Dipyridamole
Classification: AATC code: B01AC07, B01AC30
Summary
Combination therapy with dipyridamole and low dose aspirin as secondary prevention after ischemic stroke or transitory ischemic attack (TIA) losers the risk of cardiovascular ischemic events similarly for men and women.
Headache has been shown to be more common in women treated with dipyridamole in combination with low dose aspirin.
Additional information
Pharmacokinetics and dosing
No studies with a clinically relevant sex analysis regarding the pharmacokinetics or dosing of dipyridamole have been found.
Effects
The first European Stroke Prevention Study (ESPS-1) showed similar results in men and women; reduction in death and stroke was 30% and 32%, respectively. The prevention of secondary ischemic lesions was seen in both sexes, though women tended to have a better prognosis after a primary lesion and their vascular lesions appeared at a later date [1]. Other RCTs, ESPS-2 and ESPRIT also showed lowered risk of stroke in men and women. However, in all studies fewer women than men were included [2-4].
Adverse effects
Several studies have shown that dipyridamole-induced headache is more common in women than in men, and more common in younger age groups. Dipyridamole was given in combination with low-dose acetylsalicylic acid. The mechanisms behind the headache are unknown but might be similar to the mechanisms causing headache in migraine when using nitrates or other vasodilating treatment [4, 5].
Reproductive health issues
Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).
Updated: 2019-02-26
Date of litterature search: 2019-02-08
References
- Lowenthal A. Secondary prevention of myocardial infarction in the first European Stroke Prevention Study. Thromb Res Suppl. 1990;12:59-63. PubMed
- Diener HC, Cunha L, Forbes C, Sivenius J, Smets P, Lowenthal A. European Stroke Prevention Study 2 Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci. 1996;143(1):1-13. PubMed
- Sivenius J, Laakso M, Penttilä IM, Smets P, Lowenthal A, Riekkinen PJ. The European Stroke Prevention Study: results according to sex. Neurology. 1991;41(8):1189-92. PubMed
- ESPRIT Study Group, Halkes PH, van Gijn J, Kappelle LJ, Koudstaal PJ, Algra A. Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial. Lancet. 2006;367:1665-73. PubMed
- Lökk J. Dipyridamole-associated headache in stroke patients--interindividual differences?. Eur Neurol. 2009;62:109-13. PubMed
- Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2017 [cited 2019-01-30.] länk
Reviewed by: Mia von Euler
Approved by: Karin Schenck-Gustafsson