Drugs List

Therapeutic Indications

Uses

Thromboembolism+prosthetic heart valve: prophylaxis (+oral anticoagulant)

Unlicensed Uses

Kawasaki syndrome
Thrombus formation after cardiac surgery: prevention

Contraindications

Neonates under 1 month
Galactosaemia
Hereditary fructose intolerance

Precautions and Warnings

Children 1 month to 18 years
Aortic stenosis
Breastfeeding
Coagulopathy
Decompensated cardiac failure
Glucose-galactose malabsorption syndrome
Haemodynamic instability
Hypotension
Lactose intolerance
Left ventricular outflow obstruction
Migraine
Myasthenia gravis
Pregnancy
Recent myocardial infarction
Unstable angina

Oral solution with maltitol unsuitable in hereditary fructose intolerance
Some brands contain lactose
Some formulations contain hydroxybenzoate
Some formulations contain sucrose
Some formulations contain sunset yellow (E110); may cause allergic reaction
Discontinue 24 hours prior to stress testing with IV dipyridamole for CAD
Advise patient to take at separate time of day to antacid preparations

Pregnancy and Lactation

Pregnancy

Use dipyridamole with caution in pregnancy.

There is inadequate evidence of safety in human pregnancy, but dipyridamole has been used for many years without apparent ill-consequence. Animal studies have shown no hazard.

Reproduction studies have been conducted in mice, rats and rabbits at doses up to 1.3, 20 and 1.6 times the maximum recommended daily human dose based on BSA, respectively. No evidence of foetal harm was found in these studies (Briggs, 2011).

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use dipyridamole with caution in breastfeeding.

Dipyridamole is excreted in breast milk at levels approximately 6% of the plasma concentration. There is not enough information to accurately establish the milk: plasma ratio. The pharmacokinetics of dipyridamole are such that only small amounts taken orally would be expected to pass into breast milk. Oral absorption is poor (27 to 66% due to first pass effect) and protein binding is high (90 to 99%). The effect of this on the nursing infant is unknown.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Aggravation of angina
Angioedema
Diarrhoea
Dizziness
Dyspepsia
Faintness
Gallstones
Headache
Hot flushes
Hypersensitivity reactions
Hypotension
Increased bleeding (during and after surgery)
Myalgia
Nausea
Rash
Severe bronchospasm
Tachycardia
Thrombocytopenia
Urticaria
Vomiting

Presentation

Standard release oral formulations of dipyridamole

Drugs List

Therapeutic Indications

Uses

Thromboembolism+prosthetic heart valve: prophylaxis (+oral anticoagulant)

Unlicensed Uses

Kawasaki syndrome
Thrombus formation after cardiac surgery: prevention

Dosage

Adults

Children

Contraindications

Neonates under 1 month
Galactosaemia
Hereditary fructose intolerance

Precautions and Warnings

Children 1 month to 18 years
Aortic stenosis
Breastfeeding
Coagulopathy
Decompensated cardiac failure
Glucose-galactose malabsorption syndrome
Haemodynamic instability
Hypotension
Lactose intolerance
Left ventricular outflow obstruction
Migraine
Myasthenia gravis
Pregnancy
Recent myocardial infarction
Unstable angina

Oral solution with maltitol unsuitable in hereditary fructose intolerance
Some brands contain lactose
Some formulations contain hydroxybenzoate
Some formulations contain sucrose
Some formulations contain sunset yellow (E110); may cause allergic reaction
Discontinue 24 hours prior to stress testing with IV dipyridamole for CAD
Advise patient to take at separate time of day to antacid preparations

Pregnancy and Lactation

Pregnancy

Use dipyridamole with caution in pregnancy.

There is inadequate evidence of safety in human pregnancy, but dipyridamole has been used for many years without apparent ill-consequence. Animal studies have shown no hazard.

Reproduction studies have been conducted in mice, rats and rabbits at doses up to 1.3, 20 and 1.6 times the maximum recommended daily human dose based on BSA, respectively. No evidence of foetal harm was found in these studies (Briggs, 2011).

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use dipyridamole with caution in breastfeeding.

Dipyridamole is excreted in breast milk at levels approximately 6% of the plasma concentration. There is not enough information to accurately establish the milk: plasma ratio. The pharmacokinetics of dipyridamole are such that only small amounts taken orally would be expected to pass into breast milk. Oral absorption is poor (27 to 66% due to first pass effect) and protein binding is high (90 to 99%). The effect of this on the nursing infant is unknown.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Aggravation of angina
Angioedema
Diarrhoea
Dizziness
Dyspepsia
Faintness
Gallstones
Headache
Hot flushes
Hypersensitivity reactions
Hypotension
Increased bleeding (during and after surgery)
Myalgia
Nausea
Rash
Severe bronchospasm
Tachycardia
Thrombocytopenia
Urticaria
Vomiting

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: March 2016

Reference Sources

Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

Summary of Product Characteristics: Dipyridamole 50mg/5ml oral suspension. Rosemont Pharmaceuticals Ltd. Revised April 2013.

Summary of Product Characteristics: Dipyridamole 200mg/5ml oral suspension. Thame Laboratories. Revised January 2016.

Summary of Product Characteristics: Dipyridamole tablets BP 25mg. Actavis UK Ltd. Revised April 2015.
Summary of Product Characteristics: Dipyridamole tablets BP 100mg. Actavis UK Ltd. Revised April 2015.

Summary of Product Characteristics: Persantin 100mg tablets. Boehringer Ingelheim Ltd. Revised February 2015.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 28 June 2017