foods that are as near their natural state as possible– specifically butter, ghee, prepared veggies and quality proteins. Stimulants such as coffee, tea, alcohol and tobacco must be reduced. Cold and iced beverages ought to also be reduced, while warm water and herbal teas are encouraged. Lastly, excessive exercise must be avoided till somebody feels better; yoga and breathing exercises ought to 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 insufficient nurturing “yin” energy. Tcm professionals recommend that anybody struggling with low energy abstain from alcohol, foods with added sugar, cold foods and processed foods. Warm, nourishing foods and beverages should be consumed to bring energy up. Yin activities like resting, meditation, qigong, acupuncture and deep breathing are also ways to help the body metabolize food better and keep more energy.

    Adenosine vs. Caffeine

    How is adenosine impacted by caffeine? The two essentially have opposite results on your energy levels and concentration. When you consume caffeine, it obstructs the effects of adenosine in your brain. caffeine is for that reason considered an “ar antagonist.”.

    caffeine prevents adenosine from binding to different ar receptors (including a1, a2a, a3 and a2b receptors), decreasing its soothing impacts. This is how caffeine makes you feel more energized and alert– and sometimes also more pleased and positive. caffeine can likewise obstruct adenosine from binding to a2a receptors, which can increase the release of “feel excellent” chemicals like dopamine and glutamate that enhance your mood and inspiration.

    This is likewise the factor that adenosine should not be taken, or taken extremely thoroughly, with competitive methylxanthines, including caffeine and theophylline. [5]

    Medical uses

    Supraventricular tachycardia

    In people with supraventricular tachycardia (svt), adenosine is utilized to assist identify and convert the rhythm.

    Particular svts can be effectively terminated with adenosine. This consists of 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 ended with adenosine.

    Quick 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 response rate is momentarily 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 used to cardiovert an abnormal rhythm, it is normal for the heart to enter ventricular asystole for a couple of seconds. This can be troubling to a normally conscious client, and is connected 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 unable to go through sufficient tension testing with exercise. [6]

    What is it recommended for?

    Paroxysmal supraventricular tachycardia

    This medicine is utilized for the treatment of paroxysmal supraventricular tachycardia (irregular, quick 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 work out effectively. A stress test is done to determine how well the heart is working during exercise (external stress). [7]

    Negative effects

    In addition to its needed impacts, a medication may trigger some unwanted results. Although not all of these adverse effects may occur, if they do happen they might require medical attention.

    Contact your medical professional or nurse right away if any of the following negative effects happen:.

    More common

    • Chest pain
    • Difficult or labored breathing
    • Lightheadedness or dizziness
    • Throat, neck, or jaw discomfort
    • Tightness in the chest
    • Less common
    • Chest discomfort
    • Confusion
    • Dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
    • Passing out
    • Fast, sluggish, or irregular heartbeat
    • Sweating
    • Distressed breathing
    • Unusual exhaustion or weak point

    Rare

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

    Some adverse effects may happen that typically do not require medical attention. These adverse effects might disappear during treatment as your body adjusts to the medicine. Likewise, your healthcare professional may have the ability to tell you about ways to prevent or reduce a few of these adverse effects. Check with your healthcare professional if any of the following negative effects continue or are irritating or if you have any concerns about them:.

    More common

    • Diarrhea
    • Feeling of warmth
    • Indigestion
    • Loss of appetite
    • Nausea or vomiting
    • Passing of gas
    • Inflammation of the face, neck, arms, and periodically, upper chest
    • Stomach pain, fullness, or pain

    Rare

    • Location of decreased vision
    • Cough
    • Discomfort in the back, ears, or tongue
    • Drowsiness
    • 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 impacts not noted may also take place in some clients. If you observe any other results, contact your health care specialist. [8]

    How to take adenosine (adenocard)?

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

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

    Adenosine is given as an infusion into a vein. A healthcare provider will provide you this injection.

    You may receive only one dose of this medication. Repeat doses might be given if needed to bring back regular heart beats.

    Your breathing, blood pressure, oxygen levels, and other important signs will be viewed carefully.

    Your heart rate will be constantly kept track of utilizing an electrocardiograph or ecg (in some cases called an.

    Ekg). This will help your physician determine for how long to treat you with adenosine. [9]

    Adenosine dosage

    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%.

    Normal adult dosage for:.

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

    Normal pediatric dose for:.

    • Supraventricular tachycardia
    • Extra dose details:
    • Renal dosage modifications
    • Liver dosage modifications
    • Preventative measures
    • Dialysis
    • Other comments

    Usual adult dose for radionuclide myocardial perfusion research 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; may inject straight into the adenosine infusion set as near venous gain access to as possible to prevent unintentional increase in the adenosine dosage (the contents of the intravenous tubing).

    Use: adjunct to thallium 201 myocardial perfusion scintigraphy in clients unable to work out sufficiently.

    Typical adult dosage for supraventricular tachycardia

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

    Repeat dosage: if initial dose fails to eliminate supraventricular tachycardia within 1 to 2 minutes: 12 mg iv bolus over 1 to 2 seconds; may duplicate a 2nd time if required.

    Maximum dose: 12 mg.

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

    Administer directly into a vein or, if given into an iv line, as close to the patient 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 is present, a short-term modest slowing of ventricular action may take place right away after supervising this drug.

    Usage: conversion to sinus rhythm of paroxysmal supraventricular tachycardia (psvt), consisting of that related to accessory bypass systems (wolff-parkinson-white syndrome). When medically suggested, suitable vagal maneuvers (e.g., valsalva maneuver), must be tried prior to administration of this drug.

    Typical adult dosage for wolff-parkinson-white syndrome

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

    Repeat dose: if initial dose fails to eliminate 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: 12 mg.

    Remarks: for fast iv bolus just; must 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 transform atrial flutter, atrial fibrillation, or ventricular tachycardia to normal sinus rhythm; when atrial flutter or fibrillation is present, a short-term modest slowing down of ventricular response may occur immediately after administrating this drug.

    Usage: conversion to sinus rhythm of paroxysmal supraventricular tachycardia (psvt), consisting of that related to accessory bypass systems (wolff-parkinson-white syndrome). When medically suggested, appropriate vagal maneuvers (e.g., valsalva maneuver), need to be attempted prior to administration of this drug.

    Typical pediatric dose for supraventricular tachycardia

    Less than 50 kg:.

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

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

    50 kg or more:.

    Initial dosage: 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 required.

    Optimum dosage: 0.3 mg/kg; 12 mg.

    Remarks: for rapid iv bolus just; might be provided centrally or peripherally.

    Administer directly into a vein or, if given into an iv line, as near to 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 short-term modest slowing down of ventricular action may happen right away after supervising this drug.

    Usage: conversion to sinus rhythm of paroxysmal supraventricular tachycardia (psvt). When scientifically suggested, proper vagal maneuvers (e.g., valsalva maneuver), should be attempted prior to administration of this drug.

    Kidney dose adjustments

    No change suggested.

    Liver dose adjustments

    No adjustment advised.

    Precautions

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

    What other drugs engage with adenosine?

    If your medical professional has actually directed you to use this medication, your physician or pharmacist might already know any possible drug interactions and might be monitoring you for them. Do not start, stop, or change the dose of any medication prior to consulting your physician, healthcare company, or pharmacist first.

    Adenosine has no recognized extreme interactions with other drugs.

    Adenosine has no known serious interactions with other drugs.

    Moderate interactions of adenosine include:.

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

    This information does not include all possible interactions or unfavorable results. For that reason, before using this item, inform your physician or pharmacist of all the items you utilize. Keep a list of all your medications with you, and share this details with your doctor and pharmacist. Contact your health care expert or doctor for extra medical recommendations, or if you have health questions, issues, or for more details about this medication. [11]

    When not to use?

    Allergic reaction: this medication is not advised for use in patients with a recognized allergy to adenosine or any other non-active active ingredient present along with it.

    2nd or third-degree atrioventricular block: this medicine is not advised for use in clients struggling with a second or third-degree atrioventricular block and who have not gone through pacemaker implantation since it may get worse the client’s condition.

    Sick sinus syndrome: this medication is not recommended for use in patients suffering from sick sinus syndrome and who have not undergone pacemaker implantation considering that it may worsen the patient’s condition.

    Serious hypotension/shock: this medicine is not suggested for usage in patients struggling with a very low high blood pressure (serious hypotension) or shock due to the increased danger of intensifying of the patient’s condition.

    Cardiac arrest: this medication is not suggested for usage in patients experiencing a cardiac arrest because it might aggravate the client’s condition.

    Asthma: this medication is not advised for usage in clients struggling with asthma or any other extreme breathing disorder due to the increased risk of worsening of the client’s condition.

    Long qt syndrome: this medicine is not recommended for usage in clients suffering from a rare heart problem called long qt syndrome because it may worsen the patient’s condition.

    Cautions

    Cautions for unique population.

    Pregnancy: this medication is not advised for use in pregnant women unless definitely essential. All the risks and advantages must be gone over with the doctor prior to receiving this medication.

    Breast-feeding: this medication is not advised for use in breastfeeding females unless absolutely necessary. All the threats and benefits ought to be gone over with the physician before getting this medication. Your doctor might encourage you to cease breastfeeding for a particular amount of time based upon your medical condition.

    General warnings

    Other medicines: this medicine might communicate with numerous other medicines and might trigger extreme unfavorable results. For this reason, it is encouraged that you report all your current medicines including any herbs and supplements to the doctor before getting this medicine.

    Heart block: administration of this medicine might produce a short lasting initially, 2nd, or third-degree heart block. Proper corrective measures ought to be initiated based on the client’s scientific condition. If patients establish a top-level heart block after the initial dosage, additional doses ought to not be offered.

    Arrythmias: use of this medicine might cause the appearance of a range of short-lasting brand-new heart rhythms on the electrocardiogram. It is advised to continuously keep an eye on the heart rhythm of the patient while this medicine is being administered.

    Bronchoconstriction: use of this medication may make the respiratory tracts causing the lungs more narrow and trigger aggravating of symptoms of asthma, copd, and other obstructive lung diseases. It is recommended to administer this medication with severe care in patients with obstructive disease of the lungs and the breathing tract. Replacement with an ideal option may be needed based on the client’s condition.

    Cardiovascular disease: this medicine must be utilized with severe care in clients who have actually had a cardiovascular disease, heart failure, or have had a heart transplant done within the last 1 year. It must likewise be used with severe care in clients experiencing narrowing of the heart valves, swelling and enhancement of tissues around the heart, or other recognized heart problems. Close tracking of heart function, appropriate dosage changes, or replacement with an ideal alternative may be required based on the clinical condition of the client.

    Low blood volume: this medication ought to be used with severe caution in clients with a low blood volume level that has not been remedied (hypovolemia) given that it may aggravate the patient’s condition. Appropriate restorative measures and/or replacement with a suitable alternative may be necessary based on the medical condition of the patient.

    Seizure condition: this medication ought to be used with caution in clients with a history of seizures or convulsions due to the increased danger of intensifying of the patient’s condition. Close tracking of clinical condition, proper dose adjustments, or replacement with a suitable alternative may be essential in many cases.

    caffeine uptake: use of caffeine and caffeine-containing products ought to be prevented for 12 to 24 hours prior to the administration of this medication since these items may minimize the effectiveness of this medicine. [12]

    Further more care

    • Symptomatic slow heart rate (bradycardia), cardiac arrest, heart block, heart transplant patients, hypertension (high blood pressure), low blood pressure (hypotension), heart attack, frequent occurrence of pre-existing arrhythmias (proarrhythmic) occasions, low blood flow to the heart (unsteady angina)
    • Adenocard: care with bronchoconstrictive or bronchospastic lung disease (asthma)
    • Cerebrovascular accident hemorrhagic and ischemic cerebrovascular accidents reported; hemodynamic results of adenosine consisting of low blood pressure or hypertension perhaps associated with these adverse reactions
    • Nucleoside transport inhibitors (dipyridamole) and potentiate the vasoactive results of adenosine; withhold for 5 half-lives before adenosine administration
    • Methylxanthines (caffeine, theophylline) are adenosine receptor antagonists and inhibit adenosine’s vasoactive effects; keep methylxanthines for 5 half-lives prior to adenosine administration
    • New-onset or recurrence of convulsive seizures reported following adenosine; some seizures are prolonged and need emergent anticonvulsive management; aminophylline might increase danger of seizures related to adenosine;
    • Methylxanthine usage 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 may require symptomatic treatment; resuscitative steps may be essential if signs development; have trained workers and treatment readily available throughout treatment
    • Arrhythmia at time 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 often with digoxin and verapamil
    • Threat for myocardial infarction and death
    • Prevent use for cardiac nuclear stress tests in patients with signs or signs of severe myocardial anemia (unstable chest pain [angina], cardiovascular instability); use may increase the threat of deadly heart attack (myocardial infarction [mi]
    • Screen all nuclear stress test candidates for dangers

    Pregnancy and lactation

    Use adenosine during pregnancy with care if the advantages outweigh the threats. Animal research studies reveal threat and human studies are not offered, or neither animal nor human research studies were done.

    Adenosine usage when breastfeeding has the capacity for major unfavorable reactions in nursing babies. A choice to interrupt nursing after administration of adenosine must take into account the significance of the drug to the mom [13]

    Conclusions

    In conclusion, adenosine is launched in reaction to organ stress or tissue damage and displays cytoprotective results, in general, both in the brain and in the periphery. When extreme activity happens in an offered organ, adenosine acts as an endogenous quieting compound, to either lower the energy demand or increase the energy supply to that organ. Nearly every cell enter 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. Therefore, a common style to the restorative applications proposed for agonists is that adenosine serves as a cytoprotective modulator in response to tension to an organ or tissue. [14]

    Referrals

    1. Https://www.merriam-webster.com/dictionary/adenosine
    2. Https://www.webmd.com/vitamins/ai/ingredientmono-1067/adenosine
    3. Https://en.wikipedia.org/wiki/adenosine#pharmacological_effects
    4. Https://go.drugbank.com/drugs/db00640
    5. Https://draxe.com/nutrition/adenosine/#foods_and_sources
    6. Https://en.wikipedia.org/wiki/adenosine
    7. Https://www.practo.com/medicine-info/adenosine-2080-api
    8. Https://www.mayoclinic.org/drugs-supplements/adenosine-intravenous-route/side-effects/drg-20084866
    9. Https://www.everydayhealth.com/drugs/adenosine
    10. Https://www.drugs.com/dosage/adenosine.html
    11. Https://www.rxlist.com/consumer_adenosine_adenoscan/drugs-condition.htm
    12. Https://www.practo.com/medicine-info/adenosine-2080-api
    13. Https://www.rxlist.com/consumer_adenosine_adenoscan/drugs-condition.htm
    14. Https://www.ncbi.nlm.nih.gov/pmc/articles/pmc3415694/

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