title: Aminophylline and caffeine for reversal of adverse symptoms associated with regadenoson SPECT MPI.
abstract: Aminophylline shortages led us to compare intravenous (IV) aminophylline with IV and oral (PO) caffeine during routine pharmacologic stress testing with SPECT MPI.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Cardiology Division, Department of Medicine, University of Rochester Medical Center, Box 679-N, Rochester, NY, 14642, USA.
authors.forename: Jesse A
authors.initials: JA
authors.lastname: Doran
authors.affiliation: Cardiology Division, Department of Medicine, University of Rochester Medical Center, Box 679-N, Rochester, NY, 14642, USA.
authors.forename: Waseem
authors.initials: W
authors.lastname: Sajjad
authors.affiliation: Cardiology Division, Department of Medicine, University of Rochester Medical Center, Box 679-N, Rochester, NY, 14642, USA.
authors.forename: Marabel D
authors.initials: MD
authors.lastname: Schneider
authors.affiliation: Cardiology Division, Department of Medicine, University of Rochester Medical Center, Box 679-N, Rochester, NY, 14642, USA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Cardiology Division, Department of Medicine, University of Rochester Medical Center, Box 679-N, Rochester, NY, 14642, USA.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Mackin
authors.affiliation: Cardiology Division, Department of Medicine, University of Rochester Medical Center, Box 679-N, Rochester, NY, 14642, USA. ronald_schwartz@urmc.rochester.edu.|Nuclear Medicine Division, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA. ronald_schwartz@urmc.rochester.edu.
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Schwartz
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000628:Aminophylline / Q000008:administration & dosage*; D002110:Caffeine / Q000008:administration & dosage*; D002316:Cardiotonic Agents / Q000008:administration & dosage; D015984:Causality; D004347:Drug Interactions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000401:mortality* / Q000517:prevention & control*; D005080:Exercise Test / Q000187:drug effects; D005260:Female; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000401:mortality / Q000706:statistics & numerical data*; D009518:New York / Q000453:epidemiology; D011687:Purines / Q000008:administration & dosage*; D011720:Pyrazoles / Q000008:administration & dosage*; D015996:Survival Rate; D015899:Tomography, Emission-Computed, Single-Photon / Q000401:mortality / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D002316:Cardiotonic Agents; D011687:Purines; D011720:Pyrazoles; D014665:Vasodilator Agents; D000628:Aminophylline; C430916:regadenoson; D002110:Caffeine
keywords: A2A adenosine receptor agonists; Pharmacologic stress; caffeine; myocardial perfusion imaging: SPECT; vasodilator stress