Persantine

Persantine,

trademark for an inhibitor of platelet aggregation (dipyridamole).

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Persantine [per-san´tēn]

trademark for preparations of dipyridamole, a coronary vasodilator used to prevent clotting associated with mechanical heart valves and as an adjunct in radionuclide myocardial perfusion imaging.

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dipyridamole

Apo-Dipyridamole FC (CA), Apo-Dipyridamole SC (CA), Novo-Dipiradol (CA), Persantin (UK), Persantine

Pharmacologic class: Platelet adhesion inhibitor

Therapeutic class: Antiplatelet agent, diagnostic agent (coronary vasodilator)

Pregnancy risk category B

Action

Unclear. May reduce platelet aggregation by inhibiting phosphodiesterase, adenosine uptake, or formation of thromboxane A₂. Produces vasodilation, thereby increasing coronary blood flow.

Availability

Injection: 10 mg/2 ml

Tablets: 25 mg, 50 mg, 75 mg, 100 mg

⊘Indications and dosages

➣ To prevent thromboembolism in patients with prosthetic heart valves

Adults: 75 to 100 mg P.O. q.i.d.

➣ Alternative to exercise in thallium myocardial perfusion imaging

Adults: 0.57 mg/kg I.V. infused over 4 minutes (0.142 mg/kg/minute). Maximum I.V. dosage is 60 mg.

Off-label uses

• Prevention of myocardial reinfarction (given with aspirin)
• Thrombotic thrombocytopenia purpura

Contraindications

• Hypersensitivity to drug

Precautions

Use cautiously in:
• hypotension, platelet defects
• pregnant or breastfeeding patients (safety not established)
• children younger than age 12 (safety not established).

Administration

• Know that drug is usually given with warfarin when used to prevent thromboembolism.
• Dilute I.V. solution with dextrose 5% in water or normal or half-normal saline solution, as directed.
• Give single I.V. dose over 4 minutes.
• When used as diagnostic agent, administer within 5 minutes of thallium injection.
• Give oral form with a full glass of water at least 1 hour before or 2 hours after meals. If gastric distress occurs, give with food.

Route	Onset	Peak	Duration
P.O.	Unknown	Unknown	Unknown
I.V.	Unknown	6.5 min	30 min

Adverse reactions

CNS: dizziness, headache, syncope; transient cerebral ischemia or weakness (with I.V. use)

CV: hypotension, arrhythmias, myocardial infarction (all with I.V. use)

GI: nausea, vomiting diarrhea, dyspepsia

Hematologic: prolonged bleeding time

Respiratory: bronchospasm (with I.V. use)

Skin: rash, flushing (with I.V. use)

Interactions

Drug-drug. Anticoagulants, cefamandole, cefoperazone, cefotetan, nonsteroidal anti-inflammatory drugs, plicamycin, sulfinpyrazone, thrombolytics, valproic acid: increased risk of bleeding

Aspirin: increased effect on platelet aggregation

Theophylline: negation of dipyridamole effects during thallium imaging

Drug-behaviors. Alcohol use: increased risk of hypotension

Patient monitoring

• Monitor for therapeutic efficacy, including improved exercise tolerance and decreased need for nitrates.
• Assess platelet and coagulation studies regularly.
• Monitor ECG and vital signs, especially blood pressure.

Patient teaching

• Advise patient to take drug 1 hour before or 2 hours after meals for best absorption.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and behaviors mentioned above.

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Persantine®

Cardiology A formulation of dipyridamole used as an alternative to exercise in thallium myocardial perfusion imaging for evaluating CAD in Pts who cannot exercise adequately. See Exercise stress test.