Aminophylline and Caffeine for Reversal of Adverse Symptoms Associated with Regadenoson SPECT MPI

Overview

Journal J Nucl Cardiol

Specialty Cardiology & Vascular Diseases

Date 2016 Mar 31

PMID 27025843

Citations 11

Authors

Jesse A Doran

Waseem Sajjad

Marabel D Schneider

Rohit Gupta

Maria L Mackin

Ronald G Schwartz

Affiliations

Soon will be listed here.

Abstract

Background: Aminophylline shortages led us to compare intravenous (IV) aminophylline with IV and oral (PO) caffeine during routine pharmacologic stress testing with SPECT MPI.

Methods: We measured presence, duration, and reversal of adverse symptoms and cardiac events following regadenoson administration in consecutive patients randomized to IV aminophylline (100 mg administered over 30-60 seconds), IV caffeine citrate (60 mg infused over 3-5 minutes), or PO caffeine as coffee or diet cola.

Results: Of 241 patients, 152 (63%) received regadenoson reversal intervention. Complete (CR), predominant (PRE), or partial (PR) reversal was observed in 99%. CR by IV aminophylline (87%), IV caffeine (87%), and PO caffeine (78%) were similar (P = NS). Time to CR (162 ± 12.6 seconds, mean ± SD) was similar in treatment arms. PO caffeine was inferior to IV aminophylline for CR + PRE.

Conclusions: IV aminophylline and IV caffeine provide rapid, safe reversal of regadenoson-induced adverse effects during SPECT MPI. Oral caffeine appeared similarly effective for CR but not for the combined CR + PRE. Our results suggest PO caffeine may be an effective initial strategy for reversal of regadenoson, but IV aminophylline or IV caffeine should be available to optimize symptom reversal as needed.

Citing Articles

Adenosine-caffeine: the agonist-antagonist couple for vasodilator stress tests.

Songy B J Nucl Cardiol. 2022; 30(2):581-584.

PMID: 36123567 DOI: 10.1007/s12350-022-03107-0.

Safety and efficacy of IV theophylline for regadenoson-associated side effect reversal.

Shakowski C, Pham V, Raines J, Quaife R, Page 2nd R J Nucl Cardiol. 2022; 30(2):585-589.

PMID: 35799037 DOI: 10.1007/s12350-022-03031-3.

Buccal caffeine strips for reversal of adverse symptoms of vasodilator stress.

Elsadany M, Stringer B, Bote J, Abdulla K, Doran J, Schwartz R J Nucl Cardiol. 2022; 30(2):574-580.

PMID: 35794456 PMC: 9258756. DOI: 10.1007/s12350-022-03039-9.

Comparative efficacy and safety of adenosine and regadenoson for assessment of fractional flow reserve: A systematic review and meta-analysis.

Gill G, Gadre A, Kanmanthareddy A World J Cardiol. 2022; 14(5):319-328.

PMID: 35702325 PMC: 9157604. DOI: 10.4330/wjc.v14.i5.319.

Optimizing patient centered care in the cardiac intensive care unit: Harness the safety, effectiveness, and incremental value of radionuclide perfusion, function, and molecular imaging.

Bleszynski P, Schwartz R J Nucl Cardiol. 2021; 30(2):570-573.

PMID: 34169474 DOI: 10.1007/s12350-021-02691-x.

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