dipyridamole (Rx)

Brand and Other Names:Persantine
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injectable solution

  • 5mg/mL

tablet

  • 25mg
  • 50mg
  • 75mg

Thromboembolism Prophylaxis Post-Cardiac Valve Replacement

75-100 mg PO q6hr as adjunct to warfarin

Adjunct to Thallium Myocardial Perfusion Imaging (Off-label)

Adjusted according to body weight; recommended 0.142 mg/kg/min IV infusion over 4 minutes; not to exceed 60 mg

Other Indications & Uses

Prevention of MI recurrence (in combo with aspirin): No benefit over aspirin alone

See also combo with aspirin

Dosage Forms & Strengths

injectable solution

  • 5mg/mL

tablet

  • 25mg
  • 50mg
  • 75mg

Off-label Use

3-6 mg/kg/day PO divided q6-8hr

Avoid short-acting products; causes orthostatic hypotensio and more effective alternatives available; IV form acceptable for cardiac stress testing (Beers criteria)

Thromboembolism prophylaxis post-cardiac valve replacement

75-100 mg PO q6hr as adjunct to warfarin

Adjunct to thallium myocardial perfusion imaging (Off-label)

Adjusted according to body weight; recommended 0.142 mg/kg/min IV infusion over 4 minutes; no more than 60 mg

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Interactions

Interaction Checker

and dipyridamole

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            Contraindicated (2)

            • riociguat

              dipyridamole, riociguat. Either increases effects of the other by additive vasodilation. Contraindicated. Coadministration of nonspecific PDE-5 inhibitors (eg, dipyridamole, theophylline) and guanylate cyclase stimulators (eg, riociguat) is contraindicated due to risk of additive hypotension.

            • theophylline

              theophylline decreases effects of dipyridamole by pharmacodynamic antagonism. Contraindicated. May produce false negative results in dipyridamole thallium imaging tests. Separate by 24 hr.

            Serious - Use Alternative (28)

            • afatinib

              dipyridamole increases levels of afatinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Reduce afatinib daily dose by 10 mg if not tolerated when coadministered with P-gp inhibitors.

            • alpelisib

              dipyridamole will increase the level or effect of alpelisib by Other (see comment). Avoid or Use Alternate Drug. Coadministration of alpelisib (BCRP substrate) with a BCRP inhibitor may increase alpelisib concentration, which may increase the risk of toxicities. If unable to avoid or use alternant drugs, closely monitor for increased adverse reactions.

            • antithrombin alfa

              antithrombin alfa, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • antithrombin III

              antithrombin III, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • apixaban

              dipyridamole and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

            • argatroban

              argatroban, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • aspirin rectal

              aspirin rectal increases effects of dipyridamole by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

            • bivalirudin

              bivalirudin, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • bosutinib

              dipyridamole increases levels of bosutinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

            • butalbital

              butalbital decreases levels of dipyridamole by increasing metabolism. Contraindicated.

            • caffeine

              caffeine decreases effects of dipyridamole by pharmacodynamic antagonism. Contraindicated.

            • dalteparin

              dalteparin, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • darolutamide

              darolutamide will increase the level or effect of dipyridamole by Other (see comment). Avoid or Use Alternate Drug. Darolutamide is a BCRP inhibitor. Avoid coadministration with BCRP inhibitors. If use is unavoidable, closely monitor for adverse reactions and consider dose reduction of BCRP substrate drug (refer BCRP substrate prescribing information).

            • edoxaban

              dipyridamole will increase the level or effect of edoxaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Dose adjustment may be required with strong P-gp inhibitors. DVT/PE treatment: Decrease dose to 30 mg PO once daily. NVAF: No dose reduction recommended

            • enoxaparin

              enoxaparin, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • fondaparinux

              fondaparinux, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • heparin

              heparin, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • lasmiditan

              lasmiditan increases levels of dipyridamole by Other (see comment). Avoid or Use Alternate Drug. Comment: Lasmiditan inhibits BCRP in vitro. Avoid coadministration of lasmiditan with BCRP substrates.

            • ozanimod

              dipyridamole increases toxicity of ozanimod by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of ozanimod (a BCRP substrate) with BCRP inhibitors increases the exposure of the minor (RP101988, RP101075) and major active metabolites (CC112273, CC1084037) of ozanimod, which may increase the risk of ozanimod adverse reactions. .

            • pomalidomide

              dipyridamole increases levels of pomalidomide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

            • protamine

              protamine, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            • regadenoson

              dipyridamole, regadenoson. Mechanism: unspecified interaction mechanism. Contraindicated. Regadenoson's effects may be changed; mfr. recommends avoiding dipyridamole for 2 days prior to administration.

            • rimegepant

              dipyridamole will increase the level or effect of rimegepant by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of rimegepant (a BCRP substrate) with inhibitors of BCRP.

            • riociguat

              dipyridamole will increase the level or effect of riociguat by decreasing metabolism. Avoid or Use Alternate Drug. Coadministration of riociguat (substrate of CYP isoenzymes 1A1, 2C8, 3A, 2J2) with strong CYP inhibitors may require a decreased initial dose of 0.5 mg PO TID; monitor for signs of hypotension and reduce dose if needed

              dipyridamole will increase the level or effect of riociguat by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Coadministration of riociguat (P-gp substrate) with strong P-gp inhibitors may require a decreased initial dose of 0.5 mg PO TID; monitor for signs of hypotension and reduce dose if needed

            • talazoparib

              dipyridamole will increase the level or effect of talazoparib by Other (see comment). Avoid or Use Alternate Drug. BCRP inhibitors may increase systemic exposure of talazoparib (a BCRP substrate). If coadministration cannot be avoided, monitor for potential adverse reactions.

            • topotecan

              dipyridamole will increase the level or effect of topotecan by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Product labeling for PO topotecan recommends avoiding concomitant use of P-gp inhibitors; the interaction with IV topotecan may be less severe but is still likely of clinical significance

            • venetoclax

              dipyridamole will increase the level or effect of venetoclax by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If a P-gp inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.

            • warfarin

              warfarin, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

            Monitor Closely (45)

            • acalabrutinib

              acalabrutinib increases effects of dipyridamole by anticoagulation. Modify Therapy/Monitor Closely. Coadministration of acalabrutinib with antiplatelets or anticoagulants may further increase risk of hemorrhage. Monitor for signs of bleeding and consider the benefit-risk of withholding acalabrutinib for 3-7 days presurgery and postsurgery depending upon the type of surgery and the risk of bleeding.

              acalabrutinib increases levels of dipyridamole by Other (see comment). Use Caution/Monitor. Comment: Acalabrutinib may increase exposure to coadministered BCRP substrates by inhibition of intestinal BCRP.

            • adenosine

              dipyridamole increases levels of adenosine by decreasing metabolism. Use Caution/Monitor.

            • apalutamide

              apalutamide will decrease the level or effect of dipyridamole by increasing elimination. Use Caution/Monitor. Apalutamide weakly induces BCRP and may decrease systemic exposure of drugs that are BCRP substrates.

            • aspirin

              aspirin, dipyridamole. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

            • aspirin/citric acid/sodium bicarbonate

              aspirin/citric acid/sodium bicarbonate, dipyridamole. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

            • azficel-T

              azficel-T, dipyridamole. Other (see comment). Use Caution/Monitor. Comment: Coadministration with anticoagulants or antiplatelets may increase bruising or bleeding at biopsy and/or injection sites; concomitant use not recommended. Decisions regarding continued use or cessation of anticoagulants or antiplatelets should be made by a physician.

            • berotralstat

              dipyridamole increases levels of berotralstat by Other (see comment). Modify Therapy/Monitor Closely. Comment: Reduced dose of berotralstat (a BCRP substrate) to 110 mg/day when coadministered with BCRP inhibitors.

            • betrixaban

              dipyridamole increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

              dipyridamole, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

            • caplacizumab

              caplacizumab, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor.

            • ceritinib

              dipyridamole increases levels of ceritinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • cholic acid

              dipyridamole increases toxicity of cholic acid by decreasing elimination. Modify Therapy/Monitor Closely. Avoid concomitant use of inhibitors of the bile salt efflux pump (BSEP). May exacerbate accumulation of conjugated bile salts in the liver and result in clinical symptoms. If concomitant use is necessary, monitor serum transaminases and bilirubin.

            • citalopram

              citalopram increases effects of dipyridamole by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

            • dabigatran

              dabigatran, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.

              dipyridamole will increase the level or effect of dabigatran by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Atrial fibrillation: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <30 mL/min. DVT/PE treatment: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <50 mL/min

            • deferasirox

              deferasirox, dipyridamole. Other (see comment). Use Caution/Monitor. Comment: Gastric ulceration and GI bleeding have been reported in patients taking deferasirox, use caution when coadministering with other drugs known to increase the risk of peptic ulcers or gastric hemorrhage including anticoagulants.

            • duvelisib

              dipyridamole will increase the level or effect of duvelisib by Other (see comment). Use Caution/Monitor. Coadministration of duvelisib (a BCRP substrate) with a BCRP transport inhibitor may increase levels or effects of duvelisib.

            • edoxaban

              edoxaban, dipyridamole. Either increases toxicity of the other by anticoagulation. Modify Therapy/Monitor Closely. Both drugs have the potential to cause bleeding. The need for simultaneous use of platelet aggregation inhibitors with anticoagulants is common for patients with cardiovascular disease, but may result in increased bleeding; monitor closely. Promptly evaluate any signs or symptoms of blood loss.

            • eluxadoline

              eluxadoline increases levels of dipyridamole by decreasing metabolism. Use Caution/Monitor. Eluxadoline may increase the systemic exposure of coadministered BCRP substrates.

            • fish oil

              fish oil, dipyridamole. Other (see comment). Use Caution/Monitor. Comment: Patients taking fish oil and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

            • fish oil triglycerides

              fish oil triglycerides will increase the level or effect of dipyridamole by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

            • fostemsavir

              fostemsavir will increase the level or effect of dipyridamole by Other (see comment). Modify Therapy/Monitor Closely. Fostemsavir inhibits BCRP transporters. If possible, avoid coadministration or modify dose of BCRP substrate coadministered with fostemsavir.

            • glecaprevir/pibrentasvir

              dipyridamole will increase the level or effect of glecaprevir/pibrentasvir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              dipyridamole will increase the level or effect of glecaprevir/pibrentasvir by decreasing metabolism. Use Caution/Monitor. Caution when coadministering glecaprevir/pibrentasvir with BCRP inhibitors.

              glecaprevir/pibrentasvir will increase the level or effect of dipyridamole by decreasing metabolism. Use Caution/Monitor. Glecaprevir/pibrentasvir may increase plasma concentration of BCRP substrates.

            • green tea

              green tea increases effects of dipyridamole by pharmacodynamic synergism. Use Caution/Monitor. (Theoretical interaction). Dipyridamole is a platelet inhibitor and green tea has demonstrated antiplatelet effects in animals, it may be prudent to avoid the concomitant use of green tea with chronic dipyridamole therapy as the risk of bleeding may be increased.

            • ibrutinib

              ibrutinib will increase the level or effect of dipyridamole by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.

            • icosapent

              icosapent, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time; monitor periodically if coadministered with other drugs that affect bleeding.

            • melatonin

              melatonin increases effects of dipyridamole by anticoagulation. Use Caution/Monitor. Melatonin may decrease prothrombin time.

            • naldemedine

              dipyridamole increases levels of naldemedine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with P-gp inhibitors.

            • nintedanib

              dipyridamole increases levels of nintedanib by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. If nintedanib adverse effects occur, management may require interruption, dose reduction, or discontinuation of therapy .

            • omega 3 carboxylic acids

              omega 3 carboxylic acids, dipyridamole. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3 acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

            • omega 3 fatty acids

              omega 3 fatty acids, dipyridamole. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3-fatty acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

            • piracetam

              piracetam increases effects of dipyridamole by pharmacodynamic synergism. Use Caution/Monitor.

            • ponatinib

              ponatinib increases levels of dipyridamole by Other (see comment). Use Caution/Monitor.

            • porfimer

              dipyridamole decreases effects of porfimer by pharmacodynamic antagonism. Use Caution/Monitor.

            • regorafenib

              regorafenib will increase the level or effect of dipyridamole by Other (see comment). Modify Therapy/Monitor Closely. Regorafenib likely inhibits BCRP (ABCG2) transport. Coadministration with a BCRP substrate may increase systemic exposure to the substrate and related toxicity.

            • rifaximin

              dipyridamole increases levels of rifaximin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

            • rivaroxaban

              rivaroxaban, dipyridamole. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Avoid concurrent use of rivaroxaban with other anticoagulants due to increased bleeding risk other than during therapeutic transition periods where patients should be observed closely. Monitor for signs/symptoms of blood loss.

            • safinamide

              safinamide will increase the level or effect of dipyridamole by Other (see comment). Use Caution/Monitor. Safinamide and its major metabolite may inhibit intestinal BCRP. Monitor BCRP substrates for increased pharmacologic or adverse effects.

            • selexipag

              dipyridamole will increase the level or effect of selexipag by Other (see comment). Use Caution/Monitor. Selexipag is a ABCG2 (BCRP) substrate. Monitor selexipag for increased pharmacologic or adverse effects when coadministered with ABCG2 (BCRP) inhibitors.

            • selumetinib

              dipyridamole and selumetinib both increase anticoagulation. Modify Therapy/Monitor Closely. An increased risk of bleeding may occur in patients taking a vitamin-K antagonist or an antiplatelet agent with selumetinib. Monitor for bleeding and INR or PT in patients coadministered a vitamin-K antagonist or an antiplatelet agent with selumetinib.

            • sofosbuvir/velpatasvir

              sofosbuvir/velpatasvir will increase the level or effect of dipyridamole by Other (see comment). Use Caution/Monitor. Velpatasvir is an inhibitor of the drug transporter BCRP. Coadministration may increase systemic exposure of drugs that are BCRP substrates.

            • stiripentol

              stiripentol will increase the level or effect of dipyridamole by Other (see comment). Modify Therapy/Monitor Closely. Stiripentol is a BCRP transport inhibitor. Consider dosage reduction for BCRP substrates if adverse effects are experienced when coadministered.

            • tafamidis

              tafamidis will increase the level or effect of dipyridamole by Other (see comment). Use Caution/Monitor. Tafamidis inhibits breast cancer resistant protein (BCRP) in vitro and may increase exposure of BCRP substrates following tafamidis or tafamidis meglumine administration. Dosage adjustment of these BCRP substrates may be necessary.

            • tafamidis meglumine

              tafamidis meglumine will increase the level or effect of dipyridamole by Other (see comment). Use Caution/Monitor. Tafamidis inhibits breast cancer resistant protein (BCRP) in vitro and may increase exposure of BCRP substrates following tafamidis or tafamidis meglumine administration. Dosage adjustment of these BCRP substrates may be necessary.

            • ticagrelor

              ticagrelor, dipyridamole. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Increased risk of bleeding during concomitant use of medications that increase potential for bleeding.

            • vorapaxar

              dipyridamole, vorapaxar. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Coadministration of anticoagulants, antiplatelets, or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

            • vortioxetine

              dipyridamole increases effects of vortioxetine by anticoagulation. Use Caution/Monitor.

            Minor (21)

            • acebutolol

              dipyridamole, acebutolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

            • atenolol

              dipyridamole, atenolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

            • betaxolol

              dipyridamole, betaxolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

            • bisoprolol

              dipyridamole, bisoprolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

            • carvedilol

              dipyridamole, carvedilol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

            • celiprolol

              dipyridamole, celiprolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

            • devil's claw

              devil's claw, dipyridamole. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence.ÿ Use with caution.

            • esmolol

              dipyridamole, esmolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

            • ginger

              ginger, dipyridamole. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence. Use with caution.

            • ginkgo biloba

              ginkgo biloba, dipyridamole. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence.ÿ Use with caution.

            • horse chestnut seed

              horse chestnut seed, dipyridamole. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Theoretical. Use with caution.

            • labetalol

              dipyridamole, labetalol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

            • metoprolol

              dipyridamole, metoprolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

            • nadolol

              dipyridamole, nadolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

            • nebivolol

              dipyridamole, nebivolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

            • penbutolol

              dipyridamole, penbutolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

            • pindolol

              dipyridamole, pindolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

            • propranolol

              dipyridamole, propranolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

            • sotalol

              dipyridamole, sotalol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

            • timolol

              dipyridamole, timolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

            • verteporfin

              dipyridamole decreases effects of verteporfin by pharmacodynamic antagonism. Minor/Significance Unknown.

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            Adverse Effects

            >10%

            Chest pain (20%)

            Angina exacerbation, IV (19.7%)

            Abnormal ECG (15.9%)

            Headache, IV (12.2%)

            Dizziness (12%)

            1-10%

            ST-T changes (7.5%)

            Abdominal discomfort, oral (6.1%)

            Extrasystole (5%)

            Nausea, IV (4.6%)

            Hypotension, IV (4.6%)

            Flushing (3.4%)

            Generalized pain (2.6%)

            Headache, oral (2.3%)

            Frequency Not Defined

            Myocardial infarction (rare)

            Ventricular arrhythmia (rare)

            Bronchospasm (rare)

            Dyspnea

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            Warnings

            Contraindications

            Hypersensitivity

            Thrombocytopenia

            Cautions

            FDA approval for chronic angina withdrawn (not useful according to most experts)

            Dipyridamole has a vasodilatory effect and should be used with caution in patients with severe coronary artery disease (eg, unstable angina or recently sustained myocardial infarction); chest pain may be aggravated in patients with underlying coronary artery disease who are receiving drug

            Elevations of hepatic enzymes and hepatic failure reported in association with therapy administration

            Drug should be used with caution in patients with hypotension since it can produce peripheral vasodilation

            Stress Testing

            • Clinical experience suggests that patients being treated who also require pharmacological stress testing with intravenous dipyridamole or other adenosinergic agents (e.g. adenosine, regadenoson) should interrupt therapy for 48 hours prior to stress testing
            • Intake of drug within 48 hours prior to stress testing with intravenous dipyridamole or other adenosinergic agents may increase risk for cardiovascular side effects of these agents and may impair the sensitivity of test
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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: enters breast milk; use with caution

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Non-nitrate coronary vasodilator

            • Inhibition of RBC uptake of adenosine thereby inhibiting platelet reactivity
            • Phosphodiesterase inhibition increasing cAMP in platelet, OR
            • Inhibition of Thromboxane A2 formation (vasoconstrictor and a stimulator of platelet activation)

            Pharmacokinetics

            Half-life elimination: 10-12hr

            Peak time: 2-2.5 hr

            Onset: 24 min

            Duration: 3 hr

            Protein Bound: 91-99%

            Vd: 2-3 L/kg

            Clearance: 2.3-3.5 mL/min/kg

            Excretion: Feces

            Dialyzable: No

            Metabolism: Liver

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            dipyridamole oral
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            50 mg tablet
            dipyridamole oral
            -
            25 mg tablet
            dipyridamole oral
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            75 mg tablet
            dipyridamole oral
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            50 mg tablet
            dipyridamole oral
            -
            75 mg tablet
            dipyridamole oral
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            25 mg tablet
            dipyridamole intravenous
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            5 mg/mL vial
            dipyridamole intravenous
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            5 mg/mL vial

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            Patient Handout

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            Patient Education
            dipyridamole oral

            DIPYRIDAMOLE - ORAL

            (DYE-pir-ID-a-mole)

            COMMON BRAND NAME(S): Persantine

            USES: This medication is used in combination with "blood thinners" such as warfarin to keep clots from forming after heart valve replacements. Clots are a serious complication that can cause strokes, heart attacks, or blocked blood vessels in the lungs (pulmonary embolisms). Dipyridamole is an antiplatelet drug. It helps to keep blood flowing by stopping platelets from clumping together and by keeping heart blood vessels open.

            HOW TO USE: Take this medication by mouth as directed by your doctor, usually 4 times daily.The dosage is based on your medical condition and response to treatment.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.Do not stop taking this medication without consulting your doctor.

            SIDE EFFECTS: Dizziness, stomach upset, diarrhea, vomiting, headache, and flushing may occur as your body adjusts to the medication. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: fainting, stomach pain, yellowing eyes/skin, dark urine, unusual bleeding/bruising.Get medical help right away if you have any very serious side effects, including: chest pain, severe headache, weakness on one side of the body, vision changes, trouble speaking, confusion.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking dipyridamole, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: other heart problems (such as severe coronary artery disease, recent heart attack), low blood pressure (hypotension), liver disease, a certain muscle problem (myasthenia gravis).This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Older adults may be more sensitive to the side effects of this drug, especially dizziness and bleeding.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication passes into breast milk. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: riociguat, other antiplatelet drugs (such as abciximab, ticlopidine).If you are currently taking aspirin, talk to your doctor right away and ask if you should continue taking it with this medication. If you are not currently taking aspirin, talk to your doctor before starting it for any medical condition.This medication is sometimes used together with other drugs that may increase your risk of bleeding. Examples are certain "blood thinners" (such as heparin, warfarin). Follow your doctor's instructions carefully and continue your medications as directed. Tell your doctor if you notice unusual bleeding. Consult your doctor or pharmacist for more details.This medication may interfere with certain medical/lab tests (such as chemical stress tests using adenosine/dipyridamole), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: flushing, sweating, restlessness, weakness, dizziness, fast heartbeat.

            NOTES: Do not share this medication with others.

            MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

            MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.