Dipyridamole description, usages, side effects, indications, overdosage, supplying and lots more!

Dipyridamole

Zydus Pharmaceuticals (USA) Inc.
Zydus Pharmaceuticals (USA) Inc.

Dipyridamole Tablets, USP

FULL PRESCRIBING INFORMATION: CONTENTS*




FULL PRESCRIBING INFORMATION

DESCRIPTION

Dipyridamole is a platelet inhibitor chemically described as 2,2',2'',2'''-[(4,8-Dipiperidinopyrimido[5,4-d]pyrimidine-2,6-diyl)dinitrilo]-tetraethanol. It has the following structural formula:

DESCRIPTION

C24H40N8O4 Mol. Wt. 504.63

Dipyridamole, USP is intensely yellow crystalline powder or needles. It is very soluble in methanol, in alcohol, and in chloroform; slightly soluble in water; very slightly soluble in acetone and in ethyl acetate.

Each dipyridamole tablet intended for oral administration contains 25 mg or 50 mg or 75 mg of dipyridamole. In addition, each tablet contains the following inactive ingredients: corn starch, hypromellose, iron oxide yellow, lactose monohydrate, magnesium stearate, polyethylene glycol, povidone and titanium dioxide.

CLINICAL PHARMACOLOGY

It is believed that platelet reactivity and interaction with prosthetic cardiac valve surfaces, resulting in abnormally shortened platelet survival time, is a significant factor in thromboembolic complications occurring in connection with prosthetic heart valve replacement.

Dipyridamole tablets have been found to lengthen abnormally shortened platelet survival time in a dose-dependent manner.

In three randomized controlled clinical trials involving 854 patients who had undergone surgical placement of a prosthetic heart valve, dipyridamole tablets, in combination with warfarin, decreased the incidence of postoperative thromboembolic events by 62 to 91% compared to warfarin treatment alone. The incidence of thromboembolic events in patients receiving the combination of dipyridamole tablets and warfarin ranged from 1.2 to 1.8%. In three additional studies involving 392 patients taking dipyridamole tablets and coumarin-like anticoagulants, the incidence of thromboembolic events ranged from 2.3 to 6.9%.

In these trials, the coumarin anticoagulant was begun between 24 hours and 4 days postoperatively, and the dipyridamole tablets were begun between 24 hours and 10 days postoperatively. The length of follow-up in these trials varied from 1 to 2 years.

Dipyridamole tablets do not influence prothrombin time or activity measurements when administered with warfarin.

Mechanism of Action:

Dipyridamole inhibits the uptake of adenosine into platelets, endothelial cells and erythrocytes in vitro and in vivo; the inhibition occurs in a dose-dependent manner at therapeutic concentrations (0.5 to 1.9 mcg/mL). This inhibition results in an increase in local concentrations of adenosine which acts on the platelet A2-receptor thereby stimulating platelet adenylate cyclase and increasing platelet cyclic-3',5'-adenosine monophosphate (cAMP) levels. Via this mechanism, platelet aggregation is inhibited in response to various stimuli such as platelet activating factor (PAF), collagen and adenosine diphosphate (ADP).

Dipyridamole inhibits phosphodiesterase (PDE) in various tissues. While the inhibition of cAMP-PDE is weak, therapeutic levels of dipyridamole inhibit cyclic-3',5'-guanosine monophosphate-PDE (cGMP-PDE), thereby augmenting the increase in cGMP produced by EDRF (endothelium-derived relaxing factor, now identified as nitric oxide).

Hemodynamics:

In dogs intraduodenal doses of dipyridamole of 0.5 to 4.0 mg/kg produced dose-related decreases in systemic and coronary vascular resistance leading to decreases in systemic blood pressure and increases in coronary blood flow. Onset of action was in about 24 minutes and effects persisted for about 3 hours.

In man the same qualitative hemodynamic effects have been observed.

Pharmacokinetics and Metabolism:

Following an oral dose of dipyridamole tablets, the average time to peak concentration is about 75 minutes. The decline in plasma concentration following a dose of dipyridamole tablets fits a two-compartment model. The alpha half-life (the initial decline following peak concentration) is approximately 40 minutes. The beta half-life (the terminal decline in plasma concentration) is approximately 10 hours. Dipyridamole is highly bound to plasma proteins. It is metabolized in the liver where it is conjugated as a glucuronide and excreted with the bile.

INDICATIONS AND USAGE

Dipyridamole tablets are indicated as an adjunct to coumarin anticoagulants in the prevention of postoperative thromboembolic complications of cardiac valve replacement.

CONTRAINDICATIONS

Hypersensitivity to dipyridamole and any of the other components.

PRECAUTIONS

General:

Coronary Artery Disease:

Dipyridamole has a vasodilatory effect and should be used with caution in patients with severe coronary artery disease (e.g., unstable angina or recently sustained myocardial infarction). Chest pain may be aggravated in patients with underlying coronary artery disease who are receiving dipyridamole.

Hepatic Insufficiency:

Elevations of hepatic enzymes and hepatic failure have been reported in association with dipyridamole administration.

Hypotension:

Dipyridamole should be used with caution in patients with hypotension since it can produce peripheral vasodilation.

Laboratory Tests:

Dipyridamole has been associated with elevated hepatic enzymes.

Drug Interactions:

No pharmacokinetic drug-drug interaction studies were conducted with dipyridamole tablets. The following information was obtained from the literature.

Adenosine:

Dipyridamole has been reported to increase the plasma levels and cardiovascular effects of adenosine. Adjustment of adenosine dosage may be necessary.

Carcinogenesis, Mutagenesis, Impairment of Fertility:

In studies in which dipyridamole was administered in the feed to mice (up to 111 weeks in males and females) and rats (up to 128 weeks in males and up to 142 weeks in females), there was no evidence of drug-related carcinogenesis. The highest dose administered in these studies (75 mg/kg/day) was, on a mg/m2 basis, about equivalent to the maximum recommended daily human oral dose (MRHD) in mice and about twice the MRHD in rats. Mutagenicity tests of dipyridamole with bacterial and mammalian cell systems were negative. There was no evidence of impaired fertility when dipyridamole was administered to male and female rats at oral doses up to 500 mg/kg/day (about 12 times the MRHD on a mg/m2 basis). A significant reduction in number of corpora lutea with consequent reduction in implantations and live fetuses was, however, observed at 1250 mg/kg (more than 30 times the MRHD on a mg/m2 basis).

Pregnancy:

Teratogenic Effects: PREGNANCY CATEGORY B

Reproduction studies have been performed in mice, rabbits and rats at oral dipyridamole doses of up to 125 mg/kg, 40 mg/kg and 1000 mg/kg, respectively (about 11/2, 2 and 25 times the maximum recommended daily human oral dose, respectively, on a mg/m2 basis) and have revealed no evidence of harm to the fetus due to dipyridamole. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, dipyridamole tablets should be used during pregnancy only if clearly needed.

Nursing Mothers:

As dipyridamole is excreted in human milk, caution should be exercised when dipyridamole tablets are administered to a nursing woman.

Pediatric Use:

Safety and effectiveness in the pediatric population below the age of 12 years have not been established.

ADVERSE REACTIONS

Adverse reactions at therapeutic doses are usually minimal and transient. On long-term use of dipyridamole tablets initial side effects usually disappear. The following reactions in Table 1 were reported in two heart valve replacement trials comparing dipyridamole tablets and warfarin therapy to either warfarin alone or warfarin and placebo:

Table 1Adverse Reactions Reported in 2 Heart Valve Replacement Trials
Adverse  Reaction
Dipyridamole  Tablets
Placebo

Warfarin
Warfarin
Number of patients 
147 
170 
Dizziness 
13.6% 
8.2% 
Abdominal distress 
6. 1% 
3.5% 
Headache 
2.3% 
0.0% 
Rash 
2.3% 
1.1% 

Other reactions from uncontrolled studies include diarrhea, vomiting, flushing and pruritus. In addition, angina pectoris has been reported rarely and there have been rare reports of liver dysfunction. On those uncommon occasions when adverse reactions have been persistent or intolerable, they have ceased on withdrawal of the medication.

When dipyridamole tablets were administered concomitantly with warfarin, bleeding was no greater in frequency or severity than that observed when warfarin was administered alone. In rare cases, increased bleeding during or after surgery has been observed.

In post-marketing reporting experience, there have been rare reports of hypersensitivity reactions (such as rash, urticaria, severe bronchospasm, and angioedema), larynx edema, fatigue, malaise, myalgia, arthritis, nausea, dyspepsia, paresthesia, hepatitis, thrombocytopenia, alopecia, cholelithiasis, hypotension, palpitation, and tachycardia.

OVERDOSAGE

In case of real or suspected overdose, seek medical attention or contact a Poison Control Center immediately. Careful medical management is essential. Based upon the known hemodynamic effects of dipyridamole, symptoms such as warm feeling, flushes, sweating, restlessness, feeling of weakness and dizziness may occur. A drop in blood pressure and tachycardia might also be observed.

Symptomatic treatment is recommended, possibly including a vasopressor drug. Gastric lavage should be considered. Administration of xanthine derivatives (e.g., aminophylline) may reverse the hemodynamic effects of dipyridamole overdose. Since dipyridamole is highly protein bound, dialysis is not likely to be of benefit.

DOSAGE AND ADMINISTRATION

Adjunctive Use in Prophylaxis of Thromboembolism after Cardiac Valve Replacement:

The recommended dose is 75 to 100 mg four times daily as an adjunct to the usual warfarin therapy. Please note that aspirin is not to be administered concomitantly with coumarin anticoagulants.

HOW SUPPLIED

Dipyridamole Tablets USP, 25 mg are light yellow, round, biconvex, film-coated tablets debossed with ‘ZE 43’ on one side and plain on the other side are supplied as follows:

NDC 68382-187-01 in bottle of 100 tablets

NDC 68382-187-05 in bottle of 500 tablets

NDC 68382-187-10 in bottle of 1000 tablets

NDC 68382-187-30 in blister of 100 tablets

Dipyridamole Tablets USP, 50 mg are light yellow, round, biconvex, beveled-edge, film-coated tablets debossed with ‘ZE 49’ on one side and plain on the other side are supplied as follows:

NDC 68382-188-01 in bottle of 100 tablets

NDC 68382-188-05 in bottle of 500 tablets

NDC 68382-188-10 in bottle of 1000 tablets

NDC 68382-188-30 in blister of 100 tablets

Dipyridamole Tablets USP, 75 mg are light yellow, round, biconvex, beveled-edge, film-coated tablets debossed with ‘ZE 50’ on one side and plain on the other side are supplied as follows:

NDC 68382-189-01 in bottle of 100 tablets

NDC 68382-189-05 in bottle of 500 tablets

NDC 68382-189-10 in bottle of 1000 tablets

NDC 68382-189-30 in blister of 100 tablets

STORAGE AND HANDLING

Store at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature]. Keep out of reach of children.

Dispense in a tight, light-resistant container.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Manufactured by:

Cadila Healthcare Ltd.

Ahmedabad, India

Distributed by:

Zydus Pharmaceuticals USA Inc.

Pennington, NJ 08534

Rev.: 04/11

Revision Date: 04/29/2011

PACKAGE LABEL.PRINCIPAL DISPLAY PANEL

NDC 68382-187-01 in bottle of 100 tablets

Dipyridamole Tablets USP, 25 mg

Rx only

100 tablets

ZYDUS

PACKAGE LABEL.PRINCIPAL DISPLAY PANEL

NDC 68382-188-01 in bottle of 100 tablets

Dipyridamole Tablets USP, 50 mg

Rx only

100 tablets

ZYDUS

PACKAGE LABEL.PRINCIPAL DISPLAY PANEL

NDC 68382-189-01 in bottle of 100 tablets

Dipyridamole Tablets USP, 75 mg

Rx only

100 tablets

ZYDUS

PACKAGE LABEL.PRINCIPAL DISPLAY PANEL

Dipyridamole

Dipyridamole TABLET, FILM COATED

Product Information

Product Type Human prescription drug label Item Code (Source) NDC:68382-187
Route of Administration ORAL DEA Schedule

Active Ingredient/Active Moiety

Ingredient Name Basis of Strength Strength
DIPYRIDAMOLE DIPYRIDAMOLE 25 mg

Inactive Ingredients

Ingredient Name Strength
FERRIC OXIDE YELLOW
HYPROMELLOSES
lactose monohydrate
MAGNESIUM STEARATE
polyethylene glycol
povidone
titanium dioxide
STARCH, CORN

Product Characteristics

Color Size Imprint Code Shape
YELLOW (LIGHT YELLOW) 6 mm ZE;43 ROUND

Packaging

# Item Code Package Description Marketing Start Date Marketing End Date
1 NDC:68382-187-01 100 in 1 BOTTLE
2 NDC:68382-187-05 500 in 1 BOTTLE
3 NDC:68382-187-10 1000 in 1 BOTTLE
4 10 in 1 BLISTER PACK
5 NDC:68382-187-30 10 in 1 CARTON

Marketing Information

Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date
ANDA ANDA040874 2008-05-22


PLEASE, BE CAREFUL!
Be sure to consult your doctor before taking any medication!
Copyright © 2014. drugs-library.com. All rights reserved. Information on drugs-library.com is provided for educational purposes only and is not to be used for medical advice, diagnosis or treatment.
Support info@drugs-library.com.