dipyridamole (Persantine)
Classes: Antiplatelet Agents, Cardiovascular; Antiplatelet Agents, Hematologic
Dosing and uses of Persantine (dipyridamole)
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FDA approval for chronic angina withdrawn (not useful according to most experts)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
