dipyridamole

CLINICAL USE

Calcium-channel blocker:Prophylaxis and treatment of angina Hypertension

DOSE IN NORMAL RENAL FUNCTION

180–500 mg in up to 3 divided doses

PHARMACOKINETICS

Molecular weight :451

%Protein binding :80–85

%Excreted unchanged in urine : 5

Volume of distribution (L/kg) :3–8

half-life – normal/ESRD (hrs) :2–11; SR: 5–8/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Dose as in normal renal function

10 to 20 : Dose as in normal renal function

<10 : Dose as in normal renal function

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Not dialysed. Dose as in normal renal function

HD :Not dialysed. Dose as in normal renal function

HDF/high flux :Not dialysed. Dose as in normal renal function

CAV/VVHD :Not dialysed. Dose as in normal renal function

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugsAnaesthetics: enhanced hypotensive effect Anti-arrhythmics: increased risk of bradycardia, AV block and myocardial depression with amiodaroneAntibacterials: metabolism increased by rifampicinAnti-epileptics: effect probably reduced by barbiturates, phenytoin, and primidone; enhanced effect of carbamazepine; increased levels of phenytoinAntihypertensives: enhanced hypotensive effect; increased risk of first dose hypotensive effect of post-synaptic alpha-blockersAntivirals: concentration increased by amprenavir, atazanavir and ritonavir – reduce dose of diltiazem with atazanavir; concentration reduced by efavirenzBeta-blockers: risk of bradycardia and AV block if co-prescribed with beta-blockersCardiac glycosides: increased digoxin concentrationCiclosporin: increased ciclosporin concentrationsCilostazol: increased cilostazol concentration – avoid concomitant useIvabradine: avoid concomitant use Sirolimus: sirolimus concentration increasedStatins: increased myopathy with simvastatin. Do not exceed 40 mg of simvastatin with diltiazem.1Tacrolimus: increased tacrolimus concentrationTheophylline: enhanced effect of theophylline

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

Active metabolites Monitor heart rate early on in therapy. If falls below 50 beats/minute, do not increase dose Maintain patient on same brand

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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