II. 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

III. Contraindications

IV. 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

V. 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

VI. Drug Interactions

  1. Increased Bleeding risk when combined with other agents
    1. Anticoagulants
    2. Other antiplatelet agents
    3. NSAIDs

VII. 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

VIII. 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

IX. 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]

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Related Studies

Cost: Medications

dipyridamole (on 6/22/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
DIPYRIDAMOLE 50 MG TABLET Generic $1.34 each
DIPYRIDAMOLE 75 MG TABLET Generic $0.47 each

Ontology: Dipyridamole (C0012582)

Definition (NCI_NCI-GLOSS) A drug that prevents blood cell clumping and enhances the effectiveness of fluorouracil and other chemotherapeutic agents.
Definition (NCI) A synthetic agent derivative of pyrimido-pyrimidine, with antiplatelet properties. Dipyridamole inhibits adenosine uptake by platelets and endothelial cells, triggering an accumulation of cyclic adenosine monophosphate (cAMP), and inhibiting the stimulation of platelet aggregation by agents such as platelet activating factor and collagen. (NCI04)
Definition (MSH) A phosphodiesterase inhibitor that blocks uptake and metabolism of adenosine by erythrocytes and vascular endothelial cells. Dipyridamole also potentiates the antiaggregating action of prostacyclin. (From AMA Drug Evaluations Annual, 1994, p752)
Definition (CSP) platelet inhibitor and coronary vasodilator used to prevent thromboembolism associated with mechanical heart valves, as prophylactic adjunct in the prevention of myocardial reinfarction, and as a diagnostic aid adjunct in myocardial perfusion imaging; administered orally and intravenously.
Definition (PDQ) A synthetic agent derivative of pyrimido-pyrimidine, with antiplatelet properties. Dipyridamole inhibits adenosine uptake by platelets and endothelial cells, triggering an accumulation of cyclic adenosine monophosphate (cAMP), and inhibiting the stimulation of platelet aggregation by agents such as platelet activating factor and collagen. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39229&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39229&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C445" NCI Thesaurus)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D004176
SnomedCT 387371005, 66859009
LNC LP14715-4, LP35684-7, MTHU001809
English Dipyramidole, Ethanol, 2,2',2'',2'''-((4,8-di-1-piperidinylpyrimido(5,4-d)pyrimidine-2,6-diyl)dinitrilo)tetrakis-, 2,2',2'',2''''-[(4,8-Dipiperidinopyrimido-[5,4-d]pyrimidine-2,6-diyl)dinitrilo]tetraethanol, dipyridamole, DP, dipyridamole (medication), DIPYRIDAMOLE, Dipyridamole [Chemical/Ingredient], dipyramidole, Dipyridamole (product), Dipyridamole (substance), Dipyridamole
Swedish Dipyridamol
Czech dipyridamol
Finnish Dipyridamoli
Russian PERSANTIN, DIPIRIDAMOL, KURANTIL, ДИПИРИДАМОЛ, КУРАНТИЛ, ПЕРСАНТИН
Japanese ジピリダモール
Italian Dipiramidolo, Dipiridamolo
Polish Dipirydamol
Spanish dipiridamol (producto), dipiridamol (sustancia), dipiridamol, Dipiridamol
French Dypyridamole
German Dipyridamol
Portuguese Dipiridamol

Ontology: Persantine (C0700020)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D004176
English Persantin, persantin, persantine, Persantine, Boehringer Ingelheim Brand of Dipyridamole

Ontology: Aggrenox (C0732282)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C047634
English Aggrenox, aggrenox