Dipyridamole/Aspirin

 Action Antithrombotic action resulting from additive antiplatelet effects.

 Indications 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).

 Route/Dosage

ADULTS: PO 1 capsule (200 mg extended-release dipyridamole/25 mg aspirin) bid, 1 in morning and 1 in evening. Do not crush or chew.

 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.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Cardiac failure; arrhythmia; supraventricular tachycardia. CNS: Headache; amnesia; convulsions; anorexia; somnolence; confusion; coma; cerebral, subarachnoid, and intracranial hemorrhage. DERM: Stevens-Johnson syndrome. GI: Abdominal pain; dyspepsia; nausea; vomiting; diarrhea; melena; rectal hemorrhage; GI hemorrhage; hemorrhoids; perforation; Reye syndrome. HEMA: Hemorrhage; epistaxis; anemia; purpura. HEPA: Hepatic failure. RESP: Coughing; upper respiratory infection. OTHER: Arthralgia; arthritis; myalgia; arthrosis; pain; fatigue; back pain; asthenia; neoplasm; malaise; syncope; anaphylaxis; laryngeal edema; rhabdomyolysis.

 Precautions

Pregnancy: Category D (aspirin); Category B (dipyridamole). Lactation: Excreted in breast milk. Children: Safety and efficacy not established. 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. Renal function impairment: Avoid in patients with severe renal failure (ie, glomerular filtration rate < 10 mL/min).

 Administration/Storage

• Do not chew or crush. Instruct patient to swallow capsule whole.
• Give twice daily, morning and evening with a full glass of water.
• Store at controlled room temperature. Protect from excessive moisture.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note history of peptic ulcer disease, bleeding disorders, severe kidney, liver disease or heart disease, or syndrome of asthma, rhinitis, and nasal polyps.
• Monitor patient for GI, CNS, and musculoskeletal side effects. Report to physician if noted and significant.
• Monitor patient for rash, urticaria, dyspnea, or anaphylactic reaction. If any occur notify physician immediately.
• Monitor patient for signs and symptoms of cerebral ischemia. If any occur notify physician immediately.

 Patient/Family Education

• Explain name, dose, action, and potential side effects of drug.
• 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 physician immediately: recurrent signs or symptoms of cerebral ischemia, unusual bleeding, rash, hives, or difficulty breathing.
• Advise patients to inform their physician if they experience bothersome side effects such as headache, indigestion, stomach pain, nausea, dizziness, or excessive bruising while taking this medication.