Dipyridamole
PERSANTINE
Pronunciation: dye-peer-ID-a-moel
“Pursey Diapered mole”
What it isAdenosine reuptake and PDE inhibitor; stroke prevention with aspirin, and pharmacological cardiac stress testing.
Why this oneWith aspirin it reduces recurrent stroke more than aspirin alone, and it is the vasodilator used for stress perfusion imaging.
What limits itHeadache is common and limits adherence. It can provoke ischemia by coronary steal; avoid in significant coronary disease.
FDA-approved for
- thromboembolism prophylaxis (~1961)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Prophylaxis of postoperative thromboembolic complications of cardiac valve replacement (adjunct to coumarin anticoagulants) | Adult | 75–100 mg QID, adjunct to usual warfarin therapy | 75–100 mg QID | 100 mg QID |
Renal Undefined
Hepatic Undefined
Instructions
- Use as adjunct to usual warfarin therapy; aspirin is not to be administered concomitantly with coumarin anticoagulants
Available strengths
- tab 25, 50, 75 mg
- inj 5 mg/mL
Cautions
- Severe coronary artery disease (unstable angina, recent MI) — vasodilatory effect may aggravate chest pain
- Hypotension — can produce peripheral vasodilation
- Hepatic enzyme elevations and hepatic failure reported
- Interrupt for 48 hr before pharmacologic stress testing with IV dipyridamole or other adenosinergic agents (adenosine, regadenoson)
- Pediatric safety/effectiveness <12 yr not established
Adverse reactions
- Dizziness (13.6%)
- Abdominal distress (6.1%)
- Headache (2.3%)
- Rash (2.3%)
- Also: diarrhea, vomiting, flushing, pruritus; rare angina pectoris and liver dysfunction
- Rare hypersensitivity (rash, urticaria, bronchospasm, angioedema); increased surgical bleeding rarely
Pregnancy Animal studies up to ~25x human dose show no fetal harm; no adequate human studies — use only if clearly needed.
Lactation Excreted in human milk; use caution in nursing women.
Cost
Generic entry1990
NO BOXED WARNINGS
Principal riskHeadache; coronary steal in significant coronary disease
Classes and tags
Clinical profile
Legacy pregnancy categoryB
Defining liabilityGI or intracranial bleeding, especially with anticoagulants, NSAIDs or serotonergic antidepressants.
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