Comparison of intravenous and buccal caffeine for reversal of adverse effects of regadenason

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Regadenason is a common coronary vasodilator for myocardial perfusion imaging (MPI). Use has been associated with side effects including dyspnea, gastrointestinal upset and chest discomfort. Aminophylline is a common reversal agent. Due to frequent shortages caffeine has emerged as an alternative treatment. Purpose Our study aimed to compare the efficacy of intravenous (IV) caffeine and buccal caffeine strips for reversal of regadenason adverse effects. Methods Consecutive patients undergoing regadenoson stress SPECT MPI were assessed for the occurrence of symptoms during testing over an 11 week period at a single metropolitan hospital. Adverse symptoms, including their severity and duration, were recorded at the time of testing. Patient satisfaction was rated on a scale of 1 to 5 (5 being the most satisfied). Patients received reversal with caffeine if symptoms were felt to be significant enough by the patient and physician performing the test. The treatment received alternated week to week between IV caffeine (60mg) or 100 mg buccal caffeine strips. Caffeine was given at least 3 minutes after tracer injection. A rescue dose of IV caffeine was offered 10 minutes later if indicated. Results Of the 122 patients enrolled in the study, 70 (57%) were included during buccal caffeine weeks and 52 (43%) during IV caffeine weeks, and only 28 (23.9%) received reversal with a caffeine agent. Seven (5.7%) received IV caffeine and 21 (17.2%) received buccal caffeine. The most common adverse symptom reported was dyspnea, which occurred in 54 patients (44.3%). There was no significant difference in symptom duration between IV and buccal caffeine after treatment (152.8 vs 163.4 sec, p = 0.87). There was no significant difference in initial and final symptom severity between groups. Only 2 patients in the buccal group required rescue IV caffeine for ongoing symptoms and emesis. None of the IV group required rescue dose. There was no significant difference in patient satisfaction between the groups (2.8 vs 3.2, p = 0.38). Interestingly, patients were more likely to receive treatment on buccal caffeine weeks compared to IV weeks (30.0% vs 13.5%, p = 0.049) Conclusion(s) Buccal caffeine is an effective alternative to IV caffeine for the management of adverse effects from regadenason and may be a more cost effective option. Buccal caffeine is easier to store and prepare than IV caffeine, and compared to other oral caffeine alternatives provides consistent dosing and easier consumption.