Aminophylline and caffeine for reversal of adverse symptoms associated with regadenoson SPECT MPI.
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.
['Doran|Jesse A|JA|', 'Sajjad|Waseem|W|', 'Schneider|Marabel D|MD|', 'Gupta|Rohit|R|', 'Mackin|Maria L|ML|', 'Schwartz|Ronald G|RG|']
D000284:Administration, Oral D000368:Aged D000628:Aminophylline D002110:Caffeine D002316:Cardiotonic Agents D015984:Causality D004347:Drug Interactions D064420:Drug-Related Side Effects and Adverse Reactions D005080:Exercise Test D005260:Female D006801:Humans D015994:Incidence D007275:Injections, Intravenous D008297:Male D008875:Middle Aged D055414:Myocardial Perfusion Imaging D009518:New York D011687:Purines D011720:Pyrazoles D015996:Survival Rate D015899:Tomography, Emission-Computed, Single-Photon D016896:Treatment Outcome D014665:Vasodilator Agents
caffeine Pharmacologic stress A2A adenosine receptor agonists myocardial perfusion imaging: SPECT vasodilator stress