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Dipyridamole

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Dipyridamole
File:Dipyridamole.svg
Systematic (IUPAC) name
2,2',2'',2'''-(4,8-di(piperidin-1-yl)pyrimido[5,4-d]pyrimidine-2,6-diyl)bis(azanetriyl)tetraethanol
Clinical data
Trade names Persantine
AHFS/Drugs.com monograph
MedlinePlus a682830
  • B
oral, IV
Pharmacokinetic data
Protein binding 99%
Metabolism Hepatic
Half-life Alpha (40 mins), Beta (10 Hours)
Identifiers
58-32-2 7pxY
B01AC07
PubChem CID 3108
DrugBank DB00975 7pxY
ChemSpider 2997 7pxY
UNII 64ALC7F90C 7pxY
KEGG D00302 7pxY
ChEBI CHEBI:4653 7pxY
ChEMBL CHEMBL932 7pxY
Chemical data
Formula C24H40N8O4
504.626 g/mol
 14pxY (what is this?)  (verify)

Dipyridamole (trademarked as Persantine) is a medication that inhibits blood clot formation[1] when given chronically and causes blood vessel dilation when given at high doses over a short time.

Mechanism and effects

Medical uses

  • Dipyridamole is used to dilate blood vessels in people with peripheral arterial disease and coronary artery disease[2]
  • Dipyridamole has been shown to lower pulmonary hypertension without significant drop of systemic blood pressure
  • It inhibits formation of pro-inflammatory cytokines (MCP-1, MMP-9) in vitro and results in reduction of hsCRP in patients.
  • It inhibits proliferation of smooth muscle cells in vivo and modestly increases unassisted patency of synthetic arteriovenous hemodialysis grafts.[3]
  • It increases the release of t-PA from brain microvascular endothelial cells
  • It results in an increase of 13 - HODE and decrease of 12-HETE in the subendothelial matrix (SEM) and reduced thrombogenicity of the SEM.
  • Pretreatment it reduced reperfusion injury in volunteers.
  • It has been shown to increase myocardial perfusion and left ventricular function in patients with ischemic cardiomyopathy.
  • It results in a reduction of the number of thrombin and PECAM-1 receptors on platelets in stroke patients.
  • cAMP impairs platelet aggregation and also causes arteriolar smooth muscle relaxation. Chronic therapy did not show significant drop of systemic blood pressure.
  • It inhibits the replication of mengovirus RNA.[4]
  • It can be used for myocardial stress testing as an alternative to exercise-induced stress methods such as treadmills.

Use in individuals with a history of stroke

A combination of dipyridamole and aspirin (Acetylsalicylic acid/dipyridamole) is FDA-approved for the secondary prevention of stroke and has a bleeding risk equal to that of aspirin use alone.[2] Dipyridamole absorption is pH-dependent and concomitant treatment with gastric acid suppressors (such as a proton pump inhibitor) will inhibit the absorption of liquid & plain tablets.[5][6] Modified release preparations are buffered and absorption is not affected.[7][8]

However, it is not licensed as monotherapy for stroke prophylaxis, although a Cochrane Review suggested that dipyridamole may reduce the risk of further vascular events in patients presenting after cerebral ischemia.[9]

A triple therapy of aspirin, clopidogrel, and dipyridamole has been investigated, but this combination led to an increase in adverse bleeding events.[10]

  • Vasodilation occurs in healthy arteries, whereas stenosed arteries remain narrowed. This creates a "steal" phenomenon where the coronary blood supply will increase to the dilated healthy vessels compared to the stenosed arteries which can then be detected by clinical symptoms of chest pain, electrocardiogram and echocardiography when it causes ischemia.
  • Flow heterogeneity (a necessary precursor to ischemia) can be detected with gamma cameras and SPECT using nuclear imaging agents such as Thallium-201, Tc99m-Tetrofosmin and Tc99m-Sestamibi. However, relative differences in perfusion do not necessarily imply any absolute decrease in blood supply in the tissue supplied by a stenosed artery.

Other uses

Dipyridamole also has non-medicinal uses in a laboratory context, such as the inhibition of cardiovirus growth in cell culture.

Overdose

Dipyridamole overdose
Classification and external resources
ICD-10 T46.3
ICD-9 972.4
DiseasesDB 3840
NCI Dipyridamole
Patient UK Dipyridamole

Dipyridamole overdose can be treated with aminophylline[11] which reverses its dilating effect on the blood vessels. Symptomatic treatment is recommended, possibly including a vasopressor drug. Gastric lavage should be considered. Administration of xanthine derivatives (e.g., aminophylline) may reverse the hemodynamic effects of dipyridamole overdose. Since dipyridamole is highly protein bound, dialysis is not likely to be of benefit.

See also

References

  1. ^ "Dipyridamole" at Dorland's Medical Dictionary
  2. ^ a b c Brown DG, Wilkerson EC, Love WE (March 2015). "A review of traditional and novel oral anticoagulant and antiplatelet therapy for dermatologists and dermatologic surgeons". Journal of the American Academy of Dermatology 72 (3): 524–34. PMID 25486915. doi:10.1016/j.jaad.2014.10.027. 
  3. ^ Dixon BS, Beck GJ, Vazquez MA, et al; DAC Study Group. Effect of dipyridamole plus aspirin on hemodialysis graft patency. N Engl J Med. 2009;360(21):2191-2201
  4. ^ Dipyridamole in the laboratory: Fata-Hartley, Cori L.; Ann C. Palmenberg. "Dipyridamole reversibly inhibits mengovirus RNA replication". doi:10.1128/JVI.79.17.11062-11070.2005. Retrieved 2007-02-13. 
  5. ^ Russell TL, Berardi RR, Barnett JL, O’Sullivan TL, Wagner JG, Dressman JB. pH-related changes in the absorption of "dipyridamole" in the elderly. Pharm Res (1994) 11 136–43.
  6. ^ Derendorf H, VanderMaelen CP, Brickl R-S, MacGregor TR, Eisert W. "Dipyridamole" bioavailability in subjects with reduced gastric acidity. J Clin Pharmacol (2005) 45, 845–50.
  7. ^ http://emc.medicines.org.uk/medicine/304/SPC/Persantin+Retard+200mg/#EXCIPIENTS
  8. ^ Stockley, Ivan (2009). <span />Stockley’s Drug Interactions<span />. The Pharmaceutical Press. ISBN 0-85369-424-9. 
  9. ^ De Schryver ELLM, Algra A, van Gijn J. (2007). Algra, Ale, ed. "Dipyridamole for preventing stroke and other vascular events in patients with vascular disease.". Cochrane Database of Systematic Reviews (2): CD001820. PMID 17636684. doi:10.1002/14651858.CD001820.pub3. 
  10. ^ Sprigg N, Gray LJ, England T et al. (2008). Berger, Jeffrey S., ed. "A randomised controlled trial of triple antiplatelet therapy (aspirin, clopidogrel and dipyridamole) in the secondary prevention of stroke: safety, tolerability and feasibility". PLoS ONE 3 (8): e2852. PMC 2481397. PMID 18682741. doi:10.1371/journal.pone.0002852. 
  11. ^ Aggrenox. RxList.com. URL: http://www.rxlist.com/cgi/generic/aggrenox_od.htm. Accessed on: May 1, 2007.