DIPYRIDAMOLE

DIPYRIDAMOLE (dye-peer-id'a-mole) Apo-Dipyridamole , Persantine Classifications: antiplatelet agent; platelet aggregate inhibitor; coronary vasodilator; Therapeutic: platelet aggregate inhibitor; coronary vasodilator Pregnancy Category: B

Availability

25 mg, 50 mg, 75 mg tablets; 10 mg injection

Action

Nonnitrate coronary vasodilator that increases coronary blood flow by selectively dilating coronary arteries, thereby increasing myocardial oxygen supply. Additionally, it exhibits mild inotropic action as well as antiplatelet aggregation activity.

Therapeutic Effect

Has antiplatelet, and coronary vasodilator effects.

Uses

To prevent postoperative thromboembolic complications associated with prosthetic heart valves and as adjunct for thallium stress testing.

Unlabeled Uses

To reduce rate of reinfarction following MI; to prevent TIAs (transient ischemic attacks) and coronary bypass graft occlusion.

Contraindications

Safety and efficacy in children <12 y are not established.

Cautious Use

Hypotension, anticoagulant therapy; aspirin sensitivity; elderly; severe hepatic dysfunction; syncopey; pregnancy (category B), lactation.

Route & Dosage

Prevention of Thromboembolism in Cardiac Valve Replacement Adult: PO 75–100 mg q.i.d. Child: PO 1–2 mg t.i.d. Thromboembolic Disorders Adult: PO 150–400 mg/d in divided doses Thallium Stress Test Adult: IV 0.142 mg/kg/min for 4 min

Administration

Oral

• Give on an empty stomach at least 1 h before or 2 h after meals, with a full glass of water. Physician may prescribe with food if gastric distress persists.

Intravenous PREPARE: Direct: Dilute to at least a 1:2 ratio with 0.45% NaCl, NS, or D5W to yield a final volume of 20–50 mL.   ADMINISTER: Direct: Give a single dose over 4 min (0.142 mg/kg/min).

• Store in tightly closed container at 15°–30° C (59°–86° F) unless otherwise directed. Protect injection from direct light.

Adverse Effects (≥1%)

Usually dose related, minimal, and transient. CNS: Headache, dizziness, faintness, syncope, weakness. CV: Peripheral vasodilation, flushing. GI: Nausea, vomiting, diarrhea, abdominal distress. Skin: Skin rash, pruritus.

Pharmacokinetics

Absorption: Readily absorbed from GI tract. Peak: 45–150 min. Distribution: Small amount crosses placenta. Metabolism: In liver. Elimination: Mainly in feces. Half-Life: 10–12 h.

Nursing Implications

Assessment & Drug Effects

• Monitor therapeutic effectiveness. Clinical response may not be evident before second or third month of continuous therapy. Effects include reduced frequency or elimination of anginal episodes, improved exercise tolerance, reduced requirement for nitrates.

Patient & Family Education

• Notify physician of any adverse effects.
• Make all position changes slowly and in stages, especially from recumbent to upright posture, if postural hypotension or dizziness is a problem.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug