Indications
Dipyridamole Extended Release Pellets are the slow-releasing Dipyridamole part of a combination capsule that also contains low-dose immediate release Aspirin (usually 200 mg Dipyridamole with 25 mg Aspirin). The combination is used to lower the risk of another stroke in adults who have had an ischaemic stroke (caused by a clot) or a transient ischaemic attack (TIA, a mini-stroke).
How It Works
Dipyridamole makes platelets less likely to stick together. It blocks an enzyme called phosphodiesterase in platelets and prevents cells from taking back adenosine, a natural substance that relaxes blood vessels and calms platelets. It also widens small blood vessels. The extended release pellets release the medicine slowly over the day, giving steady levels. Combined with Aspirin, which acts on platelets in a different way, it gives better protection than Aspirin alone.
Dosage and Administration
Take as prescribed. The usual adult dose of the combination is one capsule twice daily, morning and evening, swallowed whole with water, with or without food. Do not open, crush or chew the capsule, as this destroys the slow release. Headache is common in the first days; the doctor may adjust the schedule for the first week. Do not stop without talking to your doctor.
Interactions
Dipyridamole increases the effect of Adenosine; tell staff if you need a heart stress test or treatment for a fast heart rhythm, as the Adenosine dose must be lowered, and the combination is usually stopped 24 hours before a Dipyridamole or Adenosine stress test. It may reduce the effect of cholinesterase inhibitors used for myasthenia gravis such as Pyridostigmine. Bleeding risk is higher with other blood thinners such as Warfarin, Heparin, Clopidogrel and NSAIDs. It may add to the effect of blood pressure medicines. Antacids can reduce its absorption.
Contraindications
- Allergy to Dipyridamole, Aspirin or other NSAIDs.
- Active bleeding or stomach ulcer.
- Severe liver or kidney disease.
- Children and teenagers under 16 years (because of the Aspirin content).
- The last 3 months of pregnancy.
Side Effects
Headache is the most common effect, especially at the start, and usually improves. Others include dizziness, flushing, nausea, indigestion, diarrhoea, stomach pain, low blood pressure, muscle pain and easy bruising. Dipyridamole can rarely worsen chest pain (angina) in people with severe heart artery disease.
Get urgent medical help if you have new or worse chest pain, fainting, black or bloody stools, vomiting blood, any severe bleeding, a sudden severe headache, weakness on one side or slurred speech, or swelling of the face with difficulty breathing.
Pregnancy and Lactation
Because the capsule also contains Aspirin, do not use it in the last 3 months of pregnancy. Earlier in pregnancy, use only if a doctor decides it is clearly needed. Dipyridamole and Aspirin pass into breast milk, so this combination is generally not recommended during breastfeeding.
Precautions and Warnings
Use with caution in severe heart artery disease, recent heart attack, unstable angina, heart failure, low blood pressure and myasthenia gravis. Tell your doctor or dentist before surgery. Do not swap this capsule for separate Aspirin and Dipyridamole tablets without advice, as the doses are not the same.
Overdose
Overdose may cause warmth and flushing, sweating, restlessness, weakness, dizziness, low blood pressure, fast heartbeat and chest pain, plus Aspirin poisoning signs such as ringing in the ears and vomiting. Go to a hospital immediately.
Therapeutic Class
Antiplatelet agent (phosphodiesterase inhibitor), used in combination with Aspirin.
Storage
Store below 30°C in a dry place, away from light and out of the reach of children. Keep the capsules in the original container with the lid tightly closed to protect them from moisture.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.