Version June 2024
| Dipyridamole | Adenosine | Regadenoson | Dobutamine | |
| Chemical | Pyrimidine derivative | Endogenous vasodilator of purine derivative | Purine derivative | Synthetic catecholamine |
| Onset and duration of action, half-life | Effect peaks at 7 to 15 minutes, half-life 30 to 45 minutes | Immediate onset, half-life less than 5 seconds, effects disappear rapidly after infusion | Peak 1 to 4 minutes after injection Half-life of ≅ 30 minutes | Onset 1 to 2 minutes, half-life 2 minutes |
| Mechanism of action | Blocks reuptake of endogenous adenosine causing coronary vasodilation | Stimulation of adenosine receptor A2A causing coronary vasodilation | Stimulates A2A adenosine receptor causes coronary vasodilation | Alpha-1, beta-1, and beta-2 stimulation increases myocardial O2 demand and secondary vasodilatation |
| Dose | 140 mcg/kg per minute for 4 minutes (maximum 0.56 mg/kg) | 140 mcg/kg per minute for 4 to 6 minutes | Regadenoson 0.4 mg/5 mL | 5 to 40 mcg/kg per minute, depending upon heart rate response |
| Radionuclide injection | 7 to 9 minutes after initiation of infusion | 3 minutes into infusion; infusion continued for further 1 to 3 minutes | 10 to 20 seconds after regadenoson | At peak stress |
| Hemodynamics | Slight increase in heart rate and slight decrease in blood pressure (BP) | Slight increase in heart rate and slight decrease in BP (adenosine more than dipyridamole) | Slight increase in heart rate and slight decrease in BP | Target heart rate 85 percent of maximum predicted heart rate |
| Side effects | Most common chest pain | Same as dipyridamole but resolve rapidly; heart block more common | Dyspnea, headache, and flushing | Most common palpitations and chest pain, most serious nonsustained ventricular tachycardia, nonfatal myocardial infarction |
| Contraindications | Bronchospasm, second- or third-degree AV block or sick sinus syndrome (unless protected by a functioning pacemaker) | Same as dipyridamole | Second- or third-degree AV block or sinus node dysfunction Caution for bronchospasm | Recent acute coronary syndrome, hemodynamic and electrophysiologic instability |
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