Is it safe to order Lexiscan (regadenoson) for a patient?

Regadenoson (Lexiscan) Safety and Ordering Guidelines

Regadenoson should not be ordered for patients with second- or third-degree AV block or sinus node dysfunction unless they have a functioning artificial pacemaker. 1

Contraindications

• Second-degree or third-degree AV block 1
• Sinus node dysfunction (unless patient has a functioning artificial pacemaker) 1
• Recent history of serious uncontrolled ventricular arrhythmia 1
• Recent myocardial infarction or unstable angina 1
• History of greater than first-degree AV block 1
• Symptomatic bradycardia 1
• Sick sinus syndrome 1
• Heart transplant 1

Safety Considerations in Special Populations

Renal Impairment

• Regadenoson appears safe in patients with end-stage renal disease (ESRD) 2
• The hemodynamic and side effect profiles in ESRD patients are similar to those with normal renal function 2
• The pharmacokinetics in dialysis patients has not been formally assessed, though regadenoson is dialyzable 1

Pulmonary Hypertension

• Regadenoson appears to be well-tolerated in patients with pulmonary hypertension 3
• Common side effects in these patients include dyspnea (70.6%), but no serious adverse events were reported 3

Hepatic Impairment

• No dose adjustment is needed in patients with hepatic impairment 1
• More than 55% of the dose is excreted in urine as unchanged drug 1

Elderly Patients

• No dose adjustment is needed in elderly patients 1
• Age has only minor influence on the pharmacokinetics of regadenoson 1

Potential Adverse Events

• Dyspnea (30%) 4
• Chest discomfort (27%) 4
• Headache (15%) 4
• Rare but serious events include:
  • Advanced heart block 5
  • Asystole (extremely rare) 5
  • Bronchospasm 4
  • Heart failure exacerbation 4

Clinical Efficacy

• Regadenoson has demonstrated similar efficacy to adenosine in detecting reversible perfusion defects in myocardial perfusion imaging 1
• Agreement rates between regadenoson and adenoscan were 62±2% and 63±3% in two pivotal studies 1
• Regadenoson causes a rapid increase in coronary blood flow that is sustained for a short duration 6

Ordering Protocol

1. Screen for contraindications before ordering regadenoson 1
2. Review patient's cardiac history for any history of arrhythmias, AV block, or sinus node dysfunction 1
3. Assess current medications that may interact with regadenoson 1
4. Consider alternative stress testing methods for patients with contraindications 1
5. Ensure appropriate monitoring equipment and resuscitation capabilities are available during administration 5

Regadenoson is generally well-tolerated with few serious adverse events when used appropriately in patients without contraindications 4. However, careful patient selection is essential to minimize risk of serious cardiac events such as advanced heart block or asystole 5.