Dipyridamole


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO Prophylaxis of thromboembolism following cardiac valve replacement As conventional tab: 300-600 mg/day in 3-4 divided doses, w/ an oral anticoagulant. Secondary prophylaxis of ischaemic stroke; Secondary prophylaxis of transient ischaemic attack As modified-release cap: 200 mg bid. IV Myocardial imaging As adjunct to thallium-201: 0.142 mg/kg/min over 4 min.
Dosage Details
Intravenous
Myocardial imaging
Adult: 0.142 mg/kg/min infused over 4 min (0.567 mg/kg total) as adjunct to thallium-201.

Oral
Prophylaxis of thromboembolism following cardiac valve replacement
Adult: As conventional tab: 300-600 mg daily in 3-4 divided doses, given w/ an oral anticoagulant.

Oral
Secondary prophylaxis of ischaemic stroke, Secondary prophylaxis of transient ischaemic attack
Adult: As modified-release cap: 200 mg bid.
Administration
Should be taken on an empty stomach. Take 1 hr before meals. May be taken w/ meals to reduce GI discomfort.
Reconstitution
Intravenous: Dilute in at least 1:2 ratio w/ NaCl 0.9% or 0.45%, or dextrose 5% to make a total volume of approx 20-50 mL.
Special Precautions
Patient w/ hypotension, severe coronary artery disease including unstable angina or recent MI, aortic stenosis, decompensated heart failure, coagulation disorder, migraine, myasthenia gravis. Pregnancy and lactation.
Adverse Reactions
Nervous: Headache, dizziness, faintness, seizure.
CV: Hypotension, angina, tachycardia.
GI: Nausea, diarrhoea, vomiting.
Resp: Bronchospasm.
Haematologic: Thrombocytopenia.
Musculoskeletal: Myalgia.
Dermatologic: Rash, urticaria, facial flushing, angioedema.
Potentially Fatal: Cardiac death, MI, ventricular fibrillation, asystole, sinus node arrest, symptomatic ventricular tachycardia, stroke, transient cerebral ischemia (IV).
IV/Parenteral/PO: B
Patient Counseling Information
This drug may cause dizziness, if affected, do not drive or operate machinery.
MonitoringParameters
Monitor BP, heart rate, ECG, LFT, respiration.
Overdosage
Symptoms: Cardiac death, cardiac arrest, MI, chest pain, angina pectoris, ECG changes, syncope, cerebrovascular events, headache, myalgia, paraesthesia, warm feeling, flushes, sweating, restlessness, weakness, dizziness, hypotension, and tachycardia. Management: Symptomatic treatment. Perform gastric lavage. Administer xanthine derivatives (e.g. aminophylline 75-100 mg) to reverse haemodynamic effects.
Drug Interactions
May increase plasma concentration and CV effects of adenosine. Enhances effects of oral anticoagulants and produces additive effects w/ other anti-platelets (e.g. aspirin). May increase hypotensive effect of BP lowering drugs. May counteract anticholinesterase effect and aggravate myasthenia gravis when used w/ cholinesterase inhibitors. May reduce the efficacy of fludarabine. Reduced absorption w/ antacids. Abolished coronary vasodilation w/ xanthine derivatives (e.g. theophylline, aminophylline, caffeine) during myocardial imaging.
Action
Description: Dipyridamole, a platelet aggregation inhibitor, causes an accumulation of adenosine, adenine nucleotides, and cyclic AMP by inhibiting the activity of adenosine deaminase and phosphodiesterase, thus inhibiting platelet aggregation and producing vasodilation. Addtionally, it stimulates the release of prostacyclin or PGD2 and causes coronary vasodilation.
Pharmacokinetics:
Absorption: Incompletely absorbed from the GI tract. Time to peak plasma concentrations: Approx 75 min.
Distribution: Widely distributed into body tissues. Crosses the placenta in small amounts and enters breast milk. Volume of distribution: 2-3 L/kg. Plasma protein binding: 91-99%, mainly to α1-acid glycoprotein.
Metabolism: Metabolised in the liver to glucuronide conjugate; may undergo enterohepatic recirculation.
Excretion: Via faeces (as glucuronide conjugates and unchanged drug). Terminal elimination half-life: 10-12 hr.
Chemical Structure

Chemical Structure Image

Source: National Center for Biotechnology Information. PubChem Database. Dipyridamole, CID=3108, https://pubchem.ncbi.nlm.nih.gov/compound/Dipyridamole (accessed on Jan. 21, 2020)

Storage
Store between 15-25°C. Do not freeze. Protect from light.
References
Anon. Dipyridamole. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 07/11/2016.

Buckingham R (ed). Dipyridamole. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/11/2016.

Dipyridamole Injection, Solution (Hospira, Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 07/11/2016.

Dipyridamole Tablet, Film Coated (Teva Pharmaceuticals USA, Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 07/11/2016.

Joint Formulary Committee. Dipyridamole. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/11/2016.

McEvoy GK, Snow EK, Miller J et al (eds). Dipyridamole. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 07/11/2016.

Disclaimer: This information is independently developed by MIMS based on Dipyridamole from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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