dipyridamole (Persantine)

Dosing and uses of Persantine (dipyridamole)

• Adult
• Pediatric
• Geriatric

 

Adult dosage forms and 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

 

Pediatric dosage forms and strengths

injectable solution

• 5mg/mL

tablet

• 25mg
• 50mg
• 75mg

 

Off-label Use

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

 

Geriatric dosage forms and strengths

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

 

Persantine (dipyridamole) adverse (side) 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

 

Warnings

Contraindications

Hypersensitivity

Thrombocytopenia

 

Cautions

FDA approval for chronic angina withdrawn (not useful according to most experts)

Risk of AMI in CAD patients with IV

 

Pregnancy and 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.

 

Pharmacology of Persantine (dipyridamole)

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: 3 months

Duration: 6 hr

Protein Bound: 99%

Vd: 2-3 L/kg

Clearance: 2.3-3.5 mL/min/kg

Excretion: Feces

Dialyzable: No

Metabolism: Liver