regadenoson (Rx)

Brand and Other Names:Lexiscan
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

intravenous solution

  • 0.4mg/5mL
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Pharmacologic Stress Agent

Indicated for radionuclide myocardial perfusion imaging (MPI) in patients unable to undergo adequate exercise stress

5 mL (0.4 mg) IVP

Administration

Administer as rapid (~10 sec) injection into a peripheral vein using 22 gauge or larger catheter or needle

Inspect visually, prior to admin, DO NOT administer if discolored or particulate matter present

Administer 5 mL saline flush, immediately after

Administer radionuclide myocardial perfusion imaging agent 10-20 sec after saline flush

  • Radionuclide may be injected directly into same catheter as regadenoson

Renal Impairment

No dose adjustment needed in renal impairment including patients end stage renal disease and/or dependent on dialysis

Safety and efficacy not established

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Interactions

Interaction Checker

and regadenoson

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Dyspnea (28%)

            Headache (26%)

            Rhythm conduction abnormalities (26%)

            Flushing (16%)

            PVCs (14%)

            Chest Discomfort (13%)

            Angina or ST segment depression (12%)

            1-10%

            Dizziness (8%)

            Chest pain (7%)

            PACs (7%)

            Nausea (6%)

            Ventricular conduction abnormalities (6%)

            Abdominal discomfort (5%)

            Dysgeusia (5%)

            Feeling hot (5%)

            First-degree AV block (3%)

            <1%

            Anaphylaxis, angioedema, cardiac arrest, respiratory arrest/distress, throat tightness, and urticaria/rashes, atrial fibrillation, seizures, cardiovascular accidents (stroke)

            Postmarketing reports

            Cardiovascular: Myocardial infarction, cardiac arrest, ventricular arrhythmias, supraventricular tachyarrhythmias including atrial fibrillation with rapid ventricular response (new-onset or recurrent), atrial flutter, heart block (including third-degree block), asystole, marked hypertension, symptomatic hypotension in association with transient ischemic attack, seizures and syncope

            Central nervous system: Tremor, seizure, transient ischemic attack, and cerebrovascular accident including intracranial hemorrhage

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            Warnings

            Contraindications

            2/3° AV block or sinus node dysfunction (unless patient has a functioning pacemaker installed)

            Cautions

            Appropriate bronchodilator therapy and resuscitative measures should be available prior to and following therapy

            1° AV block

            SA block

            QT prolongation has occurred shortly after administration in postmarketing surveillence

            Hypotension in association with transient ischemic attack, tremors, syncope, and seizures

            Hypertension (transient) may occur following administration

            Conduction disturbances; depresses SA and AV node conduction and may produce first, second, and third-degree heart block

            Anaphylaxis, angioedema, cardiac or respiratory arrest, respiratory distress, decreased oxygen saturation, hypotension, throat tightness, urticaria and rashes have occurred

            Adenosine receptor agonists may cause dyspnea, bronchoconstriction, and respiratory compromise; caution with asthma or bronchoconstrictive disease

            Nucleoside transport inhibitors (eg, dipyridamole) and potentiate the vasoactive effects of regadenoson; withhold for 5 half-lives before regadenoson administration

            Methylxanthines (eg, caffeine, theophylline) are adenosine receptor antagonists and inhibit regadenoson’s vasoactive effects; withhold methylxanthines for 5 half-lives before regadenoson administration

            Aminophylline may increase risk of seizures associated with regadenoson injection

            May lower seizure threshold; new-onset or recurrence of convulsive seizures has occurred following regadenoson injection; some seizures are prolonged and require emergent anticonvulsive management

            Hemorrhagic and ischemic cerebrovascular accidents have occurred

            New-onset or recurrent atrial fibrillation with rapid ventricular response and atrial flutter reported

            Risk for myocardial infarction and death

            • Avoid use for cardiac nuclear stress tests in patients with signs or symptoms of acute myocardial ischemia (eg, unstable angina, cardiovascular instability); use may increase risk of fatal MI
            • Screen all nuclear stress test candidates for risks
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            Pregnancy & Lactation

            Pregnancy: No available data on therapy use in pregnant women to inform drug-associated risk; in animal reproduction studies, adverse developmental outcomes were observed with therapy administration to pregnant rats and rabbits during organogenesis only at doses that produced maternal toxicity

            Lactation: There is no information on presence of regadenoson in human milk, effects on breastfed infant, or effects on milk production; because of potential risk of serious cardiac reactions in breastfed infant, advise nursing mother to pump and discard breast milk for 10 hr after therapy

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Low affinity agonist for the A2A adenosine receptor

            Activation of the A2A adenosine receptor produces coronary vasodilation and increases coronary blood flow

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
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            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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