From the Guidelines
Lexiscan (regadenoson) is a preferred pharmacological stress agent for patients who cannot exercise adequately, due to its favorable side-effect profile and single 10-s infusion administration, as recommended by the 2020 guidance from ASNC and SNMMI 1. The benefits of Lexiscan include its ability to dilate coronary arteries to detect coronary artery disease, its rapid onset of action (within 1-2 minutes), short duration (2-5 minutes), and administration as a single injection rather than continuous infusion. It's particularly useful for patients with mobility issues, lung disease, or other conditions preventing exercise. However, Lexiscan carries several risks including potential serious cardiac side effects such as heart attack, abnormal heart rhythms, and low blood pressure. Common side effects include shortness of breath, headache, flushing, chest discomfort, dizziness, nausea, and abdominal discomfort. Lexiscan is contraindicated in patients with certain heart rhythm disorders, unstable angina not well controlled with medication, and severe low blood pressure. Patients with asthma or COPD may experience bronchospasm. Before undergoing a Lexiscan stress test, patients should inform their doctor about all medications, especially those containing caffeine or theophylline, as these can interfere with the test results, as noted in the 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery 1. Patients should also avoid caffeine for 24 hours before the test. The use of Lexiscan should be guided by the principle of As Low as Reasonably Achievable (ALARA) to minimize exposure to ionizing radiation, as recommended by the 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease 1. Some key points to consider when using Lexiscan include:
- Its potential to cause serious cardiac side effects
- Its contraindications in certain patient populations
- The importance of informing patients about potential side effects and interactions with other medications
- The need to avoid caffeine for 24 hours before the test
- The principle of ALARA to minimize exposure to ionizing radiation.
From the FDA Drug Label
Myocardial Ischemia. Fatal cardiac events have occurred. Avoid use in patients with symptoms or signs of acute myocardial ischemia, for example unstable angina or cardiovascular instability, who may be at greater risk. Sinoatrial (SA) and Atrioventricular (AV) Nodal Block. Adenosine receptor agonists, including regadenoson injection, can depress the SA and AV nodes and may cause first-, second- or third-degree AV block, or sinus bradycardia Atrial Fibrillation/Atrial Flutter. New-onset or recurrent atrial fibrillation with rapid ventricular response and atrial flutter have been reported Hypersensitivity, including anaphylaxis, angioedema, cardiac or respiratory arrest, respiratory distress, decreased oxygen saturation, hypotension, throat tightness, urticaria, and rashes have occurred. Hypotension. Adenosine receptor agonists, including regadenoson injection, induce vasodilation and hypotension. Hypertension. Adenosine receptor agonists, including regadenoson injection, may induce clinically significant increases in blood pressure Bronchoconstriction. Adenosine receptor agonists, including regadenoson injection, may induce dyspnea, bronchoconstriction and respiratory compromise in patients with chronic obstructive pulmonary disease (COPD) or asthma. Seizure. regadenoson injection may lower the seizure threshold. Cerebrovascular Accident (Stroke). Hemorrhagic and ischemic cerebrovascular accidents have occurred
The risks of lexiscan (regadenoson) include:
- Myocardial ischemia and fatal cardiac events
- Sinoatrial and atrioventricular nodal block
- Atrial fibrillation/atrial flutter
- Hypersensitivity reactions, including anaphylaxis
- Hypotension and hypertension
- Bronchoconstriction and respiratory compromise
- Seizure and cerebrovascular accidents The benefits of lexiscan (regadenoson) are that it is a pharmacologic stress agent indicated for radionuclide myocardial perfusion imaging (MPI) in patients unable to undergo adequate exercise stress 2.
From the Research
Risks of Lexiscan (Regadenoson)
- Adverse events such as dyspnea, fatigue, chest pain, headache, gastrointestinal discomfort, dry mouth, flushing, feeling hot, and dizziness have been reported in patients undergoing stress testing with regadenoson 3, 4, 5
- Increased heart rate and systolic blood pressure have been observed in patients receiving regadenoson 3, 5
- Non-severe complications, including bronchospasm, have been reported in a small percentage of patients 4
- Regadenoson may cause persistent dyspnea in some patients, requiring theophylline administration 5
Benefits of Lexiscan (Regadenoson)
- Regadenoson has been shown to be safe and well-tolerated in patients with severe chronic obstructive pulmonary disease (COPD) undergoing myocardial perfusion imaging (MPI) 3
- Regadenoson has a better safety profile and tolerability compared to adenosine, with no serious immediate complications and a low incidence of non-severe complications 4
- Regadenoson is effective in detecting reversible myocardial ischemia, with non-inferiority to adenosine demonstrated in the ADVANCE phase 3 clinical trial 6
- Regadenoson has been widely used and established as a safe and effective pharmacological stress agent in most patients with chronic diseases 7, 6