Dipyridamole (Intravenous, Oral)

Dipyridamole is used to lower the risk of stroke or other serious medical problems in patients with an abnormally high risk of blood clots.

Overview

Dipyridamole prevents platelets in the blood from sticking together, making it impossible for the platelets to form a blood clot in the heart. It is often used following heart surgeries, such as heart valve replacement surgery, to stop dangerous blood clots from forming in the heart. It is occasionally also prescribed by doctors to treat other blood and heart conditions.

Dipyridamole was first developed by the pharmaceutical company Boehringer Ingelheim, and was approved for use by the FDA on December 6, 1961. On December 13, 1990, the FDA approved Boehringer Ingelheim's new, injectable form of dipyridamole. Since then, dipyridamole has been made available in its generic form, manufactured by companies such as Fresenius Kabi USA, Mylan Labs, and Lannett.

Dipyridamole is also available under the brand names Persantine (oral) and Persantine IV, both manufactured by Boehringer Ingelheim.

Conditions Treated

  • As part of a Radionuclide Myocardial Perfusion Study
  • (Risk of) stroke

Type Of Medicine

  • Platelet aggregation Inhibitor
  • Cardiac stressing agent

Side Effects

Dipyridamole can cause a variety of different side effects along with its desired effects. These side effects can be serious and demand medical condition or may only be as damaging as the discomfort they cause the patient. Patients who experience any of the following side effects should contact their doctor immediately. The following side effects may warrant medical attention:

  • Tightness in the neck
  • Swelling of the neck
  • Yellow discoloration of the eyes or skin

Some side effects of dipyridamole are the product of the body adjusting to the sudden influx of new medicine, and may not warrant medical attention. Patients who experience any of the following side effects should contact their doctor to find out how to mitigate or lessen the most unpleasant effects:

  • Abdominal pain
  • Stomach cramps
  • Nausea
  • Vomiting
  • Sudden or unexplained weakness
  • Flushing
  • Lightheadedness

Geriatric patients are most likely to feel lightheaded while using dipyridamole.

Additionally, patients who are using dipyridamole may also experience lightheadedness, dizziness, temporary loss of vision, or even fainting when rising from a prone or seated position. Patients who experience this should rise slowly to decrease the chance of this happening. If these symptoms persist or worsen, patients should consult with their doctor to determine how best to mitigate these symptoms.

This is not necessarily a complete list of side effects. Patients who experience any new or worsening symptoms after using dipyridamole should contact their doctor immediately. Patients can report new side effects to the FDA at 1 800 FDA 1088 or on the web at www.fda.gov/medwatch.

Dosage

Patients should follow the instructions of their doctor in terms of dosage for dipyridamole.

The ideal dosage of dipyridamole depends on the condition being treated and the severity of that condition.

Injections of dipyridamole are usually given as part of a Radionuclide Myocardial Perfusion Study. The dosage used is typically 0.57 milligrams of dipyridamole per kilogram of the patient's body weight over a four-minute period. Injections are usually delivered via an IV.

Dipyridamole, taken orally, can be useful for thromboembolic prophylaxis. To this end, patients are usually instructed to take doses of 75 to 100 mg of dipyridamole orally, three to four times a day. When used for this purpose, dipyridamole is usually taken in conjunction with warfarin.

Occasionally aspirin is used as a substitute for dipyridamole for this purpose.

Overdose is possible on dipyridamole. Patients should make sure to take the dose prescribed to them by their doctor.

Symptoms of dipyridamole overdose can include flushing (a feeling of warmth accompanied by redness and a tingly feeling), feelings of restlessness, rogue sweating, unexplained weakness, and fainting.

In some cases, dipyridamole overdose can be reversed by aminophylline.

Patients who have overdosed or fear they may have overdosed should contact their doctor immediately. Patients may also call poison control by dialing 1(800) 222-1222.

Patients who miss a dose of dipyridamole should take the missed dose as soon as they remember. However, if it is nearly time for the patient to take their next dose, patients should simply wait and take their next dose then. Patients should never take extra medicine in an attempt to retroactively make up for a missed dose.

Interactions

Dipyridamole can interact with a variety of different drugs, including blood thinners and anticoagulants. These medications can interact with dipyridamole to put the patients at serious risk of unexplained, uncontrollable bleeding. Patients should avoid taking any of these medicines if they are using dipyridamole.. Patients should supply their doctor with a complete list of all drugs, medications, and supplements they are taking to their doctor prior to deciding to take dipyridamole. This will enable the doctor to identify any potential interactions between dipyridamole and any medications the patient is taking.

Patients should avoid taking aspirin concurrently with dipyridamole. Aspirin and dipyridamole will enhance the effects of each other, putting the patient at increased risk of overdose and serious side effects, including increased bleeding. In some cases aspirin is prescribed with dipyridamole to potentiate the effects of the drug. This should be done on the direction of the patient's doctor.

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  • Apixaban
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  • Rivaroxaban
  • Tinzaparin
  • Tipranavir
  • Tirofiban
  • Tositumomab
  • Vorapaxar

The following drugs interact will interact negatively with dipyridamole, but not necessarily as severely or as frequently as the drugs listed above. Patients taking any of the following drugs should still avoid receiving using dipyridamole. Patients who must receive take dipyridamole while they are taking any of the following drugs should consult with their doctor to identify possible alternative treatments. Interactions can include increased risk of bleeding and possible decreased effects of dipyridamole.

SSRIs (selective serotonin reuptake inhibitor) and other antidepressant medications including duloxetine may interact negatively with dipyridamole. When taken concurrently with dipyridamole patients taking an SSRI or other antidepressants will be at a higher risk of bleeding. Kidney and liver disease may exacerbate this effect. Patients should disclose a list of all drugs, medications, and supplements they are taking to their doctor prior to deciding to take dipyridamole.

  • Adenosine
  • Alteplase
  • Aminophylline
  • Anisindione
  • Anistreplase
  • Argatroban
  • Bivalirudin
  • Bromfenac
  • Caffeine
  • Celecoxib
  • Cilostazol
  • Citalopram
  • Clomipramine
  • Capsicum
  • Chamomile
  • Deoxycholic acid
  • Desvenlafaxine
  • Dexfenfluramine
  • Diclofenac
  • Dicumarol
  • Diflunisal
  • Dong quai
  • Doxorubicin
  • Duloxetine
  • Dyphylline
  • Epoprostenol
  • Escitalopram
  • Etodolac
  • Fenfluramine
  • Fenoprofen
  • Fenugreek
  • Feverfew
  • Fludarabine
  • Fluoxetine
  • Flurbiprofen
  • Fluvoxamine
  • Garlic
  • Ginger
  • Ginkgo
  • Ginseng
  • Hemin
  • Heparin
  • Horse chestnut
  • Ibuprofen
  • Icosapent
  • Iloprost
  • Indomethacin
  • Ketoprofen
  • Ketorolac
  • Lepirudin
  • Levomilnacipran
  • Meclofenamate
  • Mefenamic acid
  • Meloxicam
  • Milnacipran
  • Nabumetone
  • Naproxen
  • Nepafenac ophthalmic
  • Nesiritide
  • Nintedanib
  • Omega-3 polyunsaturated fatty acids
  • Oxaprozin
  • Oxtriphylline
  • Paroxetine
  • Pegaspargase
  • Pentosan polysulfate sodium
  • Pentoxifylline
  • Phenylbutazone
  • Piroxicam
  • Regadenoson
  • Reteplase
  • Rofecoxib
  • Sertraline
  • Sibutramine
  • Sildenafil
  • Streptokinase
  • Sulindac
  • Suprofen ophthalmic
  • Tenecteplase
  • Theophylline
  • Ticagrelor
  • Tolmetin
  • Turmeric
  • Treprostinil
  • Urokinase
  • Valdecoxib
  • Venetoclax
  • Venlafaxine
  • Verteporfin
  • Vilazodone
  • Vitamin e
  • Vortioxetine
  • Warfarin

In some cases, foods such as garlic, ginger, and spices such as turmeric and clove can interact negatively with dipyridamole. Patients whose diets are heavy in spices or foods which may interact negatively with dipyridamole may need to adjust their diet accordingly. Patients should consult with their doctor to determine what foods and spices are safe to eat prior to deciding to take dipyridamole.

Caffeine and dipyridamole can interact with each other when taken together. When taken together, caffeine can lessen the effects of dipyridamole. It is suggested that patients forgo caffeine for 24 hours before and after they receive a dipyridamole injection. Patients who are taking dipyridamole for thromboembolic prophylaxis should not ingest caffeine (drink coffee, energy drinks, take caffeine pills, etc.).

This is not necessarily a complete list of interactions for dipyridamole. Patients should rely on their doctor to identify any potential interactions between dipyridamole and any drugs the patient is taking. Patients should disclose a complete list of all drugs, medications, and supplements they are taking to their doctor prior to deciding to take dipyridamole.

Warning

Dipyridamole is a class B drug in terms of pregnancy. This means that in studies done on animals, dipyridamole produced no damaging effects on the animal fetuses. However, no adequate studies have been done on human fetuses.

No studies have been done to determine whether or not dipyridamole can be passed through breastmilk or whether or not dipyridamole will have any negative effects on breastfeeding infants. Patients who are breastfeeding or who may begin breastfeeding should consult with their doctor to determine whether or not dipyridamole is right for them.

Dipyridamole has been known to cause serious allergic reactions in some patients. Patients who have had an allergic reaction to dipyridamole in the past should not take dipyridamole. Patients who are taking dipyridamole should remain vigilant for symptoms of a serious allergic reaction, which can include hives, rash, swelling of the neck or throat, and anaphylaxis.

Dipyridamole has not been tested in patients 12 years old and younger. While there is no evidence that dipyridamole will cause any different effects on pediatric patients, pediatric patients should exercise caution when considering using dipyridamole.

Likewise, dipyridamole has not been studied specifically in geriatric 965+ years) patients. Patients 65 years and up should exercise caution when considering using dipyridamole. There is no evidence to suggest that dipyridamole will have any age specific effects.

Patients whose arteries have hardened from coronary artery disease should consult with their doctor prior to deciding to use dipyridamole. Patients with hardened arteries may require an alternative treatment, as dipyridamole may be dangerous or ineffective on the patient. Patients who suffer from coronary artery disease may experience elevated levels of chest pain as a result of taking dipyridamole. Patients should make sure to inform their doctor of any and all medical conditions they suffer from prior to deciding to use dipyridamole.

Patients with low blood pressure should exercise caution when considering using dipyridamole. Dipyridamole can cause vasodilation, which can further lower blood pressure. Patients with low blood pressure (hypotension) should consult with their doctor to determine whether or not dipyridamole is right for them. Patients should inform their doctor of all medical conditions they have prior to deciding to use dipyridamole.

Patients with liver disease should exercise caution when considering using dipyridamole. Dipyridamole is connected with increased levels of hepatic enzymes and, in some cases, hepatic failure. Patients with liver disease should consult with their doctor to determine whether or not dipyridamole is right for them. Patients should disclose a complete list of all the medical conditions they suffer from to their doctor prior to deciding to use dipyridamole.

Patients with uncontrolled chest pain should exercise extreme caution when considering using dipyridamole. Dipyridamole may exacerbate the patient's chest pain (angina) and could lead to complications. Patients with uncontrolled chest pain should consult with their doctor to determine if dipyridamole is right for them. Patients should make sure their their doctor is fully apprised of all medical conditions they have prior to deciding to use dipyridamole.

Storage

Patients should receive dipyridamole injections from their doctor. The intravenous solution of dipyridamole should be properly stored by the doctor at his or her's office. Patients should not have to store the intravenous solution of dipyridamole themselves.

Dipyridamole tablets should be stored at room temperature, away from moisture and heat.

Summary

In its injectable form, dipyridamole is most useful as part of a myocardial perfusion study. Dipyridamole is injected and then traced through your blood, giving the patient an accurate assessment of how blood moves through their heart. This information can be used to evaluate for a variety of different conditions, such as coronary artery disease and hypertrophic cardiomyopathy. For use as part of a myocardial perfusion study dipyridamole must only be injected once, and at a relatively low dose. This means that patients are at a very low risk for any side effects, severe or otherwise. In fact, patients will most likely only experience side effects from the injection, which can include lightheadedness. As an added bonus, myocardial perfusion studies are typically done in hospitals under medical supervision, which further decreases the risk of any harm befalling the patient.

Taken orally, dipyridamole is useful for thromboembolic prophylaxis and the prevention of stroke. It is a powerful agent which prevents platelets from coming together, eliminating the possibility that they will come together and form a blood clot in places they shouldn't (such as in the heart). However, because it is so powerful, it can cause a host of different side effects. Patients who take dipyridamole orally will experience more side effects than patients who receive a single injection of dipyridamole will be at increased risk of side effects, because their dosage will be persistent, not just a one time dose. However, if patients give dipyridamole the respect it demands as a powerful drug, then they should be able to use dipyridamole safely and effectively to protect their health.