Indirectly acting adenosinomimetic agents act through endogenous adenosine by various mechanisms
Increase of synthesis or release of adenosine: there is no drug released on the market acting by this mechanism.
Decrease of adenosine reuptake: dipyridamole inhibits adenosine reuptake by cells. It is proposed for prevention of thromboembolic disorders but its clinical efficacy is not obvious. However, combined with aspirin, dipyridamole potentiates the antiplatelet effect of aspirine.
Dipyridamole
Dipyridamole + Aspirine
PERSANTINE* Tablets
AGGRENOX* Capsules
Inhibition of adenosine catabolism: pentostatin, also called 2-deoxycoformycin, isolated from Streptomyces antibioticus, is a powerful inhibiter of adenosine deaminase. It increases the intracellular concentration of adenosine and deprives the cell of inosine and its metabolites. Pentostatin has antineoplastic and immunodepressive activities. It potentiates, moreover, the effects of adenosine and of its antiviral analogues, such as arabinofuranosyl-adenine and of its immunosupressive analogues.
However because of its toxicity, pentostatin is only used in the treatment of severe diseases, in particular hairy cell leukemia.
Pentostatin
NIPENT* for injection
Note:
Hereditary adenosine deaminase deficiency results in a syndrome of immunodeficiency related to deoxyadenosine and adenosine excess. Pegademase is an adenosine deaminase of bovine origin, conjugated with polyethyleneglycol, and used to treat this deficiency.
