Theophylline and Caffeine as Alternatives During an Aminophylline Shortage

Ann Pharmacother. 2019 Mar;53(3):316-320. doi: 10.1177/1060028018806624. Epub 2018 Oct 11.


The latest aminophylline shortage has prompted a need for alternative reversal agents for pharmacological stress testing. Cardiac stress testing is common for diagnosis and prognosis in patients with coronary heart disease. Options for pharmacological stress test agents include adenosine, regadenoson, dipyridamole, and dobutamine, whereas aminophylline is the recommended reversal agent. Adenosine and dobutamine can be used as alternatives to regadenoson and dipyridamole to decrease or eliminate the use of aminophylline. Alternatives to aminophylline include theophylline and caffeine. It is important to efficiently identify alternatives during a drug shortage to maintain optimal patient outcomes.

Keywords: acute coronary syndromes; adverse drug reactions; antidotes; cardiology; diagnostic agents; drug information; ischemic heart disease; literature evaluation; myocardial infarction; vasodilators.

MeSH terms

  • Aminophylline / supply & distribution*
  • Aminophylline / therapeutic use
  • Caffeine / administration & dosage*
  • Caffeine / therapeutic use
  • Coronary Disease / diagnosis
  • Drug Utilization / trends
  • Exercise Test / adverse effects*
  • Exercise Test / methods
  • Female
  • Humans
  • Male
  • Theophylline / administration & dosage*
  • Theophylline / therapeutic use
  • Vasodilator Agents / administration & dosage*
  • Vasodilator Agents / therapeutic use


  • Vasodilator Agents
  • Aminophylline
  • Caffeine
  • Theophylline