Dipyridamole

Dipyridamole Brand Name– Persantine

What is Dipyridamole

Dipyridamole is a non-nitrate coronary vasodilator that also inhibits platelet aggregation.

When used alone, it is ineffective as an antithrombotic for patients with acute MI, DVT, or TIAs and therefore must be combined with other anticoagulant drugs, such as warfarin, to prevent thrombosis in patients with valvular or vascular disorders.

In combination with other antiplatelet agents, routine use of dipyridamole is questionable, except perhaps in patients in whom foreign surfaces (i.e., artificial heart valves) may contribute to the thrombotic risk. Intravenously administered dipyridamole is used as an adjunct to thallous chloride TI 201 in myocardial perfusion imaging to assess coronary artery disease in individuals unable to perform an exercise stress test.

Dipyridamole was originally approved in 1961 for use in the treatment of angina but has never been found effective for this condition. In 1986, dipyridamole was approved for use as an antiplatelet agent, but much controversy surrounds its place in treatment of this condition.

The FDA has classified dipyridamole as lacking evidence of effectiveness for the treatment of chronic angina pectoris; an opinion supported by one review.

Clinicians should note, however, that dipyridamole may still be useful for other indications; for example, a dosage form combining aspirin with dipyridamole is approved for stroke prophylaxis.

Indications

1. arterial thromboembolism prophylaxis
2. cardiomyopathy
3. coronary artery disease diagnosis
4. myocardial infarction prophylaxis
5. prosthetic heart valves
6. proteinuria
7. transient ischemic attack
8. valvular heart disease

For arterial thromboembolism prophylaxis

in patients with prosthetic heart valves

Side Effects

1. abdominal pain
2. alopecia
3. anaphylactoid reactions
4. angina
5. angioedema
6. anxiety
7. appetite stimulation
8. arrhythmia exacerbation
9. arthralgia
10. asthenia
11. asystole
12. atrial fibrillation
13. AV block
14. back pain
15. bleeding
16. bradycardia
17. bronchospasm
18. cardiomyopathy
19. chest pain (unspecified)
20. cholelithiasis
21. cough
22. diaphoresis
23. diarrhea
24. dizziness
25. drowsiness
26. dysgeusia
27. dyspepsia
28. dysphagia
29. dysphonia
30. dyspnea
31. edema
32. elevated hepatic enzymes
33. eructation
34. fatigue
35. flatulence
36. flushing
37. headache
38. hepatitis
39. hypertension
40. hypertonia
41. hyperventilation
42. hypoesthesia
43. hypotension
44. injection site reaction
45. laryngeal edema
46. malaise
47. migraine
48. muscle cramps
49. myalgia
50. myocardial infarction
51. nausea
52. ocular pain
53. orthostatic hypotension
54. palpitations
55. paresthesias
56. pharyngitis
57. pruritus
58. rash
59. rhinitis
60. seizures
61. sinus tachycardia
62. stroke
63. supraventricular tachycardia (SVT)
64. syncope
65. tenesmus
66. thrombocytopenia
67. tinnitus
68. tremor
69. urticaria
70. ventricular fibrillation
71. ventricular tachycardia
72. vertigo
73. visual impairment
74. vomiting
75. xerostomia

Monitoring Parameters

• ECG

Contraindications

• angina
• asthma
• breast-feeding
• children
• geriatric
• hepatic disease
• hypotension
• labor
• obstetric delivery
• orthostatic hypotension
• pregnancy
• syncope

Interactions

• Abciximab
• Acebutolol
• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Adenosine
• Ado-Trastuzumab emtansine
• ADP receptor antagonists
• Altretamine
• Aminolevulinic Acid
• Anagrelide
• Antimetabolites
• Antithrombin III
• Antithymocyte Globulin
• Apixaban
• Argatroban
• Arsenic Trioxide
• Aspirin, ASA
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Caffeine; Orphenadrine
• Aspirin, ASA; Carisoprodol
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Citric Acid; Sodium Bicarbonate
• Aspirin, ASA; Dipyridamole
• Aspirin, ASA; Omeprazole
• Aspirin, ASA; Oxycodone
• Aspirin, ASA; Pravastatin
• Atenolol
• Atenolol; Chlorthalidone
• Bendroflumethiazide; Nadolol
• Beta-blockers
• Betaxolol
• Betrixaban
• Bexarotene
• Bisoprolol
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Bivalirudin
• Brimonidine; Timolol
• Caffeine
• Caffeine; Ergotamine
• Carteolol
• Carvedilol
• Chlorambucil
• Cilostazol
• Cladribine
• Clofarabine
• Clopidogrel
• Collagenase
• Dabigatran
• Dalteparin
• Danaparoid
• Danazol
• Dasatinib
• Defibrotide
• Denileukin Diftitox
• Desirudin
• Desvenlafaxine
• Dorzolamide; Timolol
• Drotrecogin Alfa
• Duloxetine
• Edoxaban
• Enoxaparin
• Eptifibatide
• Esmolol
• Estramustine
• Fish Oil, Omega-3 Fatty Acids (Dietary Supplements)
• Fludarabine
• Folate analogs
• Fondaparinux
• Garlic, Allium sativum
• Ginger, Zingiber officinale
• Ginkgo, Ginkgo biloba
• Green Tea
• Heparin
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Propranolol
• Ibritumomab Tiuxetan
• Ibrutinib
• Icosapent ethyl
• Iloprost
• Imatinib
• Inotersen
• Intravenous Lipid Emulsions
• Labetalol
• Lepirudin
• Levobetaxolol
• Levobunolol
• Levomilnacipran
• Lomustine, CCNU
• Mercaptopurine, 6-MP
• Methoxsalen
• Methylsulfonylmethane, MSM
• Metoprolol
• Milnacipran
• Mycophenolate
• Nadolol
• Nebivolol
• Nebivolol; Valsartan
• Nelarabine
• Nonsteroidal antiinflammatory drugs
• Obinutuzumab
• Pegaspargase
• Penbutolol
• Pentosan
• Pentostatin
• Pentoxifylline
• Phentermine; Topiramate
• Photosensitizing agents (topical)
• Pindolol
• Platelet Glycoprotein IIb/IIIa Inhibitors
• Prasterone, Dehydroepiandrosterone, DHEA (Dietary Supplements)
• Prasterone, Dehydroepiandrosterone, DHEA (FDA-approved)
• Prasugrel
• Propranolol
• Purine analogs
• Regadenoson
• Riociguat
• Rivaroxaban
• Selective serotonin reuptake inhibitors
• Selumetinib
• Sodium Hyaluronate, Hyaluronic Acid
• Sotalol
• Sulfinpyrazone
• Theophylline, Aminophylline
• Thioguanine, 6-TG
• Thrombolytic Agents
• Ticagrelor
• Ticlopidine
• Timolol
• Tinzaparin
• Tipranavir
• Tirofiban
• Topiramate
• Trazodone
• Treprostinil
• Tretinoin, ATRA
• Venlafaxine
• Verteporfin
• Vilazodone
• Vorapaxar
• Vorinostat
• Vortioxetine
• Warfarin