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

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Aminophylline injection has been on an intermittent nation-wide shortage due to manufacturing delays leaving a need for an alternative reversal agent for regadenoson-associated side effects. Intravenous theophylline should be a logical acceptable pharmacological alternative; however, data regarding its safety and efficacy as a reversal agent are lacking.

Methods

Utilizing electronic medical records at the University of Colorado hospital, we identified patients ≥ 18 years of age who had a pharmacologic stress test using regadenoson during periods of aminophylline shortage (3/1/2013 to 5/31/2013 and 4/1/2018 to 8/30/2018) in which theophylline was used as an alternative antidote for side effect reversal. Intravenous theophylline was prepared by the inpatient pharmacy to a concentration of 0.8 mg/mL in a total volume of 100 mL D5W. Specific side effects and side effect resolution were evaluated.

Results

Of the 122 patients evaluated, theophylline was administered in doses ranging from 40 to 75 mg with the majority receiving 40 mg. Complete resolution of regadenoson side effects occurred in 98 patients with 12 experiencing partial resolution and 1 without resolution. No adverse effects or events were reported.

Conclusion

Due to limited availability of aminophylline, theophylline may be a safe and effective alternative to reverse regadenoson-associated side effects.

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Figure 1

Abbreviations

CAD:

Coronary artery disease

IV:

Intravenous

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Disclosures

Robert A. Quaife—Astellas Regadenoson Scientific Advisory Board; grant funding from Astellas. Courtney Shakowski, Vy Pham, Joshua Raines and Robert L. Page II have no conflict of interest to declare.

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Authors and Affiliations

  1. Department of Pharmacy, University of Colorado Health, University of Colorado Hospital, Aurora, CO, USA

    Courtney Shakowski PharmD & Robert L. Page II PharmD, MSPH

  2. Division of Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO, USA

    Vy A. Pham MD

  3. Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO, USA

    Joshua Raines MD

  4. Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO, USA

    Robert A. Quaife MD

  5. Division of Nuclear Medicine, Department of Radiology, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO, USA

    Robert A. Quaife MD

  6. Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA

    Robert L. Page II PharmD, MSPH

Authors
  1. Courtney Shakowski PharmD
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  2. Vy A. Pham MD
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  3. Joshua Raines MD
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  4. Robert A. Quaife MD
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  5. Robert L. Page II PharmD, MSPH
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Corresponding author

Correspondence to Robert L. Page II PharmD, MSPH.

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Shakowski, C., Pham, V.A., Raines, J. et al. Safety and efficacy of IV theophylline for regadenoson-associated side effect reversal. J. Nucl. Cardiol. 30, 585–589 (2023). https://doi.org/10.1007/s12350-022-03031-3

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  • DOI: https://doi.org/10.1007/s12350-022-03031-3

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