Dipyridamole Side Effects

Some side effects of dipyridamole may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

For the Consumer

Applies to dipyridamole: oral tablet

Get emergency medical help if you have any of these signs of an allergic reaction while taking dipyridamole: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• nosebleed or other bleeding that will not stop;

• black, bloody, or tarry stools; or

• coughing up blood or vomit that looks like coffee grounds.

Less serious side effects of dipyridamole may include:

• dizziness;

• upset stomach, diarrhea, vomiting;

• warmth, redness, or tingly feeling under your skin;

• muscle or joint pain;

• headache; or

• mild skin rash or itching.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

For Healthcare Professionals

Applies to dipyridamole: compounding powder, intravenous solution, oral tablet

General

Generally, oral administration of dipyridamole has been well tolerated. Adverse effects during intravenous (IV) administration have occurred in 40% to 55% of patients. The majority of dipyridamole-induced adverse effects resulting from IV administration can be reversed by intravenous aminophylline.

Cardiovascular

Cardiovascular symptoms have been the most frequently reported adverse effects associated with dipyridamole, particularly when given intravenously. Ischemia and angina have been reported following oral administration. Intravenous administration has been associated with chest pain (20% to 25%), ST segment depression (8% to 20%), facial flushing (2%), and severe ischemia (2.5%). Atrial and ventricular premature beats, ventricular tachycardia, ventricular fibrillation, bradycardia, asystole, sinus arrest, and myocardial infarction have also been reported. Hypotension may occur, with an average decrease in mean arterial pressure of 5% to 10%.

Chest pain, ischemia, and myocardial infarction associated with dipyridamole may be due to a phenomenon known as coronary "steal". Coronary steal involves shunting of blood flow away from an ischemic area where diseased vessels are already maximally dilated, to non-diseased areas when dipyridamole administration has resulted in vasodilation. Myocardial infarction has been reported in patients with unstable angina.

Aminophylline, an adenosine-receptor antagonist, may be used to reverse some of the effects of dipyridamole, including chest pain and bronchospasm. Intravenous aminophylline should be available during myocardial imaging.

Nervous system

Nervous system effects have occurred following intravenous and oral administration of dipyridamole and included headache (12.2%), lightheadedness or dizziness (11.8%), and paresthesias (1.3%). Cerebrovascular accident following intravenous administration also has been reported.

Respiratory

In one case report, a patient with asthma developed sudden bronchospasm with wheezing, coughing, and dyspnea immediately after receiving IV dipyridamole during thallium stress testing. Symptoms and hypoxemia resolved within 5 minutes after administration of IV aminophylline.

Respiratory tract adverse effects may occur, especially in patients with pre-existing asthma or chronic obstructive pulmonary disease. Dyspnea, bronchospasm, and respiratory arrest have been reported.

Gastrointestinal

Gastrointestinal disturbances associated with dipyridamole therapy have included nausea and vomiting in up to 5% of patients. Gallstones containing dipyridamole have been reported in patients on long-term dipyridamole therapy.

Hematologic

Hematologic abnormalities have included rare bleeding complications due to the platelet inhibitory effects of dipyridamole.

Renal

In one small study, dipyridamole induced a marked but reversible reduction in glomerular filtration rate in patients with elevated renin-angiotensin activity and ascites due to cirrhosis. Sodium and free water excretion were reduced as well.

Hypersensitivity

Hypersensitivity reactions have been reported rarely and included angioedema and anaphylaxis.

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