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