Aminophylline shortage and current recommendations for reversal of vasodilator stress: an ASNC information statement endorsed by SCMR

Abstract

Pharmacologic reversal of serious or intolerable side effects (SISE) from vasodilator stress is an important safety and comfort measure for patients experiencing such effects. While typically performed using intravenous aminophylline, recurrent shortages of this agent have led to a greater need to limit its use and consider alternative agents. This information statement provides background and recommendations addressing indications for vasodilator reversal, timing of a reversal agent, incidence of observed SISE with vasodilator stress, clinical and logistical considerations for aminophylline-based reversal, and alternative non-aminophylline based reversal protocols.

Plasma Concentration Detection of Aminophylline with Multi-Walled Carbon Nanotube-Modified Electrodes in the Treatment of Ticagrelor-Related Dyspnea

“…Aminophylline is a phosphodiesterase inhibitor that relaxes tracheal smooth muscles and relieves dyspnea (26). Firstly, as a purinergic receptor blocker, aminophylline can antagonize airway constriction caused by adenosine, improving dyspnea symptoms effectively.…”

Journal of Cardiovascular Magnetic Resonance: 2017/2018 in review

“…In mid-2018 there was a shortage of aminophylline, a pharmaceutical often used to reverse vasodilatory effects. This led to an American Society of Nuclear Cardiology (ASNC) informational statement led by Abidov et al [194] regarding the use of aminophylline and alternative non-aminophylline based reversal protocols. Given the frequent use of vasodilator stress CMR, the SCMR endorsed the statement.…”

Adenosine–caffeine: the agonist—antagonist couple for vasodilator stress tests

“…This has been reinforced by recurrent shortages of aminophylline. 7,8 Intravenous (IV) caffeine is safe and reliable but not completely straightforward in its use. Caffeinated beverages are easier to use but may lead to the inconsistent dosing of caffeine.…”

“…With dipyridamole, however, side effects occur in approximatively 50% of cases, but symptoms may last for longer, often for over 15 minutes. 8 Regadenoson is a selective A2a receptor agonist, which causes a near-maximal coronary vasodilation without significant stimulation of the A1, A2b, or A3 receptors in clinical conditions. An additional sympathetic stimulation is suggested by the rapid and sustained increase in heart rate, unexplained by the minor decrease in blood pressure.…”