Aspirin + dipyridamole
Class : ( Anticoagulants, Antiplatelets & Fibrinolytics (Thrombolytics) )
P - Caution when used during pregnancy
L - Caution when used during lactation
Lab ¤ - Lab interference
Food ¤ - Food interaction
Indication & Dosage
Oral
Reduce risk of stroke in patients who had transient ischaemia of the brain or completed ischaemic stroke due to thrombosis
Adult: Per capsule contains aspirin 25 mg and extended-release dipyridamole 200 mg: 1 capsule bid. For patients with intolerable headache: 1 capsule at bedtime with low-dose aspirin in the morning; may return to usual dose once tolerance to headache develops.
CrCl (ml/min)
Dosage Recommendation
<10
Avoid.
Hepatic impairment: Avoid in severe impairment.
Administration
May be taken with or without food. (Swallow whole, do not chew/ crush.)
Overdosage
Symptoms may include warm feeling, flushing, sweating, restlessness, feeling of weakness, dizziness, tinnitus. Gastric lavage may be used to remove unabsorbed drug. Treatment is mainly symptomatic and supportive.
Contraindications
Hypersensitivity, allergy to NSAIDs. Bleeding disorders (factor VII or IX deficiencies). Patients with asthma, rhinitis or nasal polyps. Children <16 yr with viral infections.
Special Precautions
Unstable angina, recent MI, subaortic stenosis, severe coronary artery disease, hypotension, history of peptic ulcer disease. Monitor for signs of ulceration or bleeding, even in the absence of previous GI symptoms. Patients with inherited or acquired bleeding disorders. Admin of dipyridamole may cause increase in hepatic enzymes and hepatic failure. Avoid aspirin in patients with severe renal failure (CrCl <10 mL/minute). Discontinue if tinnitus or impaired hearing occurs. Dose of aspirin in this preparation is insufficient to prevent MI. Pregnancy, lactation.
Adverse Drug Reactions
GI disturbances, dyspepsia, abdominal pain, nausea, diarrhoea, vomiting, epigastric discomfort, rhinitis, urticaria, prolonged bleeding time, headache, dizziness, facial flushing, fainting, skin rash. Body pain, allergic reaction, fever, hypotension, tachycardia, palpitation, arrhythmia, hyperglycaemia, thirst, agitation, uterine haemorrhage, taste loss.
Drug Interactions
Aspirin: May reduce hypotensive and hyponatraemic effects of ACE inhibitors; may increase serum levels and toxicity of acetazolamide; increases anticoagulant effect of heparin, thus increasing bleeding risk; may reduce hypotensive effect of ß-blockers; may reduce efficacy of diuretics in patients with underlying renal or CV disease; salicylate may inhibit renal clearance of methotrexate, thus increasing the risk of bone marrow toxicity; increased risk of bleeding or reduced renal function when used with NSAIDs; increased risk of hypoglycaemia when used with oral hypoglycaemic drugs; salicylate antagonises the uricosuric effect of uricosuric agents; may increase adverse effect of alendronate. Dipyridamole: May antagonise the anticholinesterase effect of cholinesterase inhibitors. Increased risk of bleeding when used with warfarin. Antiplatelet effect of aspirin may be increased by antidepressants e.g. TCAs, selective serotonin reuptake inhibitors.
Potentially Fatal: Salicylates may increase adverse effect of drotrecogin alfa. Dypyridamole may increase plasma levels and CV effects ofadenosine. Ketorolac may enhance adverse effect of aspirin. Dipyridamole may increase therapeutic effect of regadenoson. Salicylates may increase the anticoagulant effect of vit K antagonists. Salicylates may increase the adverse effect of varicella virus-containing vaccines.
Food Interaction
Increased risk of bleeding with chronic, heavy alcohol use. Gingko biloba may increase antiplatelet effects of salicylates.
Lab Interference
May elevate hepatic enzymes, blood urea nitrogen, serum creatinine, hyperkalaemia, proteinuria and prolonged bleeding time.
Pregnancy Category (US FDA)
Category D: There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).
Storage
Oral: Store at 25°C.
Mechanism of Action
Aspirin inhibits platelet aggregation by irreversible inhibition of platelet cyclooxygenase and thus the formation of thromboxane A2 in the platelets. Dipyridamole inhibits platelet aggregation by preventing the uptake of adenosine into platelets, endothelial cells and RBCs. The combination results in additive antiplatelet effects.
Absorption: Dipyridamole: Plasma levels peak 2 hr after oral admin. Aspirin: Plasma levels peak 0.63 hr after oral admin.
Distribution: Dipyridamole: About 99% bound to plasma proteins, mainly alpha 1-acid glycoprotein and albumin. Aspirin: Poorly bound to plasma proteins.
Metabolism: Dipyridamole: Hepatic metabolism, mainly by glucuronidation. Aspirin: Rapidly hydrolysed to salicylic acid; salicylic acid is mainly conjugated in the liver to form salicyluric acid.
Excretion: Dipyridamole: About 95% of the glucuronide metabolite is removed via bile into the faeces. Aspirin: Half-life of salicylic acid is 1.71 hr.
Pharmacological Classification
Dipyridamole; Belongs to the class of platelet aggregation inhibitors excluding heparin. Used in the treatment of thrombosis.
Brands : ARRENO cap CARDIWELL PLUS tab , DYNASPRIN ENCOTABS tab
Class : ( Anticoagulants, Antiplatelets & Fibrinolytics (Thrombolytics) )
P - Caution when used during pregnancy
L - Caution when used during lactation
Lab ¤ - Lab interference
Food ¤ - Food interaction
Indication & Dosage
Oral
Reduce risk of stroke in patients who had transient ischaemia of the brain or completed ischaemic stroke due to thrombosis
Adult: Per capsule contains aspirin 25 mg and extended-release dipyridamole 200 mg: 1 capsule bid. For patients with intolerable headache: 1 capsule at bedtime with low-dose aspirin in the morning; may return to usual dose once tolerance to headache develops.
CrCl (ml/min)
Dosage Recommendation
<10
Avoid.
Hepatic impairment: Avoid in severe impairment.
Administration
May be taken with or without food. (Swallow whole, do not chew/ crush.)
Overdosage
Symptoms may include warm feeling, flushing, sweating, restlessness, feeling of weakness, dizziness, tinnitus. Gastric lavage may be used to remove unabsorbed drug. Treatment is mainly symptomatic and supportive.
Contraindications
Hypersensitivity, allergy to NSAIDs. Bleeding disorders (factor VII or IX deficiencies). Patients with asthma, rhinitis or nasal polyps. Children <16 yr with viral infections.
Special Precautions
Unstable angina, recent MI, subaortic stenosis, severe coronary artery disease, hypotension, history of peptic ulcer disease. Monitor for signs of ulceration or bleeding, even in the absence of previous GI symptoms. Patients with inherited or acquired bleeding disorders. Admin of dipyridamole may cause increase in hepatic enzymes and hepatic failure. Avoid aspirin in patients with severe renal failure (CrCl <10 mL/minute). Discontinue if tinnitus or impaired hearing occurs. Dose of aspirin in this preparation is insufficient to prevent MI. Pregnancy, lactation.
Adverse Drug Reactions
GI disturbances, dyspepsia, abdominal pain, nausea, diarrhoea, vomiting, epigastric discomfort, rhinitis, urticaria, prolonged bleeding time, headache, dizziness, facial flushing, fainting, skin rash. Body pain, allergic reaction, fever, hypotension, tachycardia, palpitation, arrhythmia, hyperglycaemia, thirst, agitation, uterine haemorrhage, taste loss.
Drug Interactions
Aspirin: May reduce hypotensive and hyponatraemic effects of ACE inhibitors; may increase serum levels and toxicity of acetazolamide; increases anticoagulant effect of heparin, thus increasing bleeding risk; may reduce hypotensive effect of ß-blockers; may reduce efficacy of diuretics in patients with underlying renal or CV disease; salicylate may inhibit renal clearance of methotrexate, thus increasing the risk of bone marrow toxicity; increased risk of bleeding or reduced renal function when used with NSAIDs; increased risk of hypoglycaemia when used with oral hypoglycaemic drugs; salicylate antagonises the uricosuric effect of uricosuric agents; may increase adverse effect of alendronate. Dipyridamole: May antagonise the anticholinesterase effect of cholinesterase inhibitors. Increased risk of bleeding when used with warfarin. Antiplatelet effect of aspirin may be increased by antidepressants e.g. TCAs, selective serotonin reuptake inhibitors.
Potentially Fatal: Salicylates may increase adverse effect of drotrecogin alfa. Dypyridamole may increase plasma levels and CV effects ofadenosine. Ketorolac may enhance adverse effect of aspirin. Dipyridamole may increase therapeutic effect of regadenoson. Salicylates may increase the anticoagulant effect of vit K antagonists. Salicylates may increase the adverse effect of varicella virus-containing vaccines.
Food Interaction
Increased risk of bleeding with chronic, heavy alcohol use. Gingko biloba may increase antiplatelet effects of salicylates.
Lab Interference
May elevate hepatic enzymes, blood urea nitrogen, serum creatinine, hyperkalaemia, proteinuria and prolonged bleeding time.
Pregnancy Category (US FDA)
Category D: There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).
Storage
Oral: Store at 25°C.
Mechanism of Action
Aspirin inhibits platelet aggregation by irreversible inhibition of platelet cyclooxygenase and thus the formation of thromboxane A2 in the platelets. Dipyridamole inhibits platelet aggregation by preventing the uptake of adenosine into platelets, endothelial cells and RBCs. The combination results in additive antiplatelet effects.
Absorption: Dipyridamole: Plasma levels peak 2 hr after oral admin. Aspirin: Plasma levels peak 0.63 hr after oral admin.
Distribution: Dipyridamole: About 99% bound to plasma proteins, mainly alpha 1-acid glycoprotein and albumin. Aspirin: Poorly bound to plasma proteins.
Metabolism: Dipyridamole: Hepatic metabolism, mainly by glucuronidation. Aspirin: Rapidly hydrolysed to salicylic acid; salicylic acid is mainly conjugated in the liver to form salicyluric acid.
Excretion: Dipyridamole: About 95% of the glucuronide metabolite is removed via bile into the faeces. Aspirin: Half-life of salicylic acid is 1.71 hr.
Pharmacological Classification
Dipyridamole; Belongs to the class of platelet aggregation inhibitors excluding heparin. Used in the treatment of thrombosis.
Brands : ARRENO cap CARDIWELL PLUS tab , DYNASPRIN ENCOTABS tab