Interactions : אינטראקציות

4.5 Interaction with other medicinal products and other forms of interaction
Dipyridamole may:

•   increase the plasma levels and therefore the cardiovascular effects of adenosine (this may necess- itate adjustment of the adenosine dose);
•   abolish the anticholinesterase effect of cholinesterase inhibitors, thereby potentially aggravating myasthenia gravis;
•   increase the blood pressure-lowering effect of antihypertensives.

If dipyridamole is used concomitantly with medications affecting coagulation, such as anticoagulants and antiplatelet agents, the safety profile of these medications must be monitored.

When dipyridamole was administered in combination with warfarin (a coumarin derivative), bleeding was no greater in frequency or severity than when warfarin was administered alone.

The ASA component of Aggrenox can increase the effect of the following, leading to an increased risk of undesirable effects:

•   anticoagulants such as coumarin derivatives and heparin
•   antiplatelet agents such as clopidogrel, ticlopidine and ASA
•   antidiabetic agents such as sulphonylureas (blood glucose levels may fall)
•   methotrexate (toxicity may be increased)
•   valproic acid and phenytoin
•   SSRIs (increased risk of bleeding)
•   systemic corticosteroids, with the exception of hydrocortisone as replacement therapy in Addis- on's disease, or alcohol (increased risk of gastrointestinal ulcers and gastrointestinal bleeding)
•   NSAIDs, corticosteroids and chronic alcohol use (increased risk of undesirable gastrointestinal effects)
•   digoxin (increased plasma levels).

Dipyridamole may decrease the effects of:

•   aldosterone antagonists (spironolactone and canrenoate)
•   loop diuretics such as furosemide
•   antihypertensives, particularly ACE inhibitors
•   uricosuric agents such as probenecid or sulphinpyrazone.

The desired cardiovascular effects of ASA may be decreased by ibuprofen (though not by other NSAIDs or paracetamol).

Combining dipyridamole with ASA does not increase the bleeding risk.