Dipyridamole with Adenosine Interaction Details
Brand Names Associated with Dipyridamole
- Dipyridamole
- Permole®
- Persantine®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Jan 08, 2024
Interaction Effect
Adenosine toxicity (hypotension, dyspnea, vomiting)
Interaction Summary
In a number of case reports the administration of dipyridamole decreased the dose of adenosine required to terminate a tachycardia. This interaction has been used therapeutically to produce controlled hypotension during surgery . Significantly lower doses of adenosine should be given to patients who also receive dipyridamole .
Severity
Moderate
Onset
Rapid
Evidence
Probable
How To Manage Interaction
When dipyridamole is used before adenosine, smaller dose of adenosine may be effective.
Mechanism Of Interaction
Decreased metabolism
Literature Reports
A) Dipyridamole protects against adenosine degradation by blocking the uptake into cells and can potentiate the clinical effects of adenosine. Pretreatment with dipyridamole 5 mg/kg administered intravenously over 5 minutes followed by an infusion of 8 mg/kg/min lowered the adenosine dose by 75% . It is recommended that the initial dose of adenosine not exceed 1 mg in patients who also receive dipyridamole to avoid severe bradyarrhythmias .
B) Dipyridamole competitively inhibits the transport of adenosine into cells, thus preventing subsequent deamination of adenosine to inosine . In a study involving patients with spontaneous supraventricular tachycardia, the mean dose of adenosine required to produce restoration of sinus rhythm or ventricular slowing to less than 100 beats/minute was 1 mg in dipyridamole patients and 8.8 mg in patients who were not receiving dipyridamole. Profound bradycardia with atrial flutter was described in a patient receiving dipyridamole following adenosine administration .
C) This interaction has been used therapeutically to produce controlled hypotension during surgery produced with intravenous infusions of adenosine 200 to 300 mcg/kg/minute in patients not treated with dipyridamole; in patients receiving dipyridamole, effective adenosine doses were 140 mcg/kg/minute .
D) The extended-release formulation of dipyridamole may antagonize the breakdown of adenosine, which may result in exaggeration of the effects of adenosine, including the induction of hypotension and atrial-ventricular block . The author recommends that patients taking adenosine should be referred for an adenosine pharmacologic stress perfusion test.
Dipyridamole Overview
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Dipyridamole is used with other drugs to reduce the risk of blood clots after heart valve replacement. It works by preventing excessive blood clotting.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.