Dipyridamole

Antiplatelet / Vasodilator·Haematology - Antiplatelets

Secondary prevention of ischemic stroke and TIA

Authority requiredPBSANTIPLATELETPersantin, Asasantin SR (combo with Aspirin)100 mg tablet+2

Max Dose

400 mg/day

Half-life

10 h

Headache

SEVERE

Combination

WITH ASPIRIN

Rapid Summary

Overview

Antiplatelet agent with potent vasodilatory properties. Primarily used in combination with Aspirin for secondary stroke prevention.

Maximum Dose

Max 400 mg/day (Extended Release).

Clinical Focus

The massive vasodilation frequently causes agonizing, throbbing headaches that force patients to abandon the drug. Do not use in severe angina (coronary steal).

Bottom Line

Dipyridamole is an antiplatelet agent used with aspirin for secondary stroke prevention, but causes significant headache and flushing and has largely been superseded by other antiplatelet agents.

Formulation & Access

Brand Names

Persantin, Asasantin SR (combo with Aspirin)

Oral Routes

Tablets (100 mg). SR Capsules (200 mg).

Parenteral

Ampoules for IV diagnostic use.

Prescribing & PBS

Authority Required (PBS) for stroke prevention.

Indications & Use

Primary

PBSTGA

Secondary prevention of ischemic stroke and TIA.

Clinical Place

Superseded largely by Clopidogrel monotherapy due to terrible headache side effects, but still utilized by some neurologists based on the ESPRIT trial.

Quick reference

Class & Role

Antiplatelet / Vasodilator — Antiplatelet agent with potent vasodilatory properties.

Route / Formulation

Tablets (100 mg). SR Capsules (200 mg). (Persantin, Asasantin SR (combo with Aspirin))

Usual Dose & Max

PO 200 mg (SR) BD. (Almost universally prescribed as the combination pill Asasantin SR: 200mg Dipyridamole + 25mg Aspirin BD). Max 400 mg/day (Extended Release).

Key Indication Doses

Secondary Stroke Prevention: PO 200 mg (SR) BD. (Almost universally prescribed as the combination pill Asasantin SR: 200mg Dipyridamole + 25mg Aspirin BD). Cardiac Stress Testing: IV Infusion (used diagnostically by cardiologists to dilate coronary arteries).

Best Uses

Dipyridamole is an antiplatelet agent used with aspirin for secondary stroke prevention, but causes significant headache and flushing and has largely been superseded by other antiplatelet agents.

Avoid / Cautions

Severe coronary artery disease, recent MI, unstable angina, severe hypotension. Pregnancy Category B1.

Key Risks

Neurological: Throbbing headache, dizziness (due to vasodilation). Cardiovascular: 'Coronary Steal' syndrome. Dilates healthy coronary arteries, stealing blood away from narrowed/diseased arteries, provoking angina or MI in susceptible patients. Hypotension. Haematological: Bleeding (especially when combined with Aspirin).

Key Interactions

Additive bleeding risk with other anticoagulants. Additive hypotension with antihypertensives.

Monitoring

Warn the patient about the severe headache during the first week. Tell them to persist and use Paracetamol; it usually fades as the body adapts.

Clinical Pearl

If starting Asasantin SR (combo pill), neurologists sometimes start with 1 capsule at night for a week before moving to BD, allowing the patient to sleep through the worst of the initial vasodilation headache.

Access

Authority requiredPersantin, Asasantin SR (combo with Aspirin)100 mg tablet

Brand: Persantin, Asasantin SR (combo with Aspirin)
PBS status: Authority required
Formulation: Tablets (100 mg)

Dipyridamole

Antiplatelet / Vasodilator·Haematology - Antiplatelets

Secondary prevention of ischemic stroke and TIA

Authority requiredPBSANTIPLATELETPersantin, Asasantin SR (combo with Aspirin)100 mg tablet+2

Max Dose

400 mg/day

Half-life

10 h

Headache

SEVERE

Combination

WITH ASPIRIN

Rapid Summary

Overview

Antiplatelet agent with potent vasodilatory properties. Primarily used in combination with Aspirin for secondary stroke prevention.

Maximum Dose

Max 400 mg/day (Extended Release).

Clinical Focus

The massive vasodilation frequently causes agonizing, throbbing headaches that force patients to abandon the drug. Do not use in severe angina (coronary steal).

Bottom Line

Dipyridamole is an antiplatelet agent used with aspirin for secondary stroke prevention, but causes significant headache and flushing and has largely been superseded by other antiplatelet agents.

Formulation & Access

Brand Names

Persantin, Asasantin SR (combo with Aspirin)

Oral Routes

Tablets (100 mg). SR Capsules (200 mg).

Parenteral

Ampoules for IV diagnostic use.

Prescribing & PBS

Authority Required (PBS) for stroke prevention.

Indications & Use

Primary

PBSTGA

Secondary prevention of ischemic stroke and TIA.

Clinical Place

Superseded largely by Clopidogrel monotherapy due to terrible headache side effects, but still utilized by some neurologists based on the ESPRIT trial.

Quick reference

Class & Role

Antiplatelet / Vasodilator — Antiplatelet agent with potent vasodilatory properties.

Route / Formulation

Tablets (100 mg). SR Capsules (200 mg). (Persantin, Asasantin SR (combo with Aspirin))

Usual Dose & Max

PO 200 mg (SR) BD. (Almost universally prescribed as the combination pill Asasantin SR: 200mg Dipyridamole + 25mg Aspirin BD). Max 400 mg/day (Extended Release).

Key Indication Doses

Best Uses

Dipyridamole is an antiplatelet agent used with aspirin for secondary stroke prevention, but causes significant headache and flushing and has largely been superseded by other antiplatelet agents.

Avoid / Cautions

Severe coronary artery disease, recent MI, unstable angina, severe hypotension. Pregnancy Category B1.

Key Risks

Key Interactions

Additive bleeding risk with other anticoagulants. Additive hypotension with antihypertensives.

Monitoring

Warn the patient about the severe headache during the first week. Tell them to persist and use Paracetamol; it usually fades as the body adapts.

Clinical Pearl

Access

Authority requiredPersantin, Asasantin SR (combo with Aspirin)100 mg tablet

Brand: Persantin, Asasantin SR (combo with Aspirin)
PBS status: Authority required
Formulation: Tablets (100 mg)