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Pharmacokinetics of dipyridamole.

Dipyridamole, though originally introduced as a coronary vasodilator, has lately been increasingly investigated in the treatment of thromboembolic diseases because of its inhibitory influence upon blood platelet function. The compound is eliminated from the organism by hepatic biotransformation to the monoglucuronide, which almost exclusively is subjected to biliary and faecal excretion with simultaneous partial enterohepatic circulation taking place. Only minute amounts are excreted through the kidneys. In experiments on four normal human volunteers it was found that the serum concentration curve after intravenous administration of dipyridamole rather closely fits the pharmacokinetics of an open two-compartment model with first order, linear disposition kinetics and elimination taking place from the central compartment. Experiments with oral ingestion of the compound could be described by the use of a corresponding pharmacokinetic model with two consecutive first order input steps, representing the dissolution and absorption processes. The disposition rate constants (beta) were within the range of 0.0051--0.0083 min.-1 corresponding to biological half-lives of 84--145 min. The absorption rate constant was about 0.07 min.-1, and the systemic availability of an oral dose of 100 mg dipyridamole in tablets varied from 37 to 66%.

Administration, Oral↗

Myocardial pharmacokinetics and pharmacodynamics of dipyridamole in the isolated rabbit heart.

The myocardial accumulation and disposition pharmacokinetics of the antithrombotic drug dipyridamole were investigated in isolated perfused and spontaneously beating rabbit hearts. The rabbit myocardium behaved pharmacokinetically as a two-compartment system with regard to the drug. The half-lives of the alpha-phase of distribution and of the beta-phase of disposition were about 1.4 and 6.3 min., respectively. Perfusion with a modified Krebs-Henseleit solution containing 5.1 microgram ml-1 of dipyridamole caused an accumulation of about 140 micrograms g-1 of myocardial tissue at steady state. The initial measured pharmacokinetic parameters were unchanged after perfusion with the drug for 60 min. The accumulating dipyridamole in the rabbit heart caused a progressive decrease in myocardial contractility to about 65%. This was accompanied by a decrease in the ratio of contraction rate to oxygen consumption to about 0.7 as an expression of reduced myocardial efficiency. The coronary flow rate was not significantly increased. The heart beating frequency decreased only slightly and no dromotropic effects were observed.

Animals↗

Optical studies on the specific interaction of dipyridamole with alpha 1-acid glycoprotein (orosomucoid).

The interaction of dipyridamole with alpha 1-acid glycoprotein was investigated by circular dichroism and ultraviolet absorbance measurements as well as by equilibrium dialysis experiments. Dipyridamole is bound to the protein via one site of extremely high affinity and by at least one site of considerably lower affinity. Only the association of dipyridamole with the high affinity site produces typical extrinsic Cotton effects. As a result of experimental observations it is concluded that the high affinity site is located in a hydrophobic protein structure of the glycoprotein.

Chemical Phenomena↗

The effects of dipyridamole and indomethacin on methotrexate cytotoxicity in LoVo human colon cancer cells.

Dipyridamole and indomethacin were studied for their effects in the in-vitro response of LoVo colon cancer cells to methotrexate (MTX) using a dye elution method. Dipyridamole 0.5-5 micrograms mL-1 or indomethacin 1 microgram mL-1 alone had little or no effect on cell growth. The tumour cells were refractory to even high concentrations of MTX (2.5-10 micrograms mL-1) alone or with indomethacin 1 microgram mL-1. In contrast, dipyridamole 0.5-5 micrograms mL-1 sensitized the cells to MTX 5 micrograms mL-1 (their growth was reduced by 25 to 69%), possibly by inhibiting thymidine salvage.

Cell Division↗

Partitioning and thermodynamics of dipyridamole in the n-octanol/buffer and liposome systems.

The thermodynamics of partitioning (K) of dipyridamole has been determined in n-octanol/buffer and liposome-buffer systems at pH 7.4. Dimyristoylphosphatidylcholine (DMPC) and dipalmitoylphosphatidylcholine (DPPC) were used to prepare multilamellar liposomes. Partitioning of dipyridamole did not depend on the amount of n-octanol employed, however, partitioning was dependent upon the quantity of DMPC employed to prepare liposomes. Plots of log K vs 1/T were linear in the n-octanol and liposome systems. Partitioning was generally greater in liposomes than in the n-octanol/buffer system. Among liposomes, the partitioning was greater in DMPC liposomes at all temperatures. The values of enthalpy (delta H) and entropy (delta S) were positive in both the n-octanol and liposome systems. These values were lower in DMPC liposomes and were comparable in the n-octanol and DPPC liposomes. Thus, the interaction of dipyridamole depends on the rigidity of lipid bilayers and liposomes constitute a more selective partitioning system than the n-octanol/buffer system.

Buffers↗

Myocardial infarction secondary to dipyridamole overdose.

A case of myocardial infarction secondary to dipyridamole overdose is described in a 62-year-old woman with longstanding angina. Therapeutic doses of dipyridamole are associated with reversible myocardial ischaemia in a proportion of patients but serious adverse events are rare (Homma et al., 1987). To our knowledge this is the first reported case of dipyridamole overdose in the literature.

Dipyridamole↗

Randomised placebo controlled trial of aspirin and dipyridamole in the prevention of coronary vein graft occlusion.

Treatment with the combination of aspirin and dipyridamole is believed to reduce the incidence of coronary vein graft occlusion. A double blind randomised controlled trial was carried out in which aspirin 990 mg and dipyridamole 225 mg daily or placebo were added to the routine postoperative management (warfarin for three months) of 320 patients undergoing coronary bypass grafting. The trial treatment was given for 12 months, after which the results were assessed by coronary and graft angiography. The two randomised groups, each of 160 patients, were comparable in age, sex, symptomatic state, angiographic findings, and operative procedure. Repeat coronary arteriography was carried out on 266 patients, 133 in each group. All grafts and distal anastomoses were patent in 68% (91/133) of the placebo patients and in 75% (100/133) of those receiving active treatment. Overall graft patency was 87% (306/352) and 89% (342/385) respectively. Retrospective subgroup analysis showed patency rates of 72% (26/36) and 78% (39/50) of grafts to vessels requiring preliminary endarterectomy, and 80% (36/45) and 91% (40/44) of distal anastomoses to vessels measured at operation to have a diameter of less than or equal to 1 mm. None of these differences was significant at the 5% level. Thus in this group of patients with high graft patency rates, treatment with aspirin and dipyridamole conferred no appreciable advantage.

Adult↗

Changes in coronary sinus pH during dipyridamole stress in patients with hypertrophic cardiomyopathy.

OBJECTIVES: The presence of angina pectoris and myocardial scarring in patients with hypertrophic cardiomyopathy (HCM) suggests that myocardial ischemia is a factor in the pathophysiology of the disease. The clinical evaluation of ischaemia is problematic in HCM as baseline electrocardiographic abnormalities are frequent and thallium-201 perfusion abnormalities correlate poorly with anginal symptoms. Coronary sinus pH measurement using a catheter mounted pH electrode is a validated sensitive technique for the detection of myocardial ischaemia. METHODS AND RESULTS: 11 patients with HCM and chest pain (eight men; mean (SD) (range) age 36 (11) (19-53) years) and six controls (two men; mean (SD) (range) age 49 (11) (31-62) years) with atypical pain and normal coronary angiograms were studied. Eight patients with HCM had baseline ST segment depression of > or = 1 mm and four had reversible perfusion defects during stress 201TI scintigraphy. A catheter mounted hydrogen ion sensitive electrode was introduced into the coronary sinus and pH monitored continuously during dipyridamole infusion (0.56 mg/kg over four min). The maximal change in coronary sinus pH during dipyridamole stress was greater in patients with HCM than in controls (0.082 (0.083) (0 to -0.275) v 0.005 (0.006) (0 to -0.012), P = 0.02). In six patients (four men; mean (SD) (range) age 29 (9) (19-40 years) the development of chest pain was associated with a gradual decline in coronary sinus pH (mean 0.123 (0.089)), peaking at 442 (106) s. There were no relations among left ventricular dimensions, maximal wall thickness, and maximum pH change. In patients with HCM there was a correlation between maximum pH change and maximum heart rate during dipyridamole infusion (r = 0.70, P = 0.02). CONCLUSION: This study provides further evidence that chest pain in patients with HCM is caused by myocardial ischaemia. The role of myocardial ischaemia in the pathophysiology of the disease remains to be determined but coronary sinus pH monitoring provides a method for quantifying and prospectively assessing its effects on clinical presentation and prognosis.

Adult↗

Perfusion thallium imaging of type I diabetes patients with end stage renal disease: comparison of oral and intravenous dipyridamole administration.

Eighty patients with type I diabetes and end stage renal disease were prospectively evaluated for coronary artery disease with dipyridamole-thallium-201 scintigraphy and quantitative coronary angiography. Forty patients received dipyridamole orally, and 40 received it intravenously. The prevalence of coronary artery disease was 53%. There were no significant differences in the accuracy of the two dipyridamole tests (sensitivity = 85%, specificity = 85%, accuracy = 85% for the oral group; sensitivity = 86%, specificity = 72%, accuracy = 79% for the intravenous group). Combining the 80 patients into a single group gave a sensitivity of 86%, a specificity of 79%, and an accuracy of 83% for the detection of coronary disease. Although the accuracy of this test in this patient population was similar to that previously reported for other groups, the prevalence of disease was high and resulted in a low predictive value of a negative test (83%).

Administration, Oral↗

Effect of adenosine and dipyridamole on cerebral blood flow.

The purpose of these experiments was to determine whether infusions of adenosine and of dipyridamole, which raise levels of endogenous adenosine, increase cerebral blood flow (CBF). In anesthetized dogs and cats, intracarotid infusions of adenosine increased blood flow to cranial muscle but did not alter CBF (measured with microspheres). Anatomical limitations may prevent satisfactory examination of cerebral vascular responsiveness during intracarotid infusion of vasodilator drugs in these species. In anesthetized rabbits, infusion of adenosine 10 microM/min in the carotid artery produced a 2-fold increase in CBF. Infusion of dipyridamole 20 microM/min increased CBF 2.7-fold. Dipyridamole produced a small decrease in cerebral oxygen consumption, which indicates that the vasodilator effect of the drug is not an indirect effect secondary to increased metabolism. These data indicate that exogenous and endogenous adenosine increase CBF in rabbits.

Adenosine↗

Dipyridamole-induced coronary vasodilation in human transplanted heart: preliminary report.

Coronary sinus blood flow and resistance were studied before and after intravenous dipyridamole in 4 patients with transplanted heart and normal coronary arteriogram treated by cyclosporine-prednisolone. Results were compared to those of a normal group of 7 subjects. Left ventricular endomyocardial biopsies were performed in the heart transplanted group. Mean right atrial pressure, cardiac index and left ventricular function were normal in the transplanted heart group. Mean aortic pressure and systemic vascular resistances were significantly higher in the transplanted group than in normals (p less than 0.01), but coronary resistance were similar. Dipyridamole-induced vasodilation resulted in an increased coronary sinus blood flow and a decreased coronary resistance in both groups, but these effects were reduced in 1 patient with a transplanted heart that evidenced an important perivascular fibrosis after a subacute rejection. In conclusion, this preliminary report of coronary blood flow in patients with transplanted heart indicates that the ability of coronary sinus blood flow to increase after dipyridamole is normal in the transplanted heart without allograft rejection. A major limitation in coronary vasodilation was observed in 1 patient with rejection antecedents and perivascular fibrosis, which could play a role in left ventricular function deterioration in some patients after heart transplantation.

Adult↗

Influence of hexobendine, dipyridamole, dilazep, lidoflazine, inosine and purine riboside on adenosine uptake by the isolated epithelium of guinea pig jejunum.

The uptake of (14C)adenosine by isolated epithelium of guinea pig jejunum, administered on the blood side, was inhibited by hexobendine, dipyridamole, dilazep and lidoflazine. On the lumen side, however, weak inhibition was observed with lidoflazine only and no significant change was recorded with hexobendine, dipyridamole or dilazep. This difference was not altered when the degradation of hexobendine by the jejunal epithelium was blocked by physostigmine. When adenosine uptake was already reduced by purine riboside, further addition of hexobendine, dipyridamole, dilazep or lidoflazine caused divergent changes depending on the side of administration. Adenosine uptake was further diminished on the blood side, but raised towards control values on the lumen side. By contrast, inosine inhibited adenosine uptake on both sides of the epithleium. The results suggest that the mechanism of adenosine uptake is different on either side with respect to inhibition characteristics, corresponding to differences in morphology and function of the two sides of the intestinal epithelium.

Adenosine↗

Dipyridamole test in angina pectoris: diagnostic value and pathophysiological implications.

The value of the dipyridamole test (0.75 mg/kg i.v.) in the diagnosis of angina pectoris was studied in 54 patients with angina pectoris (35 with angina on effort associated or not associated with rest angina and 19 with angina only at rest) and in 12 control subjects. The test induced electrocardiographic signs of ischemia (positive test) in 74% of patients with angina on effort, while it was negative in all cases with angina only at rest and in control subjects. All anginal patients with normal coronary arteries or less than 50% stenosis had a negative test; a positive response was observed in 36, 79 and 60% of cases with one-, two-or three-vessel disease, respectively. Hemodynamic changes with a marked arteriolar vasodilatation were observed both in the negative and in the positive tests. In the positive tests no significant change of double product, blood pressure and left ventricular end-diastolic pressure occurred before ischemia appeared. The results of the study show that dipyridamole as a diagnostic test in angina pectoris has a high specificity but a lower sensitivity than exercise test. The hemodynamic and eletrocardiographic findings in the positive tests suggest that dipyridamole-induced ischemia is due to a flow maldistribution with selective subendocardial ischemia secondary to the coronary arteriolar dilatation caused by the drug.

Adult↗

Effects of dipyridamole on sodium and potassium content of human red blood cells.

The effects of dipyridamole on potassium and sodium content of human red blood cells from normals or from patients with hypochromic anaemia, and of normal red cells pretreated with menadione, have been studied. Dipyridamole added to the incubation medium decreases the loss of potassium and the accumulation of sodium in all three types of red cells incubated at 37 degrees C for 24 h, either with or without calcium. The possible mechanism underlying these effects of dipyridamole is discussed.

Anemia, Hypochromic↗

Heparin-dipyridamole (Persantin) treatment in pregnancy: effect on blood coagulation parameters.

13 patients suspected of intra-uterine growth retardation (IUGR) were treated with a combination of heparin and dipyridamole. The effect of this anticoagulant therapy on platelet count, clot retraction, fibrinogen degradation products, antithrombin III (AT-III), plasminogen, fibrinogen and platelet aggregation induced by epinephrine, ADP, collagen and ristocetin has been examined. All parameters were measured both before and after treatment with heparin-dipyridamole. The results were compared with the results from a control group consisting of pregnant women of the same gestational age using no medication and not suspected of IUGR (n = 17). A significant decrease in the clot retraction was observed in patients with IUGR as compared to pregnant controls (p less than 0.05). A significant decrease in the AT-III level (p less than 0.01) and a significant increase (p less than 0.01) in the fibrinogen level were observed after heparin-dipyridamole treatment of patients suspected of IUGR. We conclude that the combination of a high fibrinogen and a low AT-III level will cause an increased risk for the development of thrombosis upon termination of treatment. We also observed that heparin clearance is increased during pregnancy.

Adolescent↗

Dipyridamole, an inhibitor of mengovirus replication in FL and L cells.

Dipyridamole showed an antiviral activity aganinst mengovirus in FL cells using the agar diffusion plaque inhibition test, plaque reduction test, tube titration test, and virus yield test after one replication cycle. With the last two tests mentioned above the inhibitory action was also confirmed in L cells. In consequence of the known transport inhibition of uridine into the cell in presence of dipyridamole only a very small incorporation of 3H-uridine into acid-insoluble material could be demonstrated. Applying the method of prelabelling of FL cells at 16 degrees C for 1 h with subsequent addition of dipyridamole the drug failed to show an effect on cellular RNA synthesis per se in uninfected cells whereas the viral RNA synthesis in mengo-virus-infected L cells was completely depressed.

Antiviral Agents↗

Serial thallium-201 myocardial imaging after dipyridamole infusion: diagnostic utility in detecting coronary stenoses and relationship to regional wall motion.

After a 4-minute i.v. dipyridamole infusion, 0.14 mg/kg/min, serial thallium-201 scans were obtained in 60 patients undergoing cardiac catheterization. Forty patients had significant (greater than or equal to 50% stenosis) coronary artery disease (CAD), and 20 patients had normal coronary arteries or trivial lesions. The images were graded qualitatively for thallium activity by three observers. Sensitivity was 93% (37 of 40) and specificity was 80% (16 of 20). The sensitivity and specificity of the thallium-201 study were not affected by the extent of CAD, the presence of Q waves, or propranolol therapy. Twenty-seven of 37 patients who had initial defects (73%) had complete thallium redistribution of one or more defects. Patient-by-patient analysis using a regression model of all patients showed that the fate of a segmental thallium defect predicted abnormal wall motion by angiography better than ECG Q waves. The presence of propranolol therapy or collaterals did not significantly affect the thallium redistribution results. We conclude that qualitative interpretation by multiple observers of thallium images after dipyridamole infusion is a highly sensitive and specific test for CAD. After dipyridamole, as with exercise stress, the extent of thallium redistribution is related to the degree of myocardial wall motion abnormality.

Adult↗

Warfarin versus dipyridamole-aspirin and pentoxifylline-aspirin for the prevention of prosthetic heart valve thromboembolism: a prospective randomized clinical trial.

In a prospective, randomized, parallel study, two regimens of platelet-suppressant therapy (PST)--dipyridamole-aspirin and pentoxifylline-aspirin--were compared with standard oral anticoagulation with warfarin in the prevention of prosthetic heart valve thromboembolism. In the entire group of 254 patients followed for 395.6 patient-years, the thromboembolic rate was significantly less in the warfarin group (warfarin vs dipyridamole-aspirin, p less than .005; warfarin vs pentoxifylline-aspirin, p less than .05). Subgroup analysis disclosed that, in patients with isolated mitral valve replacement, warfarin was superior to both of the PSTs with respect to the prevention of thromboembolism (warfarin vs dipyridamole-aspirin, p = .005; warfarin vs pentoxifylline-aspirin, p less than .05). Furthermore, a significant number of our patients could not tolerate the antiplatelet agents. However, in the rare situation in which repeated significant bleeding occurs despite careful adjustment of the dosage of warfarin, PST may be an acceptable alternate method of thromboembolism prophylaxis.

Adult↗