Dipyridamole aspirin

Hypersensitivity to dipyridamole, aspirin, or any of the other product components. Allergy Aspirin is contraindicated in patients with a known allergy to NSAIDs and in patients with asthma, rhinitis, and nasal polyps. Aspirin may cause severe urticaria, angioedema, or bronchospasms (asthma). 

Zhou et al. developed an HPLC method for the determination of dipyridamole, aspirin, and salicylic acid [67]. The HPLC system consisted of a Lichrospher 5-Cig (4.6 mm x 150 mm) column and a UV detector operated at 227 nm. The mobile phase (eluted at a flow rate of 1 mL/min) was composed of disodium hydrogen phosphate solution(methanol (50 50, pH adjusted to 3 by addition of phosphoric acid). The mean recovery of dipyridamole and aspirin was 100.9-104.1% and 97.01-97.89, respectively. 

In the Second European Stroke Prevention Study, headaches associated with dipyridamole (in 8% of patients taking dipyridamole or dipyridamole + aspirin... 

Siegel AM, Sandor P, Kollias SS, Baumgartner RW. Transient ischemic attacks after dipyridamole-aspirin therapy. J Neurol 2000 247(10) 807-8. 

Dipyridamole is a PDE5/PDE6 selective inhibitor that is used widely in conjunction with aspirin to reduce clotting and prevent stroke. More recent studies with a fixed combination of these two drugs (Aggrenox) has been shown in the recent European Stroke Prevention Study 2 to be of greatly added benefit over aspirin alone for prevention of recurrent stroke. 

Administration of the thrombolytic drugp with aspirin, dipyridamole, or the anticoagulants may increase the risk of bleeding. 

The European Stroke Prevention Study 2 (ESPS-2) trial examined four treatment arms—extended-release dipyridamole (ER-DP) 200 mg twice daily alone, aspirin 25 mg twice daily alone, ER-DP 200 mg twice daily + aspirin 25 mg twice daily, or placebo. In comparison with placebo the overall reduction in stroke risk was 16% with ER-DP alone and 18% with aspirin alone. The combination of ER-DP and aspirin led to a 37% reduction in stroke risk compared to placebo. Compared with aspirin alone, the combination of ER-DP with aspirin reduced the risk of stroke by 23%. 

The European/Australian Stroke Prevention in Reversible Ischaemia Trial (ESPRIT) confirmed the finding of ESPS 2, showing that the combination of aspirin and dipyridamole is more effective than aspirin alone in the prevention of new vascular events in patients with nondisabling cerebral ischaemia of presumed arterial origin. Adding the ESPRIT data to the meta-analysis of previous trials resulted in an overall risk ratio for the composite of vascular death, stroke, or MI of 0.82 (95% Cl 0.74-0.91). 

ESPRIT Study Group, Halkes PH, van Gijn J, Kappelle LJ, Koudstaal PJ, Algra A. Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT) randomised controlled trial. Lancet 2006 367(9523) 1665-1673. 

Do not combine with an antiplatelet agent o If patient experiences a systemic embolism while receiving warfarin and has a therapeutic INR, add aspirin 75-100 mg/d. For patients unable to take aspirin, then add dipyridamole 400 mg/d or clopidogel 75 mg/d. Immediate release dipyridamole needs an acidic gastric pH (<4) for adequate absorption... 

Aspirin 25 mg + extended-release dipyridamole 200 mg twice daily daily... 

Noncard ioembolic Antiplatelet therapy Aspirin 50-325 mg daily Clopidogrel 75 mg daily Aspirin 25 mg + extended-release dipyridamole 200 mg twice daily Class 1, Level A Class Ila, Level A Class lib. Level B Class Ila, Level A... 

The AHA/ASA guidelines recommend that antiplatelet therapy as the cornerstone of antithrombotic therapy for the secondary prevention of ischemic stroke and should be used in noncardioembolic strokes. Aspirin, dopidogrel, and extended-release dipyridamole plus aspirin are all considered first-line antiplatelet agents (see Table 13-1). The combination of aspirin and clopido-grel can only be recommended in patients with ischemic stroke and a recent history of myocardial infarction or coronary stent placement and then only with ultra-low-dose aspirin to minimize bleeding risk. 

BP, blood pressure CBC, complete blood count DVT, deep vein thrombosis ECG, electrocardiogram ERDP/ASA, extended-release dipyridamole plus aspirin Hb, hemoglobin Hd, hematocrit ICP, intracranial pressure ICU, intensive care unit INR, international normalized ratio SAH, subarachnoid hemorrhage. 

The recommended dose of dipyridamole and aspirin combination therapy is 1 capsule given orally twice daily, 1 in the morning and 1 in the evening. Swallow whole do not crush or chew. 

Do not interchange with individual components of aspirin and dipyridamole tablets. 

Pharmacology Antithrombotic action is the result of the additive antiplatelet effects of dipyridamole and aspirin. 

Dipyridamole Peak plasma levels of dipyridamole are achieved approximately 2 hours after administration of a daily dose of 400 mg dipyridamole and aspirin combination (given as 200 mg twice daily). The peak plasma concentration at steady-state is approximately 1.98 mcg/mL and the steady-state trough concentration is approximately 0.53 mcg/mL. 

The elimination of acetylsalicylic acid follows first-order kinetics with the dipyridamole and aspirin combination and has a half-life of 0.33 hours. The half-life of salicylic acid is 1.71 hours. 

Renal function impairment No changes were observed in the pharmacokinetics of dipyridamole or its glucuronide metabolite with creatinine clearances ranging from approximately 15 mL/min to more than 100 mL/min if data were corrected for differences in age. Avoid aspirin in patients with severe renal failure (glomerular filtration rate less than 10 mL/min). 

Hepatic function impairment Elevations of hepatic enzymes and hepatic failure have been reported in association with dipyridamole administration. Dipyridamole can be dosed without restriction as long as there is no evidence of hepatic failure. Avoid aspirin in patients with severe hepatic insufficiency. 

Elderly Plasma concentrations (determined as AUC) of dipyridamole in healthy elderly subjects older than 65 years of age were approximately 40% higher than in subjects younger than 55 years of age receiving treatment with the dipyridamole and aspirin combination. 

Lactation Dipyridamole and aspirin are excreted in human breast milk in low concentrations. 

Children Safety and efficacy of dipyridamole and aspirin combination capsules in pediatric patients have not been studied. Because of the aspirin component, use of this product in the pediatric population is not recommended. 

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