Commonly used brand name(s)

In the U.S.

Persantine

Available Dosage Forms:

Tablet Capsule, Extended Release Solution Tablet, Extended Release

Therapeutic Class: Platelet Aggregation Inhibitor Pharmacologic Class: Phosphodiesterase Inhibitor

Uses For dipyridamole

Dipyridamole is used to lessen the chance of stroke or other serious medical problems that may occur when a blood vessel is blocked by blood clots. It is given only when there is a larger-thanusual chance that these problems may occur. For example, it is given to people who have had diseased heart valves replaced by mechanical valves, because dangerous blood clots are especially likely to occur in these patients. Dipyridamole works by helping to prevent dangerous blood clots from forming.

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Dipyridamole may also be used for other heart and blood conditions as determined by your doctor. Dipyridamole is also sometimes used as part of a medical test that shows how well blood is flowing to your heart. For information on this use of dipyridamole, see DipyridamoleDiagnostic (Systemic). Dipyridamole is available only with your doctor's prescription.

Before Using dipyridamole

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For dipyridamole, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to dipyridamole or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric
dipyridamole has been tested only in adults and in children older than 12 years of age. There is no specific information comparing use of dipyridamole in children younger than 12 years of age with use in other age groups.

Geriatric
Dipyridamole has not been studied specifically in older people taking the medicine regularly to prevent blood clots from forming. Although there is no specific information comparing this use of dipyridamole in the elderly with use in other age groups, it is not expected to cause different side effects or problems in older people than it does in younger adults.

Pregnancy
Pregnancy Category All Trimesters B Explanation

Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.

Breast Feeding
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking dipyridamole, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using dipyridamole with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Riociguat

Using dipyridamole with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Abciximab Aceclofenac Acemetacin Acenocoumarol Alipogene Tiparvovec Alteplase, Recombinant Amtolmetin Guacil Anagrelide Apixaban Ardeparin Argatroban Aspirin Bivalirudin Bromfenac Bufexamac Celecoxib Certoparin Choline Salicylate Cilostazol Citalopram Clonixin Clopidogrel Hydrogen Sulfate Dabigatran Etexilate Dalteparin Danaparoid Desirudin Desvenlafaxine

Dexibuprofen Dexketoprofen Diclofenac Diflunisal Dipyrone Duloxetine Enoxaparin Eptifibatide Escitalopram Etodolac Etofenamate Etoricoxib Felbinac Fenoprofen Fepradinol Feprazone Floctafenine Flufenamic Acid Fluoxetine Flurbiprofen Fluvoxamine Fondaparinux Heparin Sodium Ibuprofen Ibuprofen Lysine Ketoprofen Ketorolac Lepirudin Levomilnacipran Lornoxicam Loxoprofen Lumiracoxib Meclofenamate

Mefenamic Acid Meloxicam Milnacipran Morniflumate Nabumetone Nadroparin Naproxen Nefazodone Nepafenac Niflumic Acid Nimesulide Oxaprozin Oxyphenbutazone Parecoxib Parnaparin Paroxetine Phenindione Phenprocoumon Phenylbutazone Piketoprofen Piroxicam Pranoprofen Prasugrel Proglumetacin Propyphenazone Proquazone Protein C, Human Reviparin Rivaroxaban Rofecoxib Salicylic Acid Salsalate Sertraline

Sodium Salicylate Streptokinase Sulfinpyrazone Sulindac Tenoxicam Tiaprofenic Acid Ticagrelor Ticlopidine Tinzaparin Tirofiban Tolfenamic Acid Tolmetin Treprostinil Valdecoxib Venlafaxine Vortioxetine Warfarin

Using dipyridamole with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Adenosine Indomethacin Tenecteplase

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of dipyridamole. Make sure you tell your doctor if you have any other medical problems, especially:

Chest painThe chance of side effects may be increased

Low blood pressureLarge amounts of dipyridamole can make your condition worse

Proper Use of dipyridamole

dipyridamole works best when there is a constant amount in the blood. To help keep the amount constant, dipyridamole must be taken in regularly spaced doses, as ordered by your doctor. dipyridamole works best when taken with a full glass (8 ounces) of water at least 1 hour before or 2 hours after meals. However, to lessen stomach upset, your doctor may want you to take the medicine with food or milk.

Dosing
The dose of dipyridamole will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of dipyridamole. If your dose is different, do not change it unless your doctor tells you to do so. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
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For preventing blood clots: For oral dosage form (tablets): AdultsThe usual dose is 75 to 100 milligrams (mg) four times a day taken together with an anticoagulant (blood-thinning) medicine. ChildrenUse and dose must be determined by your doctor.

Missed Dose
If you miss a dose of dipyridamole, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. Keep out of the reach of children. Do not keep outdated medicine or medicine no longer needed.

Precautions While Using dipyridamole

Dipyridamole is sometimes used together with an anticoagulant (blood thinner) or aspirin. The combination of medicines may provide better protection against the formation of blood clots than any of the medicines used alone. However, the risk of bleeding may also be increased when dipyridamole is taken with aspirin. To reduce the risk of bleeding:

Do not take aspirin, or any combination medicine containing aspirin, unless the same doctor who directed you to take dipyridamole also directs you to take aspirin. This is especially important if you are taking an anticoagulant together with dipyridamole. If you have been directed to take aspirin together with dipyridamole, take only the amount of aspirin ordered by your doctor . If you need a medicine to relieve pain or a fever, your doctor may not want you to take extra aspirin. It is a good idea to discuss this with your doctor, so that you will know ahead of time what medicine to take. Your doctor should check your progress at regular visits.

Tell all medical doctors and dentists you go to that you are taking dipyridamole, and whether or not you are taking an anticoagulant (blood thinner) or aspirin together with it. Dizziness, lightheadedness, or fainting may occur, especially when you get up from a lying or sitting position. Getting up slowly may help. If this problem continues or gets worse, check with your doctor.

dipyridamole Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Check with your doctor as soon as possible if any of the following side effects occur: Rare Chest pain

gallstones tightness or swelling of neck yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them: More common Abdominal or stomach cramps

diarrhea dizziness or lightheadedness

Less common Flushing

headache nausea or vomiting weakness

Rare General discomfort and/or unusual tiredness or weakness

hair loss joint pain or swelling muscle pain runny nose sneezing

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1800-FDA-1088.

Generic Name:Furosemide Brand Name:Fumide,Furomide,Lasix,Luramide Classifications:electrolytic and water balance agent; loop diuretic Pregnancy Category:C Availability 20 mg, 40 mg, 80 mg tablets; 10 mg/mL, 40 mg/5 mL oral solution; 10 mg/mL injection Actions Rapid-acting potent sulfonamide loop diuretic and antihypertensive with pharmacologic effects and uses almost identical to those of ethacrynic acid. Exact mode of action not clearly defined; decreases renal vascular resistance and may increase renal blood flow. Therapeutic effects Inhibits reabsorption of sodium and chloride primarily in loop of Henle and also in proximal and distal renal tubules; an antihypertensive that decreases edema and intravascular volume. Reportedly less ototoxic than ethacrynic acid. Uses Treatment of edema associated with CHF, cirrhosis of liver, and kidney disease, including nephrotic syndrome. May be used for management of hypertension, alone or in combination with other antihypertensive agents, and for treatment of hypercalcemia. Has been used concomitantly with mannitol for treatment of severe cerebral edema, particularly in meningitis. Contraindications History of hypersensitivity to furosemide or sulfonamides; increasing oliguria, anuria, fluid and electrolyte depletion states; hepatic coma; pregnancy (category C), lactation. Cautious use Infants, older adults; hepatic cirrhosis, nephrotic syndrome; cardiogenic shock associated with acute MI; history of SLE, history of gout; patients receiving digitalis glycosides or potassium-depleting steroids.

Route & dosage Edema adult:PO 2080 mg in 1 or more divided doses up to 600 mg/d if needed IV/IM 2040 mg in 1 or more divided doses up to 600 mg/d child:PO 2 mg/kg, may be increased by 12 mg/kg q68h (max: 6 mg/kg/dose) IV/IM 1 mg/kg, may be increased by 1 mg/kg q2h if needed (max: mg/kg/dose) neonate:PO 14 mg/kg q1224h IV/IM 12 mg/kg q1224h Hypertension adult:PO 1040 mg b.i.d. (max: 480 mg/d) Administration Oral

Give with food or milk to reduce possibility of gastric irritation. Schedule doses to avoid sleep disturbance (e.g., a single dose is generally given in the morning; twice-a-day doses at 8 a.m. and 2 p.m.). Note: Slight discoloration of tablets reportedly does not alter potency. Store tablets at controlled room temperature, preferably at 15 30 C (5986 F) unless otherwise directed.

Protect from light. Store oral solution in refrigerator, preferably at 28C (3646 F). Protect from light and freezing. Intramuscular Protect syringes from light once they are removed from package. Discard yellow or otherwise discolored injection solutions. Intravenous

Note: Verify correct IV concentration and rate of infusion/injection with physician before administration to infants

or children. PREPARE direct: Give undiluted. ADMINISTER direct: Give undiluted at a rate of 20 mg or a fraction thereof over 1 min. With high doses a rate of 4 mg/min is recommended to decrease risk of ototoxicity. Incompatibilities Solution / Additive:Buprenorphine, chlorpromazine, ciprofloxacin, diazepam, diphenhydramine, dobutamine, doxapram, doxorubicin, droperidol, erythromycin, gentamicin, isoproterenol, labetalol, meperidine, metoclopramide, milrinone, netilmicin, pancuronium, prochlorperazine, promethazine, quinidine, thiamine vinblastine, vincristine. Y-site: Amrinone, amsacrine, ciprofloxacin, diazepam, diltiazem, dobutamine, diphenhydramine, dopamine, doxorubicin, droperidol, esmolol, filgrastim, fluconazole, gemcitabine, gentamicin, hydralazine, idarubicin, methocarbamol, metoclopramide, midazolam, milrinone, morphine, netilmicin, nicardipine, ondansetron, quinidine, thiopental, tobramycin, vecuronium, vinblastine, vincristine, vinorelbine, TPN. Use infusion solutions within 24 h. Store parenteral solution at controlled room temperature, preferably at 15 30 C (5986 F) unless otherwise directed. Protect from light. Adverse effects CV:Postural hypotension, dizziness with excessive diuresis, acute hypotensive episodes, circulatory collapse. Metabolic:Hypovolemia, dehydration, hyponatremia, hypokalemia, hypochloremia metabolic alkalosis, hypomagnesemia, hypocalcemia (tetany), hyperglycemia, glycosuria, elevated BUN, hyperuricemia;. GI:Nausea, vomiting, oral and gastric burning, anorexia, diarrhea, constipation, abdominal cramping, acute pancreatitis, jaundice. Urogenital:Allergic interstitial nephritis, irreversible renal failure, urinary frequency.

Hematologic:Anemia, leukopenia, thrombocytopenic purpura; aplastic anemia, agranulocytosis (rare). SpecSenses:Tinnitus, vertigo, feeling of fullness in ears, hearing loss (rarely permanent), blurred vision. Skin:Pruritus, urticaria, exfoliative dermatitis, purpura, photosensitivity, porphyria cutanea tarde, necrotizing angiitis (vasculitis). BodyWhole:Increased perspiration; paresthesias; activation of SLE, muscle spasms, weakness; thrombophlebitis, pain at IM injection site. Nursing implications Assessment & Drug Effects

Observe patients receiving parenteral drug carefully; closely monitor BP and vital signs. Sudden death from cardiac arrest has been reported. Monitor BP during periods of diuresis and through period of dosage adjustment. Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Report symptoms to physician. Lab tests: Obtain frequent blood count, serum and urine electrolytes, CO2, BUN, blood sugar, and uric acid values during first few months of therapy and periodically thereafter. Monitor for S&S of hypokalemia . Monitor I&O ratio and pattern. Report decrease or unusual increase in output. Excessive diuresis can result in dehydration and hypovolemia, circulatory collapse, and hypotension. Weigh patient daily under standard conditions.

Monitor urine and blood glucose & HbA1C closely in diabetics and patients with decompensated hepatic cirrhosis. Drug may cause hyperglycemia.

Note: Excessive dehydration is most likely to occur in older adults, those with chronic cardiac disease on prolonged salt restriction, or those receiving sympatholytic agents. Patient & Family Education

Consult physician regarding allowable salt and fluid intake. Ingestion potassium-rich foods daily (e.g., bananas, oranges, peaches, dried dates) to reduce or prevent potassium depletion. Learn S&S of hypokalemia . Report muscle cramps or weakness to physician. Make position changes slowly because high doses of antihypertensive drugs taken concurrently may produce episodes of dizziness or imbalance. Avoid replacing fluid losses with large amounts of water. Avoid prolonged exposure to direct sun. Do not breast feed while taking this drug.