Buccal caffeine strips for reversal of adverse symptoms of vasodilator stress View Full Text


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Article Info

DATE

2022-07-06

AUTHORS

Mohammed Elsadany, Bryan Stringer, Josiah Bote, Khaled H. Abdulla, Jesse A. Doran, Ronald G. Schwartz, W. Lane Duvall

ABSTRACT

BackgroundDue to recurrent shortages of aminophylline, intravenous caffeine has emerged as a commonly used, safe and reliable method to treat adverse effects of vasodilator stress agents. We sought to evaluate the safety and effectiveness of buccal caffeine strips which are rapidly absorbed, inexpensive, readily available, and simplify caffeine administration.MethodsConsecutive 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 (60 mg) 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.ResultsOf 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 (24%) received reversal with a caffeine agent. Seven (6%) received IV caffeine and 21 (17%) received buccal caffeine. There was no significant difference in symptom duration between IV and buccal caffeine after treatment (152.8 vs 163.4 seconds, 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 a rescue dose. There was no significant difference in patient satisfaction between the groups (2.8 vs 3.2, P = 0.38).ConclusionBuccal caffeine strips are a safe, well tolerated, and effective initial strategy to reverse adverse effects of vasodilator stress in the minority of patients who request it. Buccal caffeine alone or with IV rescue caffeine was highly effective in reversing adverse effects and was free of major adverse clinical events. More... »

PAGES

1-7

References to SciGraph publications

  • 2016-02-25. ASNC imaging guidelines for SPECT nuclear cardiology procedures: Stress, protocols, and tracers in JOURNAL OF NUCLEAR CARDIOLOGY
  • 2012-03-07. Attenuation of the side effect profile of regadenoson: A randomized double-blinded placebo-controlled study with aminophylline in patients undergoing myocardial perfusion imaging. “The ASSUAGE trial” in JOURNAL OF NUCLEAR CARDIOLOGY
  • 2016-04-12. Intravenous caffeine: An alternative to aminophylline to reverse adverse effects during regadenoson myocardial perfusion imaging in JOURNAL OF NUCLEAR CARDIOLOGY
  • 2007-09. Adenosine versus regadenoson comparative evaluation in myocardial perfusion imaging: Results of the ADVANCE phase 3 multicenter international trial in JOURNAL OF NUCLEAR CARDIOLOGY
  • 2018-12-20. Aminophylline shortage and current recommendations for reversal of vasodilator stress: An ASNC information statement endorsed by SCMR in JOURNAL OF NUCLEAR CARDIOLOGY
  • 2012-12-11. Attenuation of the side effect profile of regadenoson: a randomized double-blind placebo-controlled study with aminophylline in patients undergoing myocardial perfusion imaging and have severe chronic kidney disease—the ASSUAGE-CKD trial in THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING
  • 2011-08-23. Dipyridamole reversal using theophylline during aminophylline shortage in JOURNAL OF NUCLEAR CARDIOLOGY
  • 2016-03-29. Aminophylline and caffeine for reversal of adverse symptoms associated with regadenoson SPECT MPI in JOURNAL OF NUCLEAR CARDIOLOGY
  • 2014-07-01. Buccal caffeine for the routine reversal of Persantine in JOURNAL OF NUCLEAR CARDIOLOGY
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    http://scigraph.springernature.com/pub.10.1007/s12350-022-03039-9

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    http://dx.doi.org/10.1007/s12350-022-03039-9

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    https://app.dimensions.ai/details/publication/pub.1149272005

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/35794456


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