Pharm

Dipyridamole

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Dipyridamole, Persantine, Aggrenox

  • See Also
  1. Antiplatelet Therapy
  2. Antiplatelet Therapy in CVA and TIA
  3. Pharmacologic Stress Test
  4. Cilostazol
  5. Pentoxifylline
  • Indications
  1. Cerebrovascular Accident Prevention after TIA or CVA
  2. Alternative for Aspirin sensitive patient
    1. Use Dipyridamole alone (Aggrenox contains Aspirin)
  3. Pharmacologic Stress Test
    1. Persantine or Dipyridamole Nuclear Stress Test is an alternative to Adenosine stress test
    2. Dipyridamole is a less potent vasodilator than Adenosine and may be better tolerated
  • Contraindications
  1. Creatinine Clearance <10 ml/min
  • Mechanism
  1. Dipyridamole is a pyrimiopyrimidine derivative
  2. Inhibits Platelet phosphodiesterase to increase cAMP levels
    1. Potentiates Platelet aggregation inhibitor (PGI2)
  3. Inhibits Platelet uptake of Adenosine
    1. Inhibits Adenosine Diphosphate (ADP) induced Platelet aggregation
  • Dosing
  1. Dipyridamole (Persantine) alone
    1. Dose: 75 mg PO qid
  2. Aggrenox (Dipyridamole 200 mg and Aspirin 25 mg)
    1. Swallow whole (do not crush or chew)
    2. Take 1 capsule twice daily
  • Drug Interactions
  1. Increased Bleeding risk when combined with other agents
    1. Anticoagulants
    2. Other antiplatelet agents
    3. NSAIDs
  • Adverse Effects
  1. Adverse effects typically abate with continued use
  2. Diarrhea
  3. Dizziness or Syncope
  4. Rash
  5. Angina
  6. Headache
    1. Headache may be severe
    2. Responsible for high discontinuation rate
  • Safety
  1. Dipyridamole (Persantine)
    1. Pregnancy Category B
    2. Unknown safety in Lactation
  2. Aggrenox (Dipyridamole 200 mg and Aspirin 25 mg)
    1. Pregnancy Category D
    2. Unknown safety in Lactation
  • Efficacy
  1. More effective than Aspirin alone after TIA or CVA in preventing recurrent vascular death, stroke, MI
    1. (2006) Lancet 367:1665 [PubMed]
  2. Not more effective than Clopidogrel in preventing recurrent stroke
    1. Sacco (2008) N Engl J Med 359: 1238 [PubMed]
  • Resources
  1. Dipyridamole Tablet (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a18b2af5-7c4a-4b7f-92c7-8a76e34da373
  2. Dipyridamole and Aspirin or Aggrenox (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=369cb8a3-e1e4-4150-859d-4f788436ddca
  3. Dipyridamole Injection (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6093dcd9-82d2-414f-8507-eda22c14f626
  • References
  1. (2014) Med Lett Drugs Ther 56(1454):103-8 [PubMed]