Questions about Atrial Fibrillation? Get answers from our expert.

Dipyridamole

Pronunciation

Class: Vasodilating Agents, Miscellaneous
VA Class: BL117
CAS Number: 58-32-2
Brands: Aggrenox, Persantine

Introduction

A non-nitrate coronary vasodilator and platelet aggregation inhibitor.100 170 171 172

Uses for Dipyridamole

Thromboembolism Associated with Prosthetic Heart Valves

Used as an adjunct to coumarin anticoagulants for the prevention of postoperative thromboembolic complications of heart valve replacement.100 101 103 104 105 106 107 108

Should not be used alone, without an oral anticoagulant, in patients with mechanical prosthetic heart valves.101 105 108 109 140 141 142

Slideshow: Doctor Avoidance: 5 Reasons Why It's Not a Good Idea

TIAs and Completed Thrombotic Stroke

Used in extended-release form in fixed combination with aspirin for secondary prevention of stroke in patients who have had TIAs or completed thrombotic stroke.145 146 148 990 1009

The American College of Chest Physicians (ACCP), American Stroke Association (ASA), and AHA consider the fixed combination of aspirin and extended-release dipyridamole an acceptable antiplatelet therapy for secondary prevention of noncardioembolic ischemic stroke and TIAs; other options include aspirin monotherapy, cilostazol, or clopidogrel.150 990 1009 When selecting an appropriate antiplatelet regimen, consider factors such as the patient's individual risk for recurrent stroke, tolerance, and cost of the different agents.990

Adjunct to Thallium Myocardial Perfusion Imaging

Used IV as an adjunct to thallous (thallium) chloride Tl 201 myocardial perfusion imaging in patients unable to exercise adequately.157 158 159 165

ACC and AHA recommend myocardial stress perfusion imaging with dipyridamole or adenosine or dobutamine echocardiography before or early after hospital discharge in patients with ST-segment-elevation MI who are not undergoing cardiac catheterization and who are unable to exercise.157

Dipyridamole Dosage and Administration

Administration

Administer orally or IV.100 158

Oral Administration

Administer conventional tablets 4 times daily.100

Administer extended-release dipyridamole and aspirin fixed-combination capsules twice daily in the morning and evening without regard to food.145 Swallow capsules whole without chewing.145

Extended-release dipyridamole in fixed combination with aspirin is not interchangeable with the individual components of aspirin and conventional dipyridamole tablets (e.g., Persantine).145

IV Administration

Dilution

Dilute injection in ≥1:2 ratio with 0.45% sodium chloride injection, 0.9% sodium chloride injection, or 5% dextrose injection to a final volume of approximately 20–50 mL.158

Rate of Administration

Adjunct to thallium myocardial perfusion imaging: 0.142 mg/kg per minute for 4 minutes.158

Administration Risks

Infusion of undiluted injection may cause local irritation.158

Dosage

Adults

Thromboembolism Associated with Prosthetic Heart Valves
Prophylaxis
Oral

Conventional tablets: 75–100 mg 4 times daily; use in conjunction with coumarin anticoagulant therapy.100 101 104 105 106 107 108

TIAs and Completed Thrombotic Stroke
Secondary Prevention
Oral

Fixed combination with aspirin: 200 mg of extended-release dipyridamole and 25 mg of aspirin (1 capsule) twice daily in the morning and evening.145

If headaches become intolerable during initial treatment, reduce dosage to 200 mg of dipyridamole and 25 mg of aspirin (1 capsule) once daily at bedtime; administer low-dose aspirin in the morning.145 Resume the usual regimen (200 mg of extended-release dipyridamole and 25 mg of aspirin twice daily) as soon as possible (usually within 1 week) because no outcome data available with the reduced-dose regimen and headaches diminish during continued treatment.145

Dose of aspirin in fixed-combination product may not be adequate to prevent recurrent MI or angina pectoris in patients with stroke or TIA.145

Adjunct to Thallium Myocardial Perfusion Imaging
IV

Single IV dose of 0.57 mg/kg, infused at a rate of 0.142 mg/kg per minute for 4 minutes.158 165 Maximum tolerated IV dose not determined; clinical experience suggests that a total dose >60 mg is not needed for any patient.158

Inject thallium-201 IV ≤5 minutes following completion of the dipyridamole infusion.158

Prescribing Limits

Adults

Adjunct to Thallium Myocardial Perfusion Imaging
IV

Clinical experience suggests that a total dipyridamole dose >60 mg is not needed for any patient.158

Cautions for Dipyridamole

Contraindications

  • Known hypersensitivity to dipyridamole or any ingredient in the formulation.100 145 158

Warnings/Precautions

Warnings

Cardiovascular and Cerebrovascular Effects

Serious adverse effects, including acute myocardial ischemia or MI, cardiac death, VF, symptomatic VT, stroke, transient cerebral ischemia, and seizures, reported with IV infusion.158 Asystole, sinus node arrest, sinus node depression, and conduction block reported also reported with IV infusion.158 Patients with abnormalities of cardiac impulse formation or conduction or severe CAD (e.g., unstable angina) may be at increased risk for these events.158

Weigh the important clinical information to be gained by myocardial perfusion thallium imaging with IV dipyridamole against the risk to the patient. 158 Consider the rate of false positive and false negative results of dipyridamole-assisted thallium imaging compared with coronary arteriography when choosing to use such imaging.158

Monitor vital signs during and for 10–15 minutes after IV infusion; obtain an ECG using ≥1 chest lead.158

Appropriate resuscitative measures should be readily available for relieving adverse effects such as severe chest pain.158 If severe chest pain occurs, administer IV aminophylline in doses of 50–250 mg by slow IV injection (e.g., 50–100 mg over 30–60 seconds).158 (See Specific Drugs under Interactions.) Place patients with severe hypotension in a supine position with the head tilted down, if necessary, before administration of IV aminophylline.158 If the highest recommended dosage of aminophylline (250 mg) does not relieve chest pain within a few minutes, may administer sublingual nitroglycerin.158 If chest pain continues despite such combination therapy, consider the possibility of MI.158

If the clinical condition of the patient with an adverse event permits a 1-minute delay, may perform thallium imaging before reversal of the pharmacologic effects occurs.158 165

Sensitivity Reactions

Anaphylactoid reactions and bronchospasm reported with IV dipyridamole.158 Patients with a history of asthma may be at greater risk for bronchospasm.158

Appropriate resuscitative measures should be readily available for relieving adverse effects such as severe bronchospasm.158 165 If severe bronchospasm occurs, administer aminophylline in doses of 50–250 mg by slow IV injection (e.g., 50–100 mg over 30–60 seconds).158 (See Cardiovascular and Cerebrovascular Effects under Cautions.)

General Precautions

Use of Fixed Combinations

When used in fixed combination with aspirin, consider the cautions, precautions, and contraindications associated with aspirin.145

Cardiovascular Effects

Use with caution in patients with hypotension or severe CAD (e.g., unstable angina, recently sustained MI) since peripheral vasodilation may occur.100 145 Dipyridamole may precipitate chest pain in patients with CAD.100 145

Amount of aspirin in the commercially available fixed-combination product may not be adequate to prevent recurrent MI or angina pectoris in patients with stroke or TIA.145

Hepatic Effects

Liver dysfunction (e.g., elevations of hepatic enzymes, hepatic failure) reported.100 145

Specific Populations

Pregnancy

Category B: Conventional tablets and injection.100 158

Category D: Fixed combination with aspirin.145

Lactation

Distributed into milk.100 145 158 Use caution.100 145

Pediatric Use

Conventional tablets: Safety and efficacy not established in pediatric patients <12 years of age.100

Fixed combination with aspirin: Safety and efficacy not established;145 should not be used in pediatric patients because of aspirin component.145

Injection: Safety and efficacy not established.158

Common Adverse Effects

Conventional tablets: Headache,100 dizziness,100 GI intolerance (e.g., abdominal distress),100 vomiting,100 diarrhea,100 flushing,100 rash,100 pruritus.100

Injection: Chest pain/angina pectoris,158 ECG changes (most commonly ST-T changes),158 headache,158 dizziness.158

Interactions for Dipyridamole

Specific Drugs

Drug

Interaction

Comments

Adenosine

Potentiation of adenosine vasoactive effects100 168 169

Increased plasma adenosine concentrations100 168 169

Dosage adjustment of adenosine may be necessary100 168 169

Anticholinesterase agents

Antagonizes anticholinesterase effects100 158

Potential to aggravate myasthenia gravis100 158

Heparin

Possible increased risk of bleeding complications166 167

Use with caution and monitor closely166 167

Methylxanthines (e.g., aminophylline, caffeine [e.g., coffee], theophylline

Inhibits dipyridamole vasodilatory and bronchospastic effects158 165

Aminophylline used to terminate persistent adverse effects of dipyridamole158

Caffeine or theophylline may lead to false-negative thallium imaging results;158 some clinicians recommend withholding caffeine (e.g., coffee) for 24 hours prior to testing165

Warfarin

Possible increased risk of bleeding, particularly during or after surgery; however, concomitant use does not appear to increase frequency or severity of bleeding compared with use of warfarin alone100

Some clinicians recommend maintenance of PT in the lower end of the therapeutic rangea

Dipyridamole Pharmacokinetics

Absorption

Bioavailability

Absorption from GI tract is variable and incomplete;101 134 135 137 138 171 37–66% of an oral dose (extended-release capsules containing dipyridamole in fixed combination with aspirin) may be absorbed.171

Following oral administration of conventional tablets, peak plasma concentrations attained in about 45–150 minutes (mean: 75 minutes).100 134 135 136 138 Peak plasma dipyridamole concentrations attained in about 2 hours (range: 1–6 hours) with twice-daily dosing of extended-release capsules containing dipyridamole in fixed combination with aspirin.145

Onset

Injection: Peak increase in coronary blood flow occurs 6.5 minutes after initiation of infusion.158

Duration

Following IV infusion, vital signs return to baseline in approximately 30 minutes.158 165

Food

Capsules containing extended-release dipyridamole in fixed combination with aspirin: High-fat meal reduces peak plasma dipyridamole concentrations and total absorption at steady state by 20–30% compared with fasting state; not clinically relevant.145

Distribution

Extent

In animals, widely distributed into body tissues; small amounts cross placenta.a

Does not cross the blood-brain barrier in animals.145 171

Distributed into milk.100 158 172

Plasma Protein Binding

91–99%,101 134 138 139 158 158 171 principally to α1-acid glycoprotein (α1-AGP) but also to albumin.158 161 162

Elimination

Metabolism

Metabolized in liver principally to monoglucuronide; small amount metabolized to diglucuronide.100 145 158

Elimination Route

Metabolites eliminated principally in feces via biliary excretion100 145 158 and to a much lesser extent in urine.145

Half-life

Conventional tablets: Biphasic; initial half-life approximately 40–80 minutes and terminal half approximately 10–12 hours.100 101 134 138

Extended-release capsules containing dipyridamole in fixed combination with aspirin: 13.6 hours.145

IV: Triphasic; mean half-lives of 3–12 minutes, 33–62 minutes, and 11.6–15.5 hours.158

Stability

Storage

Oral

Capsules and Tablets

Conventional tablets: 25°C (may be exposed to 15–30°C).100

Extended-release capsules containing dipyridamole in fixed combination with aspirin: 25°C (may be exposed to 15–30°C); protect from excessive moisture.145

Parenteral

Solution for Injection

20–25°C; avoid freezing and protect from light.158

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Do not mix with other drugs in the same syringe or infusion container.158

Actions

  • Mechanism of antiplatelet effects not fully elucidated.100 101 134 170

  • Inhibits the uptake and metabolism of adenosine in platelets, endothelial cells and erythrocytes.100 145 171 Increased local concentrations of adenosine at the platelet surface stimulate platelet adenyl cyclase and increase platelet cyclic-3′,5′-adenosine monophosphate (cAMP) concentrations.100 145 171 Increased platelet cAMP concentrations affect platelet-activating factor, collagen, and adenosine diphosphate and inhibit mobilization of free calcium, which is involved in platelet activation.100 170 171 Also stimulates prostacyclin synthesis and potentiates antiplatelet effects of prostacyclin.171

  • Inhibits platelet cyclic-3′,5′-guanosine monophosphate phosphodiesterase (cGMP-PDE).100 145 171 182 Augments increase in platelet cGMP concentrations produced by nitric oxide;100 145 increased cGMP platelet concentrations inhibit platelet activation and aggregation.171 182

  • Prolongs platelet survival time in patients with prosthetic heart valves or valvular heart disease in whom platelet survival is shortened.100 a

  • Mediates coronary vasodilation by inhibiting reuptake and thereby allowing accumulation of adenosine in vascular smooth muscle.158 165 182

  • Methylxanthine derivatives (e.g., theophylline, aminophylline) block adenosine receptors on vascular smooth muscle and abolish vasodilatory effects of dipyridamole.158 165 (See Specific Drugs under Interactions.)

  • Increases blood flow in normal coronary arteries while producing reduced blood flow in stenotic arteries (“coronary steal”).158 165 Myocardial oxygen consumption and cardiac work not increased.165

  • Myocardial uptake of thallous (thallium) chloride Tl 201 is directly proportional to coronary blood flow.159 165 Less thallous chloride Tl 201 uptake159 occurs in myocardium perfused by stenotic versus normal coronary arteries.158 159 160 Enhances the differences in blood flow between areas served by stenotic versus normal arteries during thallium testing.158 159 160 165

  • With IV administration, decreases BP and increases heart rate and cardiac output because of dilation of systemic resistance vessels.158 170 a With usual oral dosages, generally no change in BP or blood flow in peripheral arteries.170 a

Advice to Patients

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as any concomitant illnesses.100 145 158

  • Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed.100 145 158

  • Importance of informing patients of other important precautionary information.100 145 158 (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Dipyridamole

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

25 mg*

Dipyridamole Tablets

Persantine

Boehringer Ingelheim

50 mg*

Dipyridamole Tablets

Persantine

Boehringer Ingelheim

75 mg*

Dipyridamole Tablets

Persantine

Boehringer Ingelheim

Parenteral

Injection, for IV use

5 mg/mL*

Dipyridamole Injection

Dipyridamole Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules, extended-release (containing dipyridamole pellets and 25 mg immediate-release aspirin tablet)

200 mg with Aspirin 25 mg

Aggrenox

Boehringer Ingelheim

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2014. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Aggrenox 25-200MG 12-hr Capsules (BOEHRINGER INGELHEIM): 60/$242.99 or 180/$696.98

Dipyridamole 25MG Tablets (TEVA PHARMACEUTICALS USA): 100/$35.99 or 300/$99.97

Dipyridamole 50MG Tablets (ZYDUS PHARMACEUTICALS (USA)): 90/$57.99 or 270/$153.97

Dipyridamole 75MG Tablets (GLENMARK PHARMACEUTICALS): 100/$81.99 or 300/$221.97

Persantine 25MG Tablets (BOEHRINGER INGELHEIM): 100/$85.99 or 300/$235.98

Persantine 50MG Tablets (BOEHRINGER INGELHEIM): 100/$139.99 or 300/$399.95

Persantine 75MG Tablets (BOEHRINGER INGELHEIM): 100/$169.99 or 300/$487.97

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions February 15, 2013. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

References

100. Boehringer Ingelheim Pharmaceuticals, Inc. Persantine (dipyridamole) prescribing information. Ridgefield, CT: 2006 Jun 20.

101. FitzGerald GA. Dipyridamole. N Engl J Med. 1987; 316:1247-57. [IDIS 229092] [PubMed 3553945]

103. Patrono C, Coller B, Dalen JE et al. Platelet-active drugs. The relationships among dose, effectiveness, and side effects. Chest. 1998; 114(Suppl):470-88S.

104. Chesebro JH, Fuster V, Elveback LR et al. Trial of combined warfarin plus dipyridamole or aspirin therapy in prosthetic heart valve replacement: danger of aspirin compared with dipyridamole. Am J Cardiol. 1983; 51:1537-41. [IDIS 170723] [PubMed 6342354]

105. Sullivan JM, Harken DE, Gorlin R. Pharmacologic control of thromboembolic complications of cardiac-valve replacement. N Engl J Med. 1971; 284:1391-4. [PubMed 4931099]

106. Fuster V, Chesebro JH. Antithrombotic therapy: role of platelet-inhibitor drugs. III: Management of arterial thromboembolic and atherosclerotic disease (third of three parts). Mayo Clin Proc. 1981; 56:265-73. [IDIS 133994] [PubMed 7012464]

107. Chesebro JH, Steele PM, Fuster V. Platelet-inhibitor therapy in cardiovascular disease: effective defense against thromboembolism. Postgrad Med. 1985; 78:48-50,57-71. [IDIS 202584] [PubMed 3160013]

108. Shattil SJ, Brass LF. The prevention of prosthetic valve thromboembolism: uses and limitations of anti-platelet drugs. Int J Cardiol. 1983; 3:87-91. [PubMed 6852996]

109. Brott WH, Zajtchuk R, Bowen TE et al. Dipyridamole-aspirin as thromboembolic prophylaxis in patients with aortic valve prosthesis. J Thorac Cardiovasc Surg. 1981; 81:632-5. [IDIS 170374] [PubMed 7206773]

110. Chesebro JH, Clements IP, Fuster V et al. A platelet-inhibitor drug trial in coronary-artery bypass operations. N Engl J Med. 1982; 307:73-8. [IDIS 151994] [PubMed 7045659]

111. Chesebro JH, Fuster V, Elverback LR et al. Effect of dipyridamole and aspirin on late vein-graft patency after coronary bypass operations. N Engl J Med. 1984; 310:209-14. [IDIS 180466] [PubMed 6361561]

112. von Schacky C. Dipyridamole and aspirin and patency of coronary bypass grafts. N Engl J Med. 1984; 310:1533-4. [PubMed 6609308]

113. Chesebro JH, Fuster V, Elveback LR. Dipyridamole and aspirin and patency of coronary bypass grafts. N Engl J Med. 1984; 310:1534. [PubMed 6538932]

114. Brown BG, Cukingnan RA, DeRouen T et al. Improved graft patency in patients treated with platelet-inhibiting therapy after coronary bypass surgery. Circulation. 1985; 72:138-46. [IDIS 202014] [PubMed 3874009]

115. The American-Canadian Co-operative Study Group. Persantine aspirin trial in cerebral ischemia. Part II. Endpoint results. Stroke. 1985; 16:406-15. [PubMed 2860740]

116. The ESPS Study Group. The European stroke prevention study (ESPS): principal end-points. Lancet. 1987; 2:1351-4. [IDIS 236469] [PubMed 2890951]

117. Grotta JC. Current medical and surgical therapy for cerebrovascular disease. N Engl J Med. 1987; 317:1505-16. [IDIS 236147] [PubMed 3317048]

118. Fields WS. Dipyridamole. N Engl J Med. 1987; 317:1735.

119. Goldberg TH. Dipyridamole. N Engl J Med. 1987; 317:1735.

120. Hess H, Mietaschk A, Deichsel G. Drug-induced inhibition of platelet function delays progression of peripheral occlusive arterial disease: a prospective double-blind arteriographically controlled trial. Lancet. 1985; 1:415-9. [IDIS 196857] [PubMed 2857803]

121. Hess H. Dipyridamole. N Engl J Med. 1987; 317:1734-5. [PubMed 3696181]

122. Loeliger EA. Does dipyridamole have antithrombotic potential? Thromb Haemostasis. 1985; 53:437.

123. Ranhosky A. Dipyridamole. N Engl J Med. 1987; 317:1734. [PubMed 3696181]

127. Keltz TN, Innerfield M, Gitler B et al. Dipyridamole-induced myocardial ischemia. JAMA. 1987; 257:1515-6. [IDIS 226491] [PubMed 2950248]

128. Ranhosky A. Dipyridamole-induced myocardial ischemia. JAMA. 1987; 258:203. [IDIS 231319] [PubMed 3599300]

129. Keltz TN, Gitler B, Cooper JA. Dipyridamole-induced myocardial ischemia. JAMA. 1987; 258:203-4.

131. The Persantine-Aspirin Reinfarction Study Research Group. Persantine and aspirin in coronary heart disease. Circulation. 1980; 62:449-61.

132. Klimt CR, Knatterud GL, Stamler J et al. Persantine-Aspirin Reinfarction Study. Part II. Secondary coronary prevention with Persantine and aspirin. J Am Coll Cardiol. 1986; 7:251-69. [PubMed 2868029]

133. Anon. Doubts about dipyridamole as an antithrombotic drug. Drug Ther Bull. 1984; 22:25-8. [PubMed 6368165]

134. Rivey MP, Alexander MR, Taylor JW. Dipyridamole: a critical evaluation. Drug Intell Clin Pharm. 1984; 18:869-80. [IDIS 192040] [PubMed 6389068]

135. Lehmann CR, Locke K, Pierson WP et al. Persantine bioavailability problems. Clin Pharm. 1984; 3:14-5. [IDIS 181030] [PubMed 6697671]

136. Dresse A, Chevolet C, Delapierre D et al. Pharmacokinetics of oral dipyridamole (Persantine) and its effect on platelet adenosine uptake in man. Eur J Clin Pharmacol. 1982; 23:229-34. [IDIS 175837] [PubMed 6756935]

137. Nielsen-Kudsk F, Pedersen AK. Pharmacokinetics of dipyridamole. Acta Pharmacol Toxicol (Copenh). 1979; 44:391-9. [PubMed 474151]

138. Mahony C, Wolfram KM, Cocchetto DM et al. Dipyridamole kinetics. Clin Pharmacol Ther. 1982; 31:330-8. [IDIS 147166] [PubMed 7060316]

139. Kopitar Z, Weisenberger H. Spezifische Bindung von Dipyridamol an ein menschliches Serumprotein. Seine Isolierung, Identifizierung und Charakterisierung als α1-saures Glycoprotein. (German; with English abstract.) Arzneim-Forsch. 1971; 21:859-62.

140. St. John Sutton MG, Miller GAH, Oldershaw PJ et al. Anticoagulants and the Björk-Shiley prosthesis: experience of 390 patients. Br Heart J. 1978; 40:558-62. [IDIS 105978] [PubMed 656224]

141. Ribeiro PA, Al Zaibag M, Idris M et al. Antiplatelet drugs and the incidence of thromboembolic complications of the St. Jude Medical aortic prosthesis in patients with rheumatic heart disease. J Thorac Cardiovasc Surg. 1986; 91:92-8. [IDIS 210201] [PubMed 3941564]

142. Moggio RA, Hammond GL, Stansel HC Jr et al. Incidence of emboli with cloth-covered Starr-Edwards valve without anticoagulation and with varying forms of anticoagulation. J Thorac Cardiovasc Surg. 1978; 75:296-9. [PubMed 625136]

143. Ryan TJ, Antman EM, Brooks NH et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction: 1999 update: a report of the Amercian College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). From website.

144. Gibbons RJ, Chatterjee K, Daley J et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Chronic Stable Angina). J Am Coll Cardiol. 1999; 33:2092-197. [IDIS 429504] [PubMed 10362225]

145. Boehringer Ingelheim. Aggrenox(aspirin/extended-release dipyridamole) capsules prescribing information. Ridgefield, CT; 2007 Jan 31.

146. Diener HC. Dipyridamole trials in stroke prevention. Neurology. 1998; 51(Suppl. 3):S17-9. [IDIS 411291] [PubMed 9744826]

148. Diener HC, Cunha L, Forbes C et al. European stroke prevention study 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci. 1996; 143:1-13. [PubMed 8981292]

150. Wolf Pa, Clagett P, Easton JD et al. Preventing ischemic stroke in patients with prior stroke and transient ischemic attack: a statement for healthcare professional for the Stroke Council of the American Heart Association. Stroke. 1999; 30:1991-4. [PubMed 10471455]

157. Antman EM, Anbe DT, Armstrong PW et al. ACC/AHA guidelines for the management of patients with ST-elevation acute myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). 2004. From website.

158. Bedford Laboratories. Dipyridamole injection prescribing information. Bedford, OH; 2007 Dec.

159. Astellas Pharma US, Inc. Adenoscan (adenosine injection) prescribing information. Deerfield, IL; 2005 Jul.

160. Reviewers’ comments (personal observations) on adenosine.

161. Smith PG, Thomas HD, Barlow HC et al. In vitro and in vivo properties of novel nucleoside transport inhibitors with improved pharmacological properties that potentiate antifolate activity. Clin Cancer Res. 2001; 7:2105-13. [PubMed 11448930]

162. Curtin NJ, Bowman KJ, Turner RN et al. Potentiation of the cytotoxicity of thymidylate synthase (TS) inhibitors by dipyridamole analogues with reduced alpha1-acid glycoprotein binding. Br J Cancer. 1999; 80:1738-46. [PubMed 10468290]

163. Eagle KA, Guyton RA, Davidoff R et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Available from website. Accessed 2006 Nov 10.

165. Travin MI, Wexler JP. Pharmacological stress testing. Semin Nuc Med. 1999; 29; 298-318.

166. Baxter Healthcare Corporation. Heparin sodium injection prescribing information. Deerfield, IL; 2004 Dec.

167. American Pharmaceutical Partners. Heparin lock flush solution (with parabens) prescribing information. Schaumburg, IL; 2002 Apr.

168. The American Heart Association. Guidelines 2005 for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2005; 112(Suppl I): IV1-211.

169. Astellas Pharma US, Inc. Adenocard IV (adenosine injection) prescribing information. Deerfield, IL; 2005 Jul.

170. Sudlow C. What is the role fo dipyridamole in long-term secondary prevention after an ischemic stroke or transient ischemic attack? Can Med Assoc J. 2005; 173:1024-6.

171. Lenz TL, Hilleman DE. Aggrenox: a fixed-dose combination of aspirin and dipyridamole. Ann Pharmacotherapy. 200; 34:1283-90.

172. Bedford Laboratories. Dipyridamole injection prescribing information. Bedford, OH; 2006 Feb.

181. Antman EM, Hand M, Armstrong PW et al. 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction. J Am Coll Cardiol. 2008; 51:210-47. [PubMed 18191746]

182. Aktas B, Utz A, Hoenig-Liedl P et al. Dipyridamole enhances NO/cGMP-mediated vasodilator-stimulated phosphoprotein phosphorylation and signaling in human platelets: in vitro and in vivo/ex vivo studies. Stroke. 2003; 34:764-9. [PubMed 12624305]

990. Furie KL, Kasner SE, Adams RJ et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011; 42:227-76. [PubMed 20966421]

996. Bonow RO, Carabello BA, Chatterjee K et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008; 118:e523-661.

1008. Whitlock RP, Sun JC, Fremes SE et al. Antithrombotic and thrombolytic therapy for valvular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e576S-600S. [PubMed 22315272]

1009. Lansberg MG, O'Donnell MJ, Khatri P et al. Antithrombotic and thrombolytic therapy for ischemic stroke: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e601S-36S. [PubMed 22315273]

1011. Alonso-Coello P, Bellmunt S, McGorrian C et al. Antithrombotic therapy in peripheral artery disease: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e669S-90S. [PubMed 22315275]

1013. Monagle P, Chan AK, Goldenberg NA et al. Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e737S-801S. [PubMed 22315277]

a. AHFS drug information 2009. McEvoy GK, ed. Dipyridamole. Bethesda, MD: American Society of Health-System Pharmacists; 2009:1852-5

Hide
(web4)