Dipyridamole / Aspirin
Class: Antiplatelet combination agent
- Capsules, ER, oral dipyridamole ER 200 mg/aspirin 25 mg
Antithrombotic action resulting from additive antiplatelet effects.
Indications and Usage
Reduce the risk of stroke in patients who have had transient ischemia of the brain or complete ischemic stroke caused by thrombosis.
Hypersensitivity to any component of the product; allergy to NSAIDs; patients with asthma, rhinitis, and nasal polyps; children or teenagers with viral infections.
Dosage and AdministrationAdults
PO Dipyridamole ER 200 mg/aspirin 25 mg twice daily. In the event of intolerable headaches during initial treatment, switch to dipyridamole ER 200 mg/aspirin 25 mg once daily at bedtime and low-dose aspirin in the morning. Patients should return to the usual regimen as soon as possible, usually within 1 wk.
- Do not interchange with individual components of aspirin and dipyridamole tablets.
- Administer with or without food. Capsules should be swallowed whole and not crushed or chewed.
Store at 59° to 86°F. Protect from excessive moisture.
Drug InteractionsACE inhibitors (eg, captopril), beta-blockers (eg, propranolol), diuretics (eg, furosemide), uricosuric agents (eg, probenecid)
The effects of these agents may be decreased by aspirin. Avoid coadministration with uricosuric agents.Adenosine
Metabolism of adenosine may be inhibited by dipyridamole, producing profound bradycardia. Adjust adenosine dose as necessary.Alcohol
Patients who consume 3 or more alcoholic drinks daily may be at increased risk of bleeding because of aspirin coadministration. Regular or excessive use of alcohol should be avoided.Anagrelide, anticoagulants (eg, heparin, warfarin), anticonvulsants (eg, valproic acid), clopidogrel, direct factor Xa inhibitors (eg, rivaroxaban), direct thrombin inhibitors (eg, dabigatran, desirudin), meglitinides (eg, nateglinide, repaglinide), methotrexate, NSAIDs (eg, ibuprofen), oral hypoglycemic agents (eg, chlorpropamide), serotonin reuptake inhibitors (eg, fluoxetine)
The pharmacologic and toxic effects of these agents may be increased by aspirin.Carbonic anhydrase inhibitors (eg, acetazolamide)
Concurrent use of aspirin can lead to high serum concentrations of acetazolamide (and toxicity) due to competition at the renal tubule for secretion. Carbonic anhydrase inhibitors may decrease the pharmacologic effects of aspirin. Use with caution.Cholinesterase inhibitors (eg, tacrine)
Dipyridamole may counteract anticholinesterase effect, potentially aggravating myasthenia gravis.Influenza virus vaccine
The use of influenza virus vaccine, a live attenuated influenza virus vaccine, is contraindicated in children and adolescents receiving aspirin.Varicella virus vaccine, live
Children and adolescents receiving live varicella virus vaccine should avoid aspirin for 6 weeks following vaccination because of the possibility of developing Reye syndrome.
Cardiac failure (2%); syncope (1%); angina pectoris, migraine (postmarketing).
Headache (39%); fatigue (6%); amnesia, asthenia, convulsions, malaise (2%); confusion, somnolence (1%); cerebral edema (postmarketing).
Purpura (1%); alopecia, angioedema, rash, skin hemorrhages (eg, bruising, ecchymosis, hematoma), Stevens-Johnson syndrome (postmarketing).
Epistaxis (2%); hearing loss (postmarketing).
Abdominal pain, dyspepsia (18%); nausea (16%); diarrhea (13%); vomiting (8%); melena, rectal hemorrhage (2%); anorexia, GI hemorrhage, hemorrhoid (1%); hematemesis, pancreatitis (postmarketing).
Antepartum and postpartum bleeding, interstitial nephritis, lower birth weight infants, papillary necrosis, prolonged pregnancy and labor, proteinuria, stillbirths (postmarketing).
Hemorrhage (3%); anemia (2%); aplastic anemia, coagulopathy, DIC, pancytopenia, prolongation of PT, thrombocytopenia, thrombocytosis (postmarketing).
Hepatic failure, hepatitis (postmarketing).
Acute anaphylaxis, hypersensitivity, laryngeal edema (postmarketing).
Dehydration, hyperkalemia, hypoglycemia, hypokalemia, metabolic acidosis, respiratory alkalosis (postmarketing).
Arthralgia (6%); back pain (5%); arthritis (2%); arthrosis, myalgia (1%); rhabdomyolysis (postmarketing).
Coughing (2%); upper respiratory tract infection (1%); dyspnea, tachypnea (postmarketing).
Pain (6%); accidental injury (3%); neoplasm (2%); allergic vasculitis, chest pain, hypothermia, Reye syndrome (postmarketing).
Monitor patient for signs of GI ulceration and bleeding even in the absence of previous GI symptoms.
Category D . Avoid use in the third trimester of pregnancy and during labor and delivery.
Excreted in breast milk.
Safety and efficacy not established; not recommended in pediatric patients.
Greater sensitivity of some older individuals cannot be ruled out.
Aspirin may cause severe urticaria, angioedema, or bronchospasm.
Avoid use in patients with severe renal failure (ie, glomerular filtration rate less than 10 mL/min).
Avoid use in patients with severe hepatic dysfunction.
Platelet function may be inhibited, increasing the risk of bleeding.
Coronary artery disease
Dipyridamole may precipitate or aggravate chest pain in patients with coronary artery disease.
Elevations of hepatic enzymes and hepatic failure have been reported with dipyridamole.
Use with caution because dipyridamole can produce peripheral vasodilation.
Peptic ulcer disease
Aspirin may cause gastric mucosal irritation and bleeding in patients with a history of active peptic ulcer disease; avoid use in these patients.
Convulsions, dizziness, flushes, hemorrhage, hypotension, metabolic acidosis, nausea, respiratory alkalosis, restlessness, sweating, tachycardia, tinnitus, vomiting, warm feeling, weakness.
- Advise patients not to crush or chew medication and to swallow the capsule whole with a full glass of water 2 times a day. Advise patients that if a dose is missed, they should not take 2 doses at once.
- Advise patients regarding risks of drinking alcohol while taking this medication.
- Inform patients that there is a general risk of bleeding, including intracranial and GI bleeding. Inform patients about the signs and symptoms of bleeding (including occult bleeding). Advise patients to notify their health care provider if they are prescribed any drug that may increase the risk of bleeding.
- Instruct patients to notify their health care provider if they are or become pregnant.
- Advise patients that headaches may occur upon initiation of therapy. If they experience intolerable headaches, they should contact their health care provider.
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