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Applies to dipyridamole: solution, tablet
Along with its needed effects, dipyridamole 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 while taking dipyridamole:
Some side effects of dipyridamole 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:
Applies to dipyridamole: compounding powder, intravenous solution, oral tablet
Generally, oral administration of dipyridamole has been well tolerated. Adverse effects during intravenous (IV) administration have occurred in 40% to 55% of patients. The majority of dipyridamole-induced adverse effects resulting from IV administration can be reversed by intravenous aminophylline.
Cardiovascular symptoms have been the most frequently reported adverse effects associated with dipyridamole, particularly when given intravenously. Ischemia and angina have been reported following oral administration. Intravenous administration has been associated with chest pain (20% to 25%), ST segment depression (8% to 20%), facial flushing (2%), and severe ischemia (2.5%). Atrial and ventricular premature beats, ventricular tachycardia, ventricular fibrillation, bradycardia, asystole, sinus arrest, and myocardial infarction have also been reported. Hypotension may occur, with an average decrease in mean arterial pressure of 5% to 10%.
Chest pain, ischemia, and myocardial infarction associated with dipyridamole may be due to a phenomenon known as coronary "steal". Coronary steal involves shunting of blood flow away from an ischemic area where diseased vessels are already maximally dilated, to non-diseased areas when dipyridamole administration has resulted in vasodilation. Myocardial infarction has been reported in patients with unstable angina.
Aminophylline, an adenosine-receptor antagonist, may be used to reverse some of the effects of dipyridamole, including chest pain and bronchospasm. Intravenous aminophylline should be available during myocardial imaging.
Nervous system effects have occurred following intravenous and oral administration of dipyridamole and included headache (12.2%), lightheadedness or dizziness (11.8%), and paresthesias (1.3%). Cerebrovascular accident following intravenous administration also has been reported.
In one case report, a patient with asthma developed sudden bronchospasm with wheezing, coughing, and dyspnea immediately after receiving IV dipyridamole during thallium stress testing. Symptoms and hypoxemia resolved within 5 minutes after administration of IV aminophylline.
Respiratory tract adverse effects may occur, especially in patients with pre-existing asthma or chronic obstructive pulmonary disease. Dyspnea, bronchospasm, and respiratory arrest have been reported.
Gastrointestinal disturbances associated with dipyridamole therapy have included nausea and vomiting in up to 5% of patients. Gallstones containing dipyridamole have been reported in patients on long-term dipyridamole therapy.
Hematologic abnormalities have included rare bleeding complications due to the platelet inhibitory effects of dipyridamole.
In one small study, dipyridamole induced a marked but reversible reduction in glomerular filtration rate in patients with elevated renin-angiotensin activity and ascites due to cirrhosis. Sodium and free water excretion were reduced as well.
Hypersensitivity reactions have been reported rarely and included angioedema and anaphylaxis.
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