Aminophylline shortage and current recommendations for reversal of vasodilator stress: an ASNC information statement endorsed by SCMR

Table 3 Aminophylline and Alternative Vasodilator stress reversal agents

Reversal Agent	HCPCS Code	Formulation	Cost per unit dose^a	Recommended dose	Additional recommendations
IV Aminophylline	J0280	250 mg in 10 mL vial	$9.92	50–125 mg; slow manual injection	May repeat additional 50–125 mg as needed if the initial dose has not completely eliminated symptoms
IV Theophylline	J2810	400 mg in 500 mL bag	$3.50	50 mg; slow manual injection (over 1 min)	May repeat additional 50 mg if needed
IV Caffeine Citrate	J0706	60 mg in 3 mL vial	$6.05	60 mg diluted in 25 cc D5W; infused over 3–5 min	May repeat an infusion (30–60 mg) if needed^b
PO Caffeine	–	Caffeinated beverage	–	Estimated 60–160 mg; given as a regular coffee, tea or caffeinated beverage^c	Consider switching to IV Aminophylline or IV Caffeine if lack of complete resolution of symptoms achieved

HCPCS code The Healthcare Common Procedure Coding System (HCPCS) is a collection of codes that represent procedures, supplies, products and services which may be provided to Medicare beneficiaries and to individuals enrolled in private health insurance programs. IV intravenous; mg milligram; PO oral; ^aCost data provided by Pete Antonopoulos, PharmD, Cook County Health, October 15, 2018. ^bNo definitive evidence available regarding the repeat dose. ^cMost regular coffees contain over 100 mg of caffeine; see data from Center for Science in the Public Interest data in Appendix 1 of 2016 ASNC Stress Protocols and Tracers guidelines.[1] For example, a 16 fluid ounce Starbucks Grande has 330 mg, and a Keurig Coffee K-Cup which makes 8 oz of coffee has 75–150 mg. A 12 oz Diet Coke has 47 mg; the Food and Drug Administration limit for cola and pepper soft drinks is 71 mg per 12 oz.

ISSN: 1532-429X