Aspirin and extended-release dipyridamole: Drug information

For additional information see "Aspirin and extended-release dipyridamole: Patient drug information"

For abbreviations, symbols, and age group definitions show table

Brand Names: Canada

TARO-Dipyridamole w/ ASA [DSC]

Pharmacologic Category

Antiplatelet Agent

Dosing: Adult

Ischemic stroke or transient ischemic attack, noncardioembolic, secondary prevention

Ischemic stroke or transient ischemic attack, noncardioembolic, secondary prevention:

Note: In patients who receive IV thrombolytic therapy, antiplatelet therapy is generally delayed for at least 24 hours, but administered as soon as possible thereafter (Ref).

Oral: One capsule (aspirin 25 mg/dipyridamole ER 200 mg) twice daily. Note: If patient experiences intolerable headache during initial therapy, reduce dose to one capsule (aspirin 25 mg/dipyridamole ER 200 mg) at bedtime and low-dose aspirin in the morning. Return to usual dose (one capsule twice daily) as soon as tolerance to headache develops (usually within 1 week).

Carotid artery stenosis, symptomatic

Carotid artery stenosis, symptomatic (including recent carotid endarterectomy) (off-label use): Oral: One capsule (aspirin 25 mg/dipyridamole ER 200 mg) twice daily (Ref).

Hemodialysis graft patency

Hemodialysis graft patency (off-label use): Oral: One capsule (aspirin 25 mg/dipyridamole ER 200 mg) twice daily (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

GFR ≥10 mL/minute: There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied).

GFR <10 mL/minute: Avoid use.

Dosing: Liver Impairment: Adult

Mild to moderate impairment: There are no dosage adjustments provided in the manufacturer’s labeling (has not been studied).

Severe impairment: Avoid use.

Dosing: Older Adult

Refer to adult dosing.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Also see individual agents.

>10%:

Central nervous system: Headache (39%; tolerance usually develops)

Gastrointestinal: Abdominal pain (18%), dyspepsia (18%), nausea (16%), diarrhea (13%)

1% to 10%:

Gastrointestinal: Vomiting (8%), gastrointestinal hemorrhage (3%)

Hematologic & oncologic: Hemorrhage (3%)

<1%, postmarketing, and/or case reports: Agitation, alopecia, anaphylaxis, angina pectoris, angioedema, anorexia, aplastic anemia, bronchospasm, bruise, cardiac arrhythmia, cerebral edema, cerebral hemorrhage, chest pain, cholelithiasis, confusion, dehydration, disorder of hemostatic components of blood, disseminated intravascular coagulation, dizziness, dyspnea, ecchymoses, flushing, gastritis, gastrointestinal perforation, gastrointestinal ulcer, gingival hemorrhage, hearing loss, hematemesis, hematoma, hematuria, hemoptysis, hepatic failure, hepatic insufficiency, hepatitis, hyperkalemia, hypersensitivity angiitis, hypersensitivity reaction, hypoglycemia, hypokalemia, hypotension, hypothermia, interstitial nephritis, intracranial hemorrhage, jaundice, laryngeal edema, melena, metabolic acidosis, migraine, myalgia, nonthrombocytopenic purpura, palpitations, pancreatitis, pancytopenia, prolonged prothrombin time, proteinuria, pruritus, rectal hemorrhage, renal failure syndrome, renal insufficiency, renal papillary necrosis, respiratory alkalosis, Reye's syndrome, rhabdomyolysis, skin rash, Stevens-Johnson syndrome, subarachnoid hemorrhage, supraventricular tachycardia, syncope, tachycardia, tachypnea, thrombocythemia, thrombocytopenia, urticaria

Contraindications

Hypersensitivity to aspirin, dipyridamole, or any component of the formulation; allergy to nonsteroidal anti-inflammatory drugs (NSAIDs); patients with the syndrome of asthma, rhinitis, and nasal polyps; children or adolescents with viral infections.

Canadian labeling: Additional contraindications (not in US labeling): Patients with hereditary fructose and/or galactose intolerance; active GI ulcer or bleeding disorders; last trimester of pregnancy

Warnings/Precautions

Concerns related to adverse effects:

• Bleeding: Aspirin may increase the risk of bleeding; risk factors include the use of other drugs that increase the risk of bleeding (eg, anticoagulants, antiplatelet agents, heparin, fibrinolytic therapy, chronic use of nonsteroidal anti-inflammatory drugs). Use with caution in patients with acquired or inherited platelet and bleeding disorders; monitor for signs and symptoms of GI ulcers and bleeding. Use in active GI ulcer or bleeding disorders is contraindicated in the Canadian labeling.

• Drug reaction with eosinophilia and systemic symptoms: Potentially serious, sometimes fatal, drug reaction with eosinophilia and systemic symptoms (DRESS), also known as multiorgan hypersensitivity reactions, has been reported with nonsteroidal anti-inflammatory drugs. Monitor for signs and symptoms (eg, fever, rash, lymphadenopathy, eosinophilia) in association with other organ system involvement (eg, hepatitis, nephritis, hematological abnormalities, myocarditis, myositis). Early symptoms of hypersensitivity reaction (eg, lymphadenopathy, fever) may occur without rash; discontinue therapy and further evaluate if DRESS is suspected.

• GI effects: Stomach pain, heartburn, nausea, vomiting, and GI bleeding may occur. Avoid use in patients with a history of active peptic ulcer disease. Use with caution in patients with erosive gastritis or peptic ulcer disease.

• Hepatic effects: Elevated hepatic enzymes and hepatic failure have been reported with dipyridamole.

• Salicylate sensitivity: Patients with sensitivity to tartrazine dyes, nasal polyps, and asthma may have an increased risk of salicylate sensitivity.

• Tinnitus: Discontinue use if tinnitus or impaired hearing occurs.

Disease-related concerns:

• Cardiovascular disease: Dipyridamole produces peripheral vasodilation; may exacerbate preexisting hypotension and/or chest pain in patients with coronary artery disease. Use with caution in patients with hypotension, unstable angina, and/or recent myocardial infarction (MI); discontinue use 48 hours prior to pharmacologic (IV dipyridamole) stress testing. Note: Amount of aspirin provided may not be adequate for cardiac indications (eg, angina pectoris, MI prophylaxis).

• Ethanol use: Heavy ethanol use (>3 drinks/day) may increase bleeding risk and may enhance gastric mucosal irritation and bleeding.

• Hepatic impairment: Avoid use in severe hepatic impairment.

• Renal impairment: Use with caution in patients with renal impairment (GFR ≥10 mL/minute); avoid use in severe impairment (GFR <10 mL/minute).

Concurrent drug therapy issues:

• Pharmacologic stress testing: Interrupt therapy for 48 hours prior to stress testing with adenosine, IV dipyridamole, or regadenoson; may increase risk for cardiovascular adverse effects and impair the test sensitivity.

Special populations:

• Pediatric: Avoid use in children due to risk of Reye syndrome associated with aspirin component.

• Surgical patients: Aspirin should be avoided (if possible) in surgical patients for 1 to 2 weeks prior to surgery, to reduce the risk of excessive bleeding. Consider risk versus benefit when discontinuing prior to surgery.

Dosage form specific issues:

• Interchangeability: Aspirin/dipyridamole ER combination product is not interchangeable with the individual components of aspirin and dipyridamole.

• Lactose/sucrose: Formulation may contain lactose and/or sucrose; use in patients with fructose and/or galactose intolerance is contraindicated in the Canadian labeling.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule Extended Release 12 Hour, Oral:

Generic: Aspirin 25 mg [immediate release] and dipyridamole 200 mg [extended release]

Generic Equivalent Available: US

Yes

Pricing: US

Capsule, 12-hour (Aspirin-Dipyridamole ER Oral)

25-200 mg (per each): $8.36 - $8.37

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule Extended Release 12 Hour, Oral:

Generic: Aspirin 25 mg [immediate release] and dipyridamole 200 mg [extended release] [DSC]

Administration: Adult

Oral: Administer with or without food. Capsule should be swallowed whole; do not crush or chew.

Bariatric surgery: Capsule, extended release: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate. Cannot open capsule and cannot separate into its separate components on a same mg basis since aspirin is not available in that strength. Switch to a different antiplatelet medication.

Use: Labeled Indications

Ischemic stroke or transient ischemic attack, noncardioembolic, secondary prevention: Reduction in the risk of stroke in patients who have had transient ischemia of the brain or complete ischemic stroke due to thrombosis (AHA/ASA [Kleindorfer 2021]; manufacturer’s labeling).

Use: Off-Label: Adult

Carotid artery stenosis, symptomatic (including recent carotid endarterectomy); Hemodialysis graft patency

Medication Safety Issues

Sound-alike/look-alike issues:

Aggrenox may be confused with Aggrastat.

Pediatric patients: High-risk medication:

KIDs List: Salicylates, when used in pediatric patients <18 years of age with suspicion of viral illness (influenza, chickenpox), are identified on the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list and should be used with caution due to risk of Reye syndrome (weak recommendation; very low quality of evidence) (PPA [Meyers 2020]).

Metabolism/Transport Effects

Refer to individual components.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Abciximab: Dipyridamole may increase antiplatelet effects of Abciximab. Risk C: Monitor

Abrocitinib: Aspirin may increase antiplatelet effects of Abrocitinib. Management: Do not use aspirin at doses greater than 81 mg/day with abrocitinib during the first 3 months of abrocitinib therapy. The abrocitinib prescribing information lists this combination as contraindicated. Risk D: Consider Therapy Modification

Acalabrutinib: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor

Acetylcholinesterase Inhibitors: Dipyridamole may decrease therapeutic effects of Acetylcholinesterase Inhibitors. Risk C: Monitor

Adenosine: Dipyridamole may increase adverse/toxic effects of Adenosine. Specifically, cardiovascular effects of adenosine may be enhanced. Adenosine dose reduction may be needed. Management: For patients requiring pharmacologic stress testing with adenosine, hold dipyridamole tablets for 48 hours. Hold aspirin/dipyridamole capsules for 24 to 48 hours. For treatment of SVT, monitor for prolonged adenosine effects, consider lower initial doses. Risk D: Consider Therapy Modification

Aducanumab: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor

Agents with Blood Glucose Lowering Effects: Salicylates may increase hypoglycemic effects of Agents with Blood Glucose Lowering Effects. Risk C: Monitor

Ajmaline: Salicylates may increase adverse/toxic effects of Ajmaline. Specifically, the risk for cholestasis may be increased. Risk C: Monitor

Alcohol (Ethyl): May increase adverse/toxic effects of Aspirin. Specifically, alcohol may increase the bleeding risk of aspirin. Alcohol (Ethyl) may decrease therapeutic effects of Aspirin. Specifically, alcohol may interfere with the controlled release mechanism of extended release aspirin. Risk C: Monitor

Alendronate: Aspirin may increase adverse/toxic effects of Alendronate. Specifically, the incidence of upper gastrointestinal adverse events may be increased Risk C: Monitor

Ammonium Chloride: May increase serum concentration of Salicylates. Risk C: Monitor

Anagrelide: May increase antiplatelet effects of Aspirin. Risk C: Monitor

Angiotensin-Converting Enzyme Inhibitors: Salicylates may decrease therapeutic effects of Angiotensin-Converting Enzyme Inhibitors. Salicylates may increase nephrotoxic effects of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor

Anticoagulants (Miscellaneous Agents): Aspirin may increase anticoagulant effects of Anticoagulants (Miscellaneous Agents). Risk C: Monitor

Antiplatelet Agents (P2Y12 Inhibitors): Therapeutic Antiplatelets may increase antiplatelet effects of Antiplatelet Agents (P2Y12 Inhibitors). Risk C: Monitor

Benzbromarone: Salicylates may decrease therapeutic effects of Benzbromarone. Risk C: Monitor

Beta-Blockers: Dipyridamole may increase bradycardic effects of Beta-Blockers. Risk C: Monitor

Calcium Channel Blockers (Nondihydropyridine): May increase antiplatelet effects of Aspirin. Risk C: Monitor

Caplacizumab: May increase antiplatelet effects of Therapeutic Antiplatelets. Management: Avoid this combination if possible. If coadministration is required, monitor closely for bleeding. Interrupt caplacizumab if clinically significant bleeding occurs and administer von Willebrand factor concentrate to rapidly correct hemostasis, if needed. Risk D: Consider Therapy Modification

Carbonic Anhydrase Inhibitors: Salicylates may increase adverse/toxic effects of Carbonic Anhydrase Inhibitors. Salicylate toxicity might be enhanced by this same combination. Management: Avoid these combinations when possible.Dichlorphenamide use with high-dose aspirin as contraindicated. If another combination is used, monitor patients closely for adverse effects. Tachypnea, anorexia, lethargy, and coma have been reported. Risk D: Consider Therapy Modification

Certoparin: Dipyridamole may increase anticoagulant effects of Certoparin. Risk C: Monitor

Cladribine: Inhibitors of Equilibrative Nucleoside (ENT1) and Concentrative Nucleoside (CNT3) Transporters may increase serum concentration of Cladribine. Management: Avoid concomitant use of ENT1 or CNT3 inhibitors during the 4 to 5 day oral cladribine treatment cycles whenever possible. If combined, consider an ENT1 or CNT3 inhibitor dose reduction and separation in the timing of administration. Risk D: Consider Therapy Modification

ClomiPRAMINE: May increase antiplatelet effects of Aspirin. Risk C: Monitor

Collagenase (Systemic): Aspirin may increase adverse/toxic effects of Collagenase (Systemic). Specifically, the risk of injection site bruising and or bleeding may be increased. Risk C: Monitor

Corticosteroids (Systemic): Salicylates may increase adverse/toxic effects of Corticosteroids (Systemic). These specifically include gastrointestinal ulceration and bleeding. Corticosteroids (Systemic) may decrease serum concentration of Salicylates. Withdrawal of corticosteroids may result in salicylate toxicity. Risk C: Monitor

Dasatinib: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor

Deoxycholic Acid: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor

Desirudin: Dipyridamole may increase adverse/toxic effects of Desirudin. Specifically, the risk of bleeding may be increased. Risk C: Monitor

Dexibuprofen: Aspirin may increase adverse/toxic effects of Dexibuprofen. Dexibuprofen may decrease cardioprotective effects of Aspirin. Risk X: Avoid

Dexketoprofen: Salicylates may increase adverse/toxic effects of Dexketoprofen. Dexketoprofen may decrease therapeutic effects of Salicylates. Salicylates may decrease serum concentration of Dexketoprofen. Management: The use of high-dose salicylates (3 g/day or more in adults) together with dexketoprofen is inadvisable. Consider administering dexketoprofen 30-120 min after or at least 8 hrs before cardioprotective doses of aspirin to minimize any possible interaction. Risk X: Avoid

Dipyrone: May decrease antiplatelet effects of Aspirin. Management: Use caution and consider avoiding use of dipyrone in patients treated with aspirin for the treatment or prevention of cardiovascular events or stroke. Risk D: Consider Therapy Modification

Direct Oral Anticoagulants (DOACs): Aspirin may increase anticoagulant effects of Direct Oral Anticoagulants (DOACs). Risk C: Monitor

Donanemab: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor

Enoxaparin: Dipyridamole may increase adverse/toxic effects of Enoxaparin. Specifically, the risk of bleeding may be increased. Management: If possible, discontinue dipyridamole prior to initiating enoxaparin. If coadministration is unavoidable, monitor closely for clinical and laboratory evidence of bleeding. Risk D: Consider Therapy Modification

Fondaparinux: Aspirin may increase anticoagulant effects of Fondaparinux. Management: Discontinue aspirin prior to fondaparinux therapy, if possible. If co-administration is required use caution and monitor for bleeding. Risk D: Consider Therapy Modification

Ginkgo Biloba: May increase anticoagulant effects of Salicylates. Management: Consider alternatives to this combination of agents. Monitor for signs and symptoms of bleeding (especially intracranial bleeding) if salicylates are used in combination with ginkgo biloba. Risk D: Consider Therapy Modification

Glycoprotein IIb/IIIa Inhibitors: Therapeutic Antiplatelets may increase anticoagulant effects of Glycoprotein IIb/IIIa Inhibitors. Risk C: Monitor

Heparin: Dipyridamole may increase adverse/toxic effects of Heparin. Specifically, the risk of bleeding may be increased. Management: Use caution and reduce the dose of heparin or dipyridamole if these agents are combined. Risk D: Consider Therapy Modification

Heparins (Low Molecular Weight): Aspirin may increase anticoagulant effects of Heparins (Low Molecular Weight). Risk C: Monitor

Herbal Products with Anticoagulant/Antiplatelet Effects: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor

Hyaluronidase: Salicylates may decrease therapeutic effects of Hyaluronidase. Risk C: Monitor

Ibritumomab Tiuxetan: Therapeutic Antiplatelets may increase antiplatelet effects of Ibritumomab Tiuxetan. Risk C: Monitor

Ibrutinib: Therapeutic Antiplatelets may increase adverse/toxic effects of Ibrutinib. Specifically, the risks of bleeding and hemorrhage may be increased. Risk C: Monitor

Icosapent Ethyl: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor

Influenza Virus Vaccine (Live/Attenuated): May increase adverse/toxic effects of Salicylates. Specifically, Reye's syndrome may develop. Risk X: Avoid

Inotersen: Therapeutic Antiplatelets may increase adverse/toxic effects of Inotersen. Specifically, the risk of bleeding may be increased. Risk C: Monitor

Ketorolac (Nasal): May increase adverse/toxic effects of Aspirin. An increased risk of bleeding may be associated with use of this combination. Ketorolac (Nasal) may decrease cardioprotective effects of Aspirin. Management: Concurrent use of nasal ketorolac with analgesic doses of aspirin is generally not recommended. If using low-dose, cardioprotective aspirin with nasal ketorolac, monitor the patient closely for evidence of adverse GI effects. Risk D: Consider Therapy Modification

Ketorolac (Systemic): May increase adverse/toxic effects of Aspirin. An increased risk of bleeding may be associated with use of this combination. Ketorolac (Systemic) may decrease cardioprotective effects of Aspirin. Risk X: Avoid

Lecanemab: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor

Limaprost: May increase adverse/toxic effects of Therapeutic Antiplatelets. Specifically, the risk of bleeding may be increased. Risk C: Monitor

Lipid Emulsion (Fish Oil Based): May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor

Loop Diuretics: Salicylates may decrease therapeutic effects of Loop Diuretics. Loop Diuretics may increase serum concentration of Salicylates. Risk C: Monitor

Macimorelin: Coadministration of Aspirin and Macimorelin may alter diagnostic results. Risk X: Avoid

Methotrexate: Salicylates may increase serum concentration of Methotrexate. Salicylate doses used for prophylaxis of cardiovascular events are not likely to be of concern. Management: Consider avoiding coadministration of methotrexate and salicylates. If coadministration cannot be avoided, monitor for increased toxic effects of methotrexate. Salicylate doses used for prophylaxis of cardiovascular events are not likely to be of concern. Risk D: Consider Therapy Modification

Miscellaneous Antiplatelets: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor

Multivitamins/Fluoride (with ADE): May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor

Multivitamins/Minerals (with ADEK, Folate, Iron): May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor

Multivitamins/Minerals (with AE, No Iron): May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor

Nicorandil: Aspirin may increase adverse/toxic effects of Nicorandil. Specifically, the risk of gastrointestinal ulceration and hemorrhage may be increased. Risk C: Monitor

Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective): Aspirin may increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective). Specifically, the risk of gastrointestinal adverse effects may be increased. Management: Concurrent use of aspirin at doses beyond cardioprotective levels is not recommended. While concurrent use of low-dose aspirin with a COX-2 inhibitor is permissible, patients should be monitored closely for signs/symptoms of GI ulceration/bleeding. Risk D: Consider Therapy Modification

Nonsteroidal Anti-Inflammatory Agents (Nonselective): May decrease therapeutic effects of Aspirin. Aspirin may increase adverse/toxic effects of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Specifically, the risk for bleeding may be increased. Aspirin may decrease serum concentration of Nonsteroidal Anti-Inflammatory Agents (Nonselective). Management: In general, avoid regular, frequent use of NSAIDs with aspirin whenever possible. If combined, monitor for increased bleeding and a reduced cardioprotective effect of aspirin. Risk D: Consider Therapy Modification

Nonsteroidal Anti-Inflammatory Agents (Topical): May increase adverse/toxic effects of Salicylates. Specifically, the risk of gastrointestinal (GI) toxicity is increased. Management: Coadministration of salicylates and topical NSAIDs is not recommended. If salicylates and topical NSAIDs are coadministered, ensure the benefits outweigh the risks and monitor for increased NSAID toxicities. Risk D: Consider Therapy Modification

Obinutuzumab: Therapeutic Antiplatelets may increase adverse/toxic effects of Obinutuzumab. Specifically, the risk of bleeding may be increased. Management: Consider avoiding coadministration of obinutuzumab and therapeutic antiplatelets, especially during the first cycle of obinutuzumab therapy. Risk D: Consider Therapy Modification

Omacetaxine: Aspirin may increase adverse/toxic effects of Omacetaxine. Specifically, the risk for bleeding-related events may be increased. Management: Avoid concurrent use of aspirin with omacetaxine in patients with a platelet count of less than 50,000/uL. Risk X: Avoid

Omega-3 Fatty Acids: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor

Pentosan Polysulfate Sodium: Therapeutic Antiplatelets may increase adverse/toxic effects of Pentosan Polysulfate Sodium. Specifically, the risk of hemorrhage may be increased. Risk C: Monitor

Phenindione: Dipyridamole may increase adverse/toxic effects of Phenindione. Specifically, the risk of bleeding may be increased. Management: Avoid coadministration of dipyridamole and phenindione if possible. If coadministration is required, monitor closely for clinical and laboratory evidence of bleeding. Risk D: Consider Therapy Modification

Pirtobrutinib: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor

Potassium Phosphate: May increase serum concentration of Salicylates. Risk C: Monitor

PRALAtrexate: Salicylates may increase serum concentration of PRALAtrexate. Salicylate doses used for prophylaxis of cardiovascular events are unlikely to be of concern. Management: Consider avoiding concomitant use of salicylates and pralatrexate. If coadministered, monitor for increased pralatrexate adverse effects. Salicylate doses used for prophylaxis of cardiovascular events are not likely to be of concern. Risk D: Consider Therapy Modification

Probenecid: Salicylates may decrease therapeutic effects of Probenecid. Salicylates may increase serum concentration of Probenecid. Probenecid may increase serum concentration of Salicylates. Risk X: Avoid

Regadenoson: Dipyridamole may increase adverse/toxic effects of Regadenoson. Specifically, adenosine mediated effects may be enhanced. Management: Avoid dipyridamole for 48 hours prior to the administration of regadenoson when possible. Risk D: Consider Therapy Modification

Riociguat: Dipyridamole may increase hypotensive effects of Riociguat. Risk X: Avoid

Salicylates: May increase anticoagulant effects of Salicylates. Risk C: Monitor

Selective Serotonin Reuptake Inhibitor: May increase antiplatelet effects of Aspirin. Risk C: Monitor

Selumetinib: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor

Serotonin/Norepinephrine Reuptake Inhibitor: May increase antiplatelet effects of Aspirin. Risk C: Monitor

Sincalide: Drugs that Affect Gallbladder Function may decrease therapeutic effects of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction. Risk D: Consider Therapy Modification

Spironolactone: Aspirin may decrease therapeutic effects of Spironolactone. Risk C: Monitor

Sucroferric Oxyhydroxide: May decrease serum concentration of Aspirin. Management: Administer aspirin at least 1 hour before administration of sucroferric oxyhydroxide. Risk D: Consider Therapy Modification

Sulfinpyrazone: Salicylates may decrease serum concentration of Sulfinpyrazone. Risk X: Avoid

Talniflumate: Aspirin may increase adverse/toxic effects of Talniflumate. Management: When possible, consider alternatives to this combination. Concurrent use is generally not recommended. Risk D: Consider Therapy Modification

Thiopental: Aspirin may decrease protein binding of Thiopental. Risk C: Monitor

Thrombolytic Agents: Therapeutic Antiplatelets may increase adverse/toxic effects of Thrombolytic Agents. Specifically, the risk of bleeding may be increased. Risk C: Monitor

Ticagrelor: Aspirin may increase antiplatelet effects of Ticagrelor. Aspirin may decrease therapeutic effects of Ticagrelor. More specifically, the benefits of ticagrelor relative to clopidogrel may be diminished in adult patients receiving daily aspirin doses greater than 100-150 mg daily. Management: Avoid maintenance aspirin doses greater than 150 mg/day in patients receiving ticagrelor. After any initial dose, only low-dose aspirin (75 to 100 mg/day) is recommended. Risk D: Consider Therapy Modification

Tinzaparin: Dipyridamole may increase adverse/toxic effects of Tinzaparin. Specifically, the risk of bleeding may be increased. Risk C: Monitor

Tipranavir: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor

Valproic Acid and Derivatives: Salicylates may increase serum concentration of Valproic Acid and Derivatives. Risk C: Monitor

Varicella Virus-Containing Vaccines: Salicylates may increase adverse/toxic effects of Varicella Virus-Containing Vaccines. Specifically, the risk for Reye's syndrome may increase. Risk X: Avoid

Vitamin E (Systemic): May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor

Vitamin K Antagonists: Aspirin may increase anticoagulant effects of Vitamin K Antagonists. Risk C: Monitor

Volanesorsen: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor

Zanubrutinib: May increase antiplatelet effects of Therapeutic Antiplatelets. Risk C: Monitor

Pregnancy Considerations

Refer to individual monographs

Breastfeeding Considerations

Aspirin and dipyridamole are present in breast milk.

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother. Refer to individual monographs.

Monitoring Parameters

Signs and symptoms of GI ulcers and bleeding; signs or symptoms of stroke or transient ischemic attack in patients taking concomitant aspirin therapy for cardiac indications.

Mechanism of Action

The antithrombotic action results from additive antiplatelet effects. Dipyridamole inhibits the uptake of adenosine into platelets, endothelial cells, and erythrocytes. Aspirin inhibits platelet aggregation by irreversible inhibition of platelet cyclooxygenase and thus inhibits the generation of thromboxane A₂.

Pharmacokinetics (Adult Data Unless Noted)

See individual agents.

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AE) United Arab Emirates: Aggrenox;
(AR) Argentina: Agrenox | Asasantin;
(AT) Austria: Asasantin | Thrombosantin;
(AU) Australia: Apo dipyridamole/aspirin | Asasantin | Diasp SR;
(BD) Bangladesh: Aggreno;
(BE) Belgium: Aggrenox;
(BR) Brazil: Persantin s;
(CH) Switzerland: Asasantin;
(CN) China: De li shu;
(CO) Colombia: Aggrenox | Asasantin;
(CZ) Czech Republic: Aggrenox;
(DE) Germany: Aggrenox | Asasantin | Dipyridamol Ass;
(EE) Estonia: Asasantin;
(EG) Egypt: Persantin plus;
(ES) Spain: Asasantin;
(FI) Finland: Asasantin;
(FR) France: Asasantine;
(GB) United Kingdom: Asasantin;
(GR) Greece: Aggrenox;
(HK) Hong Kong: Aggrenox | Persantin plus;
(HR) Croatia: Aggrenox;
(HU) Hungary: Asasantin;
(ID) Indonesia: Aggrenox;
(IE) Ireland: Asasantin;
(IT) Italy: Aggrenox;
(KR) Korea, Republic of: Asasantin | Dipyrin er;
(KW) Kuwait: Aggrenox;
(LT) Lithuania: Aggrenox;
(LU) Luxembourg: Aggrenox;
(MX) Mexico: Aggrenox | Asasantin | Dipiridamol + Acido Acetilsalicilico Biomep;
(NL) Netherlands: Asasantin;
(NO) Norway: Asasantin;
(PH) Philippines: Aggrenox;
(PR) Puerto Rico: Aggrenox | Aspirin and dipyridamole | Aspirin and extended release dipyridamole;
(PT) Portugal: Aggrenox;
(QA) Qatar: Aggrenox;
(RO) Romania: Aggrenox;
(SE) Sweden: Asasantin;
(SI) Slovenia: Asasantin;
(TH) Thailand: Aggrenox | Persantin plus;
(TW) Taiwan: Aggrenox;
(UY) Uruguay: Asasantin;
(ZA) South Africa: Asasantin

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Aggrenox (aspirin/dipyridamole ER) [product monograph]. Burlington, Ontario: Boehringer Ingelheim (Canada) Ltd; August 2015.
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Aspirin and extended-release dipyridamole: Drug information