What is the reversal dose for regadenoson in patients with conditions like asthma or COPD?

Reversal Dose for Regadenoson

Administer aminophylline 50-100 mg IV over 30-60 seconds or theophylline 40-75 mg IV (most commonly 40 mg) to reverse regadenoson-induced adverse effects, with oral caffeine (60-200 mg) as an acceptable but less reliable alternative. 1, 2

Primary Reversal Agents

Intravenous Aminophylline (First-Line)

• Standard dose: 100 mg IV administered over 30-60 seconds 1
• Achieves complete symptom resolution in 87% of patients 1
• Mean time to complete reversal: 162 ± 12.6 seconds (approximately 2.5-3 minutes) 1
• Combined complete plus predominant reversal approaches 99% 1

Intravenous Theophylline (Alternative During Aminophylline Shortage)

• Dose range: 40-75 mg IV, with 40 mg being most commonly used 2
• Prepared as 0.8 mg/mL concentration in 100 mL D5W 2
• Complete resolution achieved in 80% of patients, partial resolution in 10%, with no adverse events reported 2
• This is a safe and effective alternative when aminophylline is unavailable 2

Secondary Reversal Options

Intravenous Caffeine Citrate

• Dose: 60 mg infused over 3-5 minutes 1
• Achieves complete reversal in 87% of patients, equivalent to aminophylline 1
• Time to complete reversal similar to aminophylline 1

Oral Caffeine (Coffee or Diet Cola)

• Achieves complete reversal in only 78% of patients 1
• Significantly inferior to IV aminophylline for combined complete plus predominant reversal 1
• May be used as initial strategy, but IV agents should be immediately available for inadequate response 1

Special Considerations for COPD and Asthma Patients

Safety Profile in Respiratory Disease

• Regadenoson can be safely used in patients with asthma or COPD without causing bronchospasm or major respiratory complications 3, 4
• In a cohort of 206 patients with asthma or COPD, no bronchospasm or major side effects occurred 3
• Zero percent incidence of clinical exacerbation of COPD or asthma after regadenoson administration 4

Symptom Patterns Requiring Reversal

• Dyspnea is more common in COPD patients (40.3% vs 22.4% in asthmatics) 5
• Headache and feeling hot are more common in asthmatic patients 5
• Persistent dyspnea requiring reversal occurs in approximately 2-3% of respiratory disease patients 5

When to Administer Reversal Agent

• Any symptom persisting beyond 30 minutes 3
• Symptoms requiring investigation or treatment 3
• Patient distress or request for symptom relief 1
• Most symptoms are transient and self-limiting (84% classified as mild), so reversal is not routinely required 3

Clinical Algorithm for Reversal

1. Assess symptom severity and duration - most regadenoson symptoms resolve spontaneously within minutes 3
2. If reversal needed, use IV aminophylline 100 mg over 30-60 seconds as first choice 1
3. If aminophylline unavailable, use IV theophylline 40 mg 2
4. If IV access problematic, oral caffeine may be attempted but have IV agents ready 1
5. Expect symptom resolution within 2-3 minutes of IV administration 1

Important Caveats

• Vasovagal episodes account for the majority of adverse events (7 of 8 in one series), not true drug toxicity 3
• No deaths, myocardial infarctions, or hospital admissions have been reported from regadenoson use in respiratory disease patients 3, 4
• Zero percent incidence of AV block with regadenoson (compared to 4.2% with adenosine) 4
• Reversal agents should be immediately available but are only needed in a minority of patients 1, 3