DrugindexOnline^{2nd edition}

Pronouncation: (dye-peer-ID-a-mole/ASS-pihr-in)
Class: Antiplatelet combination agent

Trade Names:
Aggrenox
- Capsules 200 mg dipyridamole, extended-release/25 mg aspirin

Mechanism of Action

Pharmacology

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.

Contraindications

Hypersensitivity to dipyridamole, aspirin, or other components of product; allergy to NSAIDs; patients with asthma, rhinitis, and nasal polyps; children or teenagers with viral infections, with or without fever (Reye syndrome).

Dosage and Administration

Adults

PO 1 capsule (200 mg extended-release dipyridamole/25 mg aspirin) twice daily, 1 in morning and 1 in evening with a full glass of water. Do not crush or chew.

Storage/Stability

Store at controlled room temperature. Protect from excessive moisture.

Drug Interactions

Adenosine

Metabolism of adenosine may be inhibited by dipyridamole, producing profound bradycardia.

Cholinesterase inhibitors (eg, tacrine)

Dipyridamole may counteract anticholinesterase effect, potentially aggravating myasthenia gravis.

ACE inhibitors (eg, captopril), beta blockers (eg, propranolol), diuretics (eg, furosemide), uricosuric agents (eg, probenecid)

The effects of these agents may be decreased by aspirin.

Acetazolamide, anticoagulants (eg, warfarin), anticonvulsants (eg, valproic acid), methotrexate, NSAIDs (eg, ibuprofen), oral hypoglycemic agents (eg, chlorpropamide)

The pharmacologic and toxic effects of these agents may be increased by aspirin.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Cardiac failure; arrhythmia; supraventricular tachycardia.

CNS

Headache; amnesia; convulsions; anorexia; somnolence; confusion; coma; cerebral, subarachnoid, and intracranial hemorrhage.

Dermatologic

Stevens-Johnson syndrome.

GI

Abdominal pain; dyspepsia; nausea; vomiting; diarrhea; melena; rectal hemorrhage; GI hemorrhage; hemorrhoids; perforation; Reye syndrome.

Hematologic

Hemorrhage; epistaxis; anemia; purpura.

Hepatic

Hepatic failure.

Respiratory

Coughing; upper respiratory infection.

Miscellaneous

Arthralgia; arthritis; myalgia; arthrosis; pain; fatigue; back pain; asthenia; neoplasm; malaise; syncope; anaphylaxis; laryngeal edema; rhabdomyolysis.

Precautions

Monitor Monitor patient for signs and symptoms of cerebral ischemia.

Pregnancy

Category D (aspirin); Category B (dipyridamole).

Lactation

Excreted in breast milk.

Children

Safety and efficacy not established.

Renal Function

Avoid in patients with severe renal failure (ie, glomerular filtration rate less than 10 mL/min).

Alcohol

Concurrent consumption of alcohol may increase risk of bleeding.

Coagulation

Platelet function may be inhibited, increasing the risk of bleeding.

Coronary artery disease

Use with caution.

Hypotension

Use with caution.

Overdosage

Symptoms

Dipyridamole: warm feeling, flushes, sweating, restlessness, weakness, dizziness, hypotension, tachycardia. Aspirin: tinnitus, nausea, vomiting, dizziness, respiratory alkalosis, metabolic acidosis, hemorrhage, convulsions. Significant overdose (4 to 10 g aspirin) is a medical emergency.

Patient Information

• Advise patient to not crush or chew medication and to swallow the capsule whole with a full glass of water two times a day.
• Advise patient regarding risks of drinking alcohol while taking this medication.
• Advise patient to report any of the following to their health care provider immediately: recurrent signs or symptoms of cerebral ischemia, unusual bleeding, rash, hives, or difficulty breathing.
• Advise patients to inform their health care provider if they experience bothersome side effects such as headache, indigestion, stomach pain, nausea, dizziness, or excessive bruising while taking this medication.