dipyridamole (Rx)

Thromboembolism Prophylaxis Post-Cardiac Valve Replacement

75-100 mg PO q6hr as adjunct to warfarin

Adjunct to Thallium Myocardial Perfusion Imaging (Off-label)

Adjusted according to body weight; recommended 0.142 mg/kg/min IV infusion over 4 minutes; not to exceed 60 mg

Other Indications & Uses

Prevention of MI recurrence (in combo with aspirin): No benefit over aspirin alone

See also combo with aspirin

Off-label Use

3-6 mg/kg/day PO divided q6-8hr

Avoid short-acting products; causes orthostatic hypotensio and more effective alternatives available; IV form acceptable for cardiac stress testing (Beers criteria)

Thromboembolism prophylaxis post-cardiac valve replacement

75-100 mg PO q6hr as adjunct to warfarin

Adjunct to thallium myocardial perfusion imaging (Off-label)

Adjusted according to body weight; recommended 0.142 mg/kg/min IV infusion over 4 minutes; no more than 60 mg

Contraindicated (3)

• abrocitinib

  abrocitinib and dipyridamole both increase anticoagulation. Contraindicated. Antiplatelet drugs, except for low-dose aspirin (=81 mg qDay), during the first 3 months of treatment are contraindicated.

• riociguat

  dipyridamole, riociguat. Either increases effects of the other by additive vasodilation. Contraindicated. Coadministration of nonspecific PDE-5 inhibitors (eg, dipyridamole, theophylline) and guanylate cyclase stimulators (eg, riociguat) is contraindicated due to risk of additive hypotension.

• theophylline

  theophylline decreases effects of dipyridamole by pharmacodynamic antagonism. Contraindicated. May produce false negative results in dipyridamole thallium imaging tests. Separate by 24 hr.

Serious - Use Alternative (28)

• afatinib

  dipyridamole increases levels of afatinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Reduce afatinib daily dose by 10 mg if not tolerated when coadministered with P-gp inhibitors.

• alpelisib

  dipyridamole will increase the level or effect of alpelisib by Other (see comment). Avoid or Use Alternate Drug. Coadministration of alpelisib (BCRP substrate) with a BCRP inhibitor may increase alpelisib concentration, which may increase the risk of toxicities. If unable to avoid or use alternant drugs, closely monitor for increased adverse reactions.

• antithrombin alfa

  antithrombin alfa, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

• antithrombin III

  antithrombin III, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

• apixaban

  dipyridamole and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

• argatroban

  argatroban, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

• aspirin rectal

  aspirin rectal increases effects of dipyridamole by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

• bivalirudin

  bivalirudin, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

• bosutinib

  dipyridamole increases levels of bosutinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• butalbital

  butalbital decreases levels of dipyridamole by increasing metabolism. Contraindicated.

• caffeine

  caffeine decreases effects of dipyridamole by pharmacodynamic antagonism. Contraindicated.

• caplacizumab

  caplacizumab, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug.

• dalteparin

  dalteparin, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

• darolutamide

  darolutamide will increase the level or effect of dipyridamole by Other (see comment). Avoid or Use Alternate Drug. Darolutamide is a BCRP inhibitor. Avoid coadministration with BCRP inhibitors. If use is unavoidable, closely monitor for adverse reactions and consider dose reduction of BCRP substrate drug (refer BCRP substrate prescribing information).

• edoxaban

  dipyridamole will increase the level or effect of edoxaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Dose adjustment may be required with strong P-gp inhibitors. DVT/PE treatment: Decrease dose to 30 mg PO once daily. NVAF: No dose reduction recommended

• enoxaparin

  enoxaparin, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

• fondaparinux

  fondaparinux, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

• heparin

  heparin, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

• lasmiditan

  lasmiditan increases levels of dipyridamole by Other (see comment). Avoid or Use Alternate Drug. Comment: Lasmiditan inhibits BCRP in vitro. Avoid coadministration of lasmiditan with BCRP substrates.

• ozanimod

  dipyridamole increases toxicity of ozanimod by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of ozanimod (a BCRP substrate) with BCRP inhibitors increases the exposure of the minor (RP101988, RP101075) and major active metabolites (CC112273, CC1084037) of ozanimod, which may increase the risk of ozanimod adverse reactions. .

• pomalidomide

  dipyridamole increases levels of pomalidomide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• protamine

  protamine, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

• regadenoson

  dipyridamole, regadenoson. Mechanism: unspecified interaction mechanism. Contraindicated. Regadenoson's effects may be changed; mfr. recommends avoiding dipyridamole for 2 days prior to administration.

• rimegepant

  dipyridamole will increase the level or effect of rimegepant by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of rimegepant (a BCRP substrate) with inhibitors of BCRP.

• riociguat

  dipyridamole will increase the level or effect of riociguat by decreasing metabolism. Avoid or Use Alternate Drug. Coadministration of riociguat (substrate of CYP isoenzymes 1A1, 2C8, 3A, 2J2) with strong CYP inhibitors may require a decreased initial dose of 0.5 mg PO TID; monitor for signs of hypotension and reduce dose if needed
  
  dipyridamole will increase the level or effect of riociguat by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Coadministration of riociguat (P-gp substrate) with strong P-gp inhibitors may require a decreased initial dose of 0.5 mg PO TID; monitor for signs of hypotension and reduce dose if needed

• talazoparib

  dipyridamole will increase the level or effect of talazoparib by Other (see comment). Avoid or Use Alternate Drug. BCRP inhibitors may increase systemic exposure of talazoparib (a BCRP substrate). If coadministration cannot be avoided, monitor for potential adverse reactions.

• topotecan

  dipyridamole will increase the level or effect of topotecan by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Product labeling for PO topotecan recommends avoiding concomitant use of P-gp inhibitors; the interaction with IV topotecan may be less severe but is still likely of clinical significance

• venetoclax

  dipyridamole will increase the level or effect of venetoclax by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If a P-gp inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.

Monitor Closely (47)

• acalabrutinib

  acalabrutinib increases effects of dipyridamole by anticoagulation. Modify Therapy/Monitor Closely. Coadministration of acalabrutinib with antiplatelets or anticoagulants may further increase risk of hemorrhage. Monitor for signs of bleeding and consider the benefit-risk of withholding acalabrutinib for 3-7 days presurgery and postsurgery depending upon the type of surgery and the risk of bleeding.
  
  acalabrutinib increases levels of dipyridamole by Other (see comment). Use Caution/Monitor. Comment: Acalabrutinib may increase exposure to coadministered BCRP substrates by inhibition of intestinal BCRP.

• adenosine

  dipyridamole increases levels of adenosine by decreasing metabolism. Use Caution/Monitor.

• apalutamide

  apalutamide will decrease the level or effect of dipyridamole by increasing elimination. Use Caution/Monitor. Apalutamide weakly induces BCRP and may decrease systemic exposure of drugs that are BCRP substrates.

• aspirin

  aspirin, dipyridamole. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• aspirin/citric acid/sodium bicarbonate

  aspirin/citric acid/sodium bicarbonate, dipyridamole. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• azficel-T

  azficel-T, dipyridamole. Other (see comment). Use Caution/Monitor. Comment: Coadministration with anticoagulants or antiplatelets may increase bruising or bleeding at biopsy and/or injection sites; concomitant use not recommended. Decisions regarding continued use or cessation of anticoagulants or antiplatelets should be made by a physician.

• berotralstat

  dipyridamole increases levels of berotralstat by Other (see comment). Modify Therapy/Monitor Closely. Comment: Reduced dose of berotralstat (a BCRP substrate) to 110 mg/day when coadministered with BCRP inhibitors.

• betrixaban

  dipyridamole increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.
  
  dipyridamole, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

• ceritinib

  dipyridamole increases levels of ceritinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• cholic acid

  dipyridamole increases toxicity of cholic acid by decreasing elimination. Modify Therapy/Monitor Closely. Avoid concomitant use of inhibitors of the bile salt efflux pump (BSEP). May exacerbate accumulation of conjugated bile salts in the liver and result in clinical symptoms. If concomitant use is necessary, monitor serum transaminases and bilirubin.

• citalopram

  citalopram increases effects of dipyridamole by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• dabigatran

  dabigatran, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.
  
  dipyridamole will increase the level or effect of dabigatran by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Atrial fibrillation: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <30 mL/min. DVT/PE treatment: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <50 mL/min

• deferasirox

  deferasirox, dipyridamole. Other (see comment). Use Caution/Monitor. Comment: Gastric ulceration and GI bleeding have been reported in patients taking deferasirox, use caution when coadministering with other drugs known to increase the risk of peptic ulcers or gastric hemorrhage including anticoagulants.

• duvelisib

  dipyridamole will increase the level or effect of duvelisib by Other (see comment). Use Caution/Monitor. Coadministration of duvelisib (a BCRP substrate) with a BCRP transport inhibitor may increase levels or effects of duvelisib.

• edoxaban

  edoxaban, dipyridamole. Either increases toxicity of the other by anticoagulation. Modify Therapy/Monitor Closely. Both drugs have the potential to cause bleeding. The need for simultaneous use of platelet aggregation inhibitors with anticoagulants is common for patients with cardiovascular disease, but may result in increased bleeding; monitor closely. Promptly evaluate any signs or symptoms of blood loss.

• eluxadoline

  eluxadoline increases levels of dipyridamole by decreasing metabolism. Use Caution/Monitor. Eluxadoline may increase the systemic exposure of coadministered BCRP substrates.

• encorafenib

  encorafenib will increase the level or effect of dipyridamole by Other (see comment). Modify Therapy/Monitor Closely. Encorafenib (a BCRP inhibitor) may increase the concentration and toxicities of BCRP substrates. Closely monitor for signs and symptoms of increased exposure and consider adjusting the dose of these substrates.

• fish oil

  fish oil, dipyridamole. Other (see comment). Use Caution/Monitor. Comment: Patients taking fish oil and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

• fish oil triglycerides

  fish oil triglycerides will increase the level or effect of dipyridamole by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

• fostemsavir

  fostemsavir will increase the level or effect of dipyridamole by Other (see comment). Modify Therapy/Monitor Closely. Fostemsavir inhibits BCRP transporters. If possible, avoid coadministration or modify dose of BCRP substrate coadministered with fostemsavir.

• glecaprevir/pibrentasvir

  dipyridamole will increase the level or effect of glecaprevir/pibrentasvir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  dipyridamole will increase the level or effect of glecaprevir/pibrentasvir by decreasing metabolism. Use Caution/Monitor. Caution when coadministering glecaprevir/pibrentasvir with BCRP inhibitors.
  
  glecaprevir/pibrentasvir will increase the level or effect of dipyridamole by decreasing metabolism. Use Caution/Monitor. Glecaprevir/pibrentasvir may increase plasma concentration of BCRP substrates.

• green tea

  green tea increases effects of dipyridamole by pharmacodynamic synergism. Use Caution/Monitor. (Theoretical interaction). Dipyridamole is a platelet inhibitor and green tea has demonstrated antiplatelet effects in animals, it may be prudent to avoid the concomitant use of green tea with chronic dipyridamole therapy as the risk of bleeding may be increased.

• ibrutinib

  ibrutinib will increase the level or effect of dipyridamole by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.

• icosapent

  icosapent, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time; monitor periodically if coadministered with other drugs that affect bleeding.

• melatonin

  melatonin increases effects of dipyridamole by anticoagulation. Use Caution/Monitor. Melatonin may decrease prothrombin time.

• naldemedine

  dipyridamole increases levels of naldemedine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with P-gp inhibitors.

• nintedanib

  dipyridamole increases levels of nintedanib by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. If nintedanib adverse effects occur, management may require interruption, dose reduction, or discontinuation of therapy .

• omega 3 carboxylic acids

  omega 3 carboxylic acids, dipyridamole. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3 acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

• omega 3 fatty acids

  omega 3 fatty acids, dipyridamole. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3-fatty acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

• oteseconazole

  oteseconazole will increase the level or effect of dipyridamole by Other (see comment). Modify Therapy/Monitor Closely. Otesezonale, a BCRP inhibitor, may increase the effects and risk of toxicities of BCRP substrates. Use lowest starting dose of BCRP substrate, or consider reducing BCRP substrate dose.

• piracetam

  piracetam increases effects of dipyridamole by pharmacodynamic synergism. Use Caution/Monitor.

• ponatinib

  ponatinib increases levels of dipyridamole by Other (see comment). Use Caution/Monitor.

• porfimer

  dipyridamole decreases effects of porfimer by pharmacodynamic antagonism. Use Caution/Monitor.

• regorafenib

  regorafenib will increase the level or effect of dipyridamole by Other (see comment). Modify Therapy/Monitor Closely. Regorafenib likely inhibits BCRP (ABCG2) transport. Coadministration with a BCRP substrate may increase systemic exposure to the substrate and related toxicity.

• rifaximin

  dipyridamole increases levels of rifaximin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• rivaroxaban

  rivaroxaban, dipyridamole. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Avoid concurrent use of rivaroxaban with other anticoagulants due to increased bleeding risk other than during therapeutic transition periods where patients should be observed closely. Monitor for signs/symptoms of blood loss.

• safinamide

  safinamide will increase the level or effect of dipyridamole by Other (see comment). Use Caution/Monitor. Safinamide and its major metabolite may inhibit intestinal BCRP. Monitor BCRP substrates for increased pharmacologic or adverse effects.

• selexipag

  dipyridamole will increase the level or effect of selexipag by Other (see comment). Use Caution/Monitor. Selexipag is a ABCG2 (BCRP) substrate. Monitor selexipag for increased pharmacologic or adverse effects when coadministered with ABCG2 (BCRP) inhibitors.

• selumetinib

  dipyridamole and selumetinib both increase anticoagulation. Modify Therapy/Monitor Closely. An increased risk of bleeding may occur in patients taking a vitamin-K antagonist or an antiplatelet agent with selumetinib. Monitor for bleeding and INR or PT in patients coadministered a vitamin-K antagonist or an antiplatelet agent with selumetinib.

• sofosbuvir/velpatasvir

  sofosbuvir/velpatasvir will increase the level or effect of dipyridamole by Other (see comment). Use Caution/Monitor. Velpatasvir is an inhibitor of the drug transporter BCRP. Coadministration may increase systemic exposure of drugs that are BCRP substrates.

• stiripentol

  stiripentol will increase the level or effect of dipyridamole by Other (see comment). Modify Therapy/Monitor Closely. Stiripentol is a BCRP transport inhibitor. Consider dosage reduction for BCRP substrates if adverse effects are experienced when coadministered.

• tafamidis

  tafamidis will increase the level or effect of dipyridamole by Other (see comment). Use Caution/Monitor. Tafamidis inhibits breast cancer resistant protein (BCRP) in vitro and may increase exposure of BCRP substrates following tafamidis or tafamidis meglumine administration. Dosage adjustment of these BCRP substrates may be necessary.

• tafamidis meglumine

  tafamidis meglumine will increase the level or effect of dipyridamole by Other (see comment). Use Caution/Monitor. Tafamidis inhibits breast cancer resistant protein (BCRP) in vitro and may increase exposure of BCRP substrates following tafamidis or tafamidis meglumine administration. Dosage adjustment of these BCRP substrates may be necessary.

• ticagrelor

  ticagrelor, dipyridamole. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Increased risk of bleeding during concomitant use of medications that increase potential for bleeding.

• vorapaxar

  dipyridamole, vorapaxar. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Coadministration of anticoagulants, antiplatelets, or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

• vortioxetine

  dipyridamole increases effects of vortioxetine by anticoagulation. Use Caution/Monitor.

• warfarin

  dipyridamole, warfarin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Drugs with antiplatelet properties may increase anticoagulation effect of warfarin.

Minor (21)

• acebutolol

  dipyridamole, acebutolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• atenolol

  dipyridamole, atenolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• betaxolol

  dipyridamole, betaxolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• bisoprolol

  dipyridamole, bisoprolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• carvedilol

  dipyridamole, carvedilol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• celiprolol

  dipyridamole, celiprolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• devil's claw

  devil's claw, dipyridamole. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence.ÿ Use with caution.

• esmolol

  dipyridamole, esmolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• ginger

  ginger, dipyridamole. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence. Use with caution.

• ginkgo biloba

  ginkgo biloba, dipyridamole. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence.ÿ Use with caution.

• horse chestnut seed

  horse chestnut seed, dipyridamole. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Theoretical. Use with caution.

• labetalol

  dipyridamole, labetalol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• metoprolol

  dipyridamole, metoprolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• nadolol

  dipyridamole, nadolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• nebivolol

  dipyridamole, nebivolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• penbutolol

  dipyridamole, penbutolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• pindolol

  dipyridamole, pindolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• propranolol

  dipyridamole, propranolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• sotalol

  dipyridamole, sotalol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• timolol

  dipyridamole, timolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• verteporfin

  dipyridamole decreases effects of verteporfin by pharmacodynamic antagonism. Minor/Significance Unknown.

• abrocitinib

  Contraindicated (1)abrocitinib and dipyridamole both increase anticoagulation. Contraindicated. Antiplatelet drugs, except for low-dose aspirin (=81 mg qDay), during the first 3 months of treatment are contraindicated.

• acalabrutinib

  Monitor Closely (2)acalabrutinib increases levels of dipyridamole by Other (see comment). Use Caution/Monitor. Comment: Acalabrutinib may increase exposure to coadministered BCRP substrates by inhibition of intestinal BCRP.
  
  acalabrutinib increases effects of dipyridamole by anticoagulation. Modify Therapy/Monitor Closely. Coadministration of acalabrutinib with antiplatelets or anticoagulants may further increase risk of hemorrhage. Monitor for signs of bleeding and consider the benefit-risk of withholding acalabrutinib for 3-7 days presurgery and postsurgery depending upon the type of surgery and the risk of bleeding.

• acebutolol

  Minor (1)dipyridamole, acebutolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• adenosine

  Monitor Closely (1)dipyridamole increases levels of adenosine by decreasing metabolism. Use Caution/Monitor.

• afatinib

  Serious - Use Alternative (1)dipyridamole increases levels of afatinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Reduce afatinib daily dose by 10 mg if not tolerated when coadministered with P-gp inhibitors.

• alpelisib

  Serious - Use Alternative (1)dipyridamole will increase the level or effect of alpelisib by Other (see comment). Avoid or Use Alternate Drug. Coadministration of alpelisib (BCRP substrate) with a BCRP inhibitor may increase alpelisib concentration, which may increase the risk of toxicities. If unable to avoid or use alternant drugs, closely monitor for increased adverse reactions.

• antithrombin alfa

  Serious - Use Alternative (1)antithrombin alfa, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

• antithrombin III

  Serious - Use Alternative (1)antithrombin III, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

• apalutamide

  Monitor Closely (1)apalutamide will decrease the level or effect of dipyridamole by increasing elimination. Use Caution/Monitor. Apalutamide weakly induces BCRP and may decrease systemic exposure of drugs that are BCRP substrates.

• apixaban

  Serious - Use Alternative (1)dipyridamole and apixaban both increase anticoagulation. Avoid or Use Alternate Drug.

• argatroban

  Serious - Use Alternative (1)argatroban, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

• aspirin

  Monitor Closely (1)aspirin, dipyridamole. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• aspirin rectal

  Serious - Use Alternative (1)aspirin rectal increases effects of dipyridamole by pharmacodynamic synergism. Avoid or Use Alternate Drug. Enhanced risk of hemorrhage.

• aspirin/citric acid/sodium bicarbonate

  Monitor Closely (1)aspirin/citric acid/sodium bicarbonate, dipyridamole. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. The need for simultaneous use of low-dose aspirin and anticoagulant or antiplatelet agents are common for patients with cardiovascular disease; monitor closely.

• atenolol

  Minor (1)dipyridamole, atenolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• azficel-T

  Monitor Closely (1)azficel-T, dipyridamole. Other (see comment). Use Caution/Monitor. Comment: Coadministration with anticoagulants or antiplatelets may increase bruising or bleeding at biopsy and/or injection sites; concomitant use not recommended. Decisions regarding continued use or cessation of anticoagulants or antiplatelets should be made by a physician.

• berotralstat

  Monitor Closely (1)dipyridamole increases levels of berotralstat by Other (see comment). Modify Therapy/Monitor Closely. Comment: Reduced dose of berotralstat (a BCRP substrate) to 110 mg/day when coadministered with BCRP inhibitors.

• betaxolol

  Minor (1)dipyridamole, betaxolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• betrixaban

  Monitor Closely (2)dipyridamole increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.
  
  dipyridamole, betrixaban. Either increases levels of the other by anticoagulation. Use Caution/Monitor.

• bisoprolol

  Minor (1)dipyridamole, bisoprolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• bivalirudin

  Serious - Use Alternative (1)bivalirudin, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

• bosutinib

  Serious - Use Alternative (1)dipyridamole increases levels of bosutinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• butalbital

  Serious - Use Alternative (1)butalbital decreases levels of dipyridamole by increasing metabolism. Contraindicated.

• caffeine

  Serious - Use Alternative (1)caffeine decreases effects of dipyridamole by pharmacodynamic antagonism. Contraindicated.

• caplacizumab

  Serious - Use Alternative (1)caplacizumab, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug.

• carvedilol

  Minor (1)dipyridamole, carvedilol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• celiprolol

  Minor (1)dipyridamole, celiprolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• ceritinib

  Monitor Closely (1)dipyridamole increases levels of ceritinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• cholic acid

  Monitor Closely (1)dipyridamole increases toxicity of cholic acid by decreasing elimination. Modify Therapy/Monitor Closely. Avoid concomitant use of inhibitors of the bile salt efflux pump (BSEP). May exacerbate accumulation of conjugated bile salts in the liver and result in clinical symptoms. If concomitant use is necessary, monitor serum transaminases and bilirubin.

• citalopram

  Monitor Closely (1)citalopram increases effects of dipyridamole by pharmacodynamic synergism. Use Caution/Monitor. Combination may increase risk of bleeding.

• dabigatran

  Monitor Closely (2)dabigatran, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs have the potential to cause bleeding. Concomitant use may increase risk of bleeding.
  
  dipyridamole will increase the level or effect of dabigatran by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Atrial fibrillation: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <30 mL/min. DVT/PE treatment: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <50 mL/min

• dalteparin

  Serious - Use Alternative (1)dalteparin, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

• darolutamide

  Serious - Use Alternative (1)darolutamide will increase the level or effect of dipyridamole by Other (see comment). Avoid or Use Alternate Drug. Darolutamide is a BCRP inhibitor. Avoid coadministration with BCRP inhibitors. If use is unavoidable, closely monitor for adverse reactions and consider dose reduction of BCRP substrate drug (refer BCRP substrate prescribing information).

• deferasirox

  Monitor Closely (1)deferasirox, dipyridamole. Other (see comment). Use Caution/Monitor. Comment: Gastric ulceration and GI bleeding have been reported in patients taking deferasirox, use caution when coadministering with other drugs known to increase the risk of peptic ulcers or gastric hemorrhage including anticoagulants.

• devil's claw

  Minor (1)devil's claw, dipyridamole. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence.ÿ Use with caution.

• duvelisib

  Monitor Closely (1)dipyridamole will increase the level or effect of duvelisib by Other (see comment). Use Caution/Monitor. Coadministration of duvelisib (a BCRP substrate) with a BCRP transport inhibitor may increase levels or effects of duvelisib.

• edoxaban

  Monitor Closely (1)edoxaban, dipyridamole. Either increases toxicity of the other by anticoagulation. Modify Therapy/Monitor Closely. Both drugs have the potential to cause bleeding. The need for simultaneous use of platelet aggregation inhibitors with anticoagulants is common for patients with cardiovascular disease, but may result in increased bleeding; monitor closely. Promptly evaluate any signs or symptoms of blood loss.Serious - Use Alternative (1)dipyridamole will increase the level or effect of edoxaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Dose adjustment may be required with strong P-gp inhibitors. DVT/PE treatment: Decrease dose to 30 mg PO once daily. NVAF: No dose reduction recommended

• eluxadoline

  Monitor Closely (1)eluxadoline increases levels of dipyridamole by decreasing metabolism. Use Caution/Monitor. Eluxadoline may increase the systemic exposure of coadministered BCRP substrates.

• encorafenib

  Monitor Closely (1)encorafenib will increase the level or effect of dipyridamole by Other (see comment). Modify Therapy/Monitor Closely. Encorafenib (a BCRP inhibitor) may increase the concentration and toxicities of BCRP substrates. Closely monitor for signs and symptoms of increased exposure and consider adjusting the dose of these substrates.

• enoxaparin

  Serious - Use Alternative (1)enoxaparin, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

• esmolol

  Minor (1)dipyridamole, esmolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• fish oil

  Monitor Closely (1)fish oil, dipyridamole. Other (see comment). Use Caution/Monitor. Comment: Patients taking fish oil and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

• fish oil triglycerides

  Monitor Closely (1)fish oil triglycerides will increase the level or effect of dipyridamole by anticoagulation. Use Caution/Monitor. Prolonged bleeding reported in patients taking antiplatelet agents or anticoagulants and oral omega-3 fatty acids. Periodically monitor bleeding time in patients receiving fish oil triglycerides and concomitant antiplatelet agents or anticoagulants.

• fondaparinux

  Serious - Use Alternative (1)fondaparinux, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

• fostemsavir

  Monitor Closely (1)fostemsavir will increase the level or effect of dipyridamole by Other (see comment). Modify Therapy/Monitor Closely. Fostemsavir inhibits BCRP transporters. If possible, avoid coadministration or modify dose of BCRP substrate coadministered with fostemsavir.

• ginger

  Minor (1)ginger, dipyridamole. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence. Use with caution.

• ginkgo biloba

  Minor (1)ginkgo biloba, dipyridamole. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Conflicting evidence.ÿ Use with caution.

• glecaprevir/pibrentasvir

  Monitor Closely (3)dipyridamole will increase the level or effect of glecaprevir/pibrentasvir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  dipyridamole will increase the level or effect of glecaprevir/pibrentasvir by decreasing metabolism. Use Caution/Monitor. Caution when coadministering glecaprevir/pibrentasvir with BCRP inhibitors.
  
  glecaprevir/pibrentasvir will increase the level or effect of dipyridamole by decreasing metabolism. Use Caution/Monitor. Glecaprevir/pibrentasvir may increase plasma concentration of BCRP substrates.

• green tea

  Monitor Closely (1)green tea increases effects of dipyridamole by pharmacodynamic synergism. Use Caution/Monitor. (Theoretical interaction). Dipyridamole is a platelet inhibitor and green tea has demonstrated antiplatelet effects in animals, it may be prudent to avoid the concomitant use of green tea with chronic dipyridamole therapy as the risk of bleeding may be increased.

• heparin

  Serious - Use Alternative (1)heparin, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

• horse chestnut seed

  Minor (1)horse chestnut seed, dipyridamole. pharmacodynamic synergism. Minor/Significance Unknown. May prolong bleeding time. Theoretical. Use with caution.

• ibrutinib

  Monitor Closely (1)ibrutinib will increase the level or effect of dipyridamole by anticoagulation. Use Caution/Monitor. Ibrutinib may increase the risk of hemorrhage in patients receiving antiplatelet or anticoagulant therapies and monitor for signs of bleeding.

• icosapent

  Monitor Closely (1)icosapent, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Icosapent may prolong bleeding time; monitor periodically if coadministered with other drugs that affect bleeding.

• labetalol

  Minor (1)dipyridamole, labetalol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• lasmiditan

  Serious - Use Alternative (1)lasmiditan increases levels of dipyridamole by Other (see comment). Avoid or Use Alternate Drug. Comment: Lasmiditan inhibits BCRP in vitro. Avoid coadministration of lasmiditan with BCRP substrates.

• melatonin

  Monitor Closely (1)melatonin increases effects of dipyridamole by anticoagulation. Use Caution/Monitor. Melatonin may decrease prothrombin time.

• metoprolol

  Minor (1)dipyridamole, metoprolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• nadolol

  Minor (1)dipyridamole, nadolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• naldemedine

  Monitor Closely (1)dipyridamole increases levels of naldemedine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with P-gp inhibitors.

• nebivolol

  Minor (1)dipyridamole, nebivolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• nintedanib

  Monitor Closely (1)dipyridamole increases levels of nintedanib by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. If nintedanib adverse effects occur, management may require interruption, dose reduction, or discontinuation of therapy .

• omega 3 carboxylic acids

  Monitor Closely (1)omega 3 carboxylic acids, dipyridamole. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3 acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

• omega 3 fatty acids

  Monitor Closely (1)omega 3 fatty acids, dipyridamole. Other (see comment). Use Caution/Monitor. Comment: Patients taking omega-3-fatty acids and an anticoagulant or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding. .

• oteseconazole

  Monitor Closely (1)oteseconazole will increase the level or effect of dipyridamole by Other (see comment). Modify Therapy/Monitor Closely. Otesezonale, a BCRP inhibitor, may increase the effects and risk of toxicities of BCRP substrates. Use lowest starting dose of BCRP substrate, or consider reducing BCRP substrate dose.

• ozanimod

  Serious - Use Alternative (1)dipyridamole increases toxicity of ozanimod by Other (see comment). Avoid or Use Alternate Drug. Comment: Coadministration of ozanimod (a BCRP substrate) with BCRP inhibitors increases the exposure of the minor (RP101988, RP101075) and major active metabolites (CC112273, CC1084037) of ozanimod, which may increase the risk of ozanimod adverse reactions. .

• penbutolol

  Minor (1)dipyridamole, penbutolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• pindolol

  Minor (1)dipyridamole, pindolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• piracetam

  Monitor Closely (1)piracetam increases effects of dipyridamole by pharmacodynamic synergism. Use Caution/Monitor.

• pomalidomide

  Serious - Use Alternative (1)dipyridamole increases levels of pomalidomide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• ponatinib

  Monitor Closely (1)ponatinib increases levels of dipyridamole by Other (see comment). Use Caution/Monitor.

• porfimer

  Monitor Closely (1)dipyridamole decreases effects of porfimer by pharmacodynamic antagonism. Use Caution/Monitor.

• propranolol

  Minor (1)dipyridamole, propranolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• protamine

  Serious - Use Alternative (1)protamine, dipyridamole. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Enhanced risk of hemorrhage.

• regadenoson

  Serious - Use Alternative (1)dipyridamole, regadenoson. Mechanism: unspecified interaction mechanism. Contraindicated. Regadenoson's effects may be changed; mfr. recommends avoiding dipyridamole for 2 days prior to administration.

• regorafenib

  Monitor Closely (1)regorafenib will increase the level or effect of dipyridamole by Other (see comment). Modify Therapy/Monitor Closely. Regorafenib likely inhibits BCRP (ABCG2) transport. Coadministration with a BCRP substrate may increase systemic exposure to the substrate and related toxicity.

• rifaximin

  Monitor Closely (1)dipyridamole increases levels of rifaximin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• rimegepant

  Serious - Use Alternative (1)dipyridamole will increase the level or effect of rimegepant by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of rimegepant (a BCRP substrate) with inhibitors of BCRP.

• riociguat

  Contraindicated (1)dipyridamole, riociguat. Either increases effects of the other by additive vasodilation. Contraindicated. Coadministration of nonspecific PDE-5 inhibitors (eg, dipyridamole, theophylline) and guanylate cyclase stimulators (eg, riociguat) is contraindicated due to risk of additive hypotension.Serious - Use Alternative (2)dipyridamole will increase the level or effect of riociguat by decreasing metabolism. Avoid or Use Alternate Drug. Coadministration of riociguat (substrate of CYP isoenzymes 1A1, 2C8, 3A, 2J2) with strong CYP inhibitors may require a decreased initial dose of 0.5 mg PO TID; monitor for signs of hypotension and reduce dose if needed
  
  dipyridamole will increase the level or effect of riociguat by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Coadministration of riociguat (P-gp substrate) with strong P-gp inhibitors may require a decreased initial dose of 0.5 mg PO TID; monitor for signs of hypotension and reduce dose if needed

• rivaroxaban

  Monitor Closely (1)rivaroxaban, dipyridamole. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Avoid concurrent use of rivaroxaban with other anticoagulants due to increased bleeding risk other than during therapeutic transition periods where patients should be observed closely. Monitor for signs/symptoms of blood loss.

• safinamide

  Monitor Closely (1)safinamide will increase the level or effect of dipyridamole by Other (see comment). Use Caution/Monitor. Safinamide and its major metabolite may inhibit intestinal BCRP. Monitor BCRP substrates for increased pharmacologic or adverse effects.

• selexipag

  Monitor Closely (1)dipyridamole will increase the level or effect of selexipag by Other (see comment). Use Caution/Monitor. Selexipag is a ABCG2 (BCRP) substrate. Monitor selexipag for increased pharmacologic or adverse effects when coadministered with ABCG2 (BCRP) inhibitors.

• selumetinib

  Monitor Closely (1)dipyridamole and selumetinib both increase anticoagulation. Modify Therapy/Monitor Closely. An increased risk of bleeding may occur in patients taking a vitamin-K antagonist or an antiplatelet agent with selumetinib. Monitor for bleeding and INR or PT in patients coadministered a vitamin-K antagonist or an antiplatelet agent with selumetinib.

• sofosbuvir/velpatasvir

  Monitor Closely (1)sofosbuvir/velpatasvir will increase the level or effect of dipyridamole by Other (see comment). Use Caution/Monitor. Velpatasvir is an inhibitor of the drug transporter BCRP. Coadministration may increase systemic exposure of drugs that are BCRP substrates.

• sotalol

  Minor (1)dipyridamole, sotalol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• stiripentol

  Monitor Closely (1)stiripentol will increase the level or effect of dipyridamole by Other (see comment). Modify Therapy/Monitor Closely. Stiripentol is a BCRP transport inhibitor. Consider dosage reduction for BCRP substrates if adverse effects are experienced when coadministered.

• tafamidis

  Monitor Closely (1)tafamidis will increase the level or effect of dipyridamole by Other (see comment). Use Caution/Monitor. Tafamidis inhibits breast cancer resistant protein (BCRP) in vitro and may increase exposure of BCRP substrates following tafamidis or tafamidis meglumine administration. Dosage adjustment of these BCRP substrates may be necessary.

• tafamidis meglumine

  Monitor Closely (1)tafamidis meglumine will increase the level or effect of dipyridamole by Other (see comment). Use Caution/Monitor. Tafamidis inhibits breast cancer resistant protein (BCRP) in vitro and may increase exposure of BCRP substrates following tafamidis or tafamidis meglumine administration. Dosage adjustment of these BCRP substrates may be necessary.

• talazoparib

  Serious - Use Alternative (1)dipyridamole will increase the level or effect of talazoparib by Other (see comment). Avoid or Use Alternate Drug. BCRP inhibitors may increase systemic exposure of talazoparib (a BCRP substrate). If coadministration cannot be avoided, monitor for potential adverse reactions.

• theophylline

  Contraindicated (1)theophylline decreases effects of dipyridamole by pharmacodynamic antagonism. Contraindicated. May produce false negative results in dipyridamole thallium imaging tests. Separate by 24 hr.

• ticagrelor

  Monitor Closely (1)ticagrelor, dipyridamole. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Increased risk of bleeding during concomitant use of medications that increase potential for bleeding.

• timolol

  Minor (1)dipyridamole, timolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• topotecan

  Serious - Use Alternative (1)dipyridamole will increase the level or effect of topotecan by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Product labeling for PO topotecan recommends avoiding concomitant use of P-gp inhibitors; the interaction with IV topotecan may be less severe but is still likely of clinical significance

• venetoclax

  Serious - Use Alternative (1)dipyridamole will increase the level or effect of venetoclax by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If a P-gp inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.

• verteporfin

  Minor (1)dipyridamole decreases effects of verteporfin by pharmacodynamic antagonism. Minor/Significance Unknown.

• vorapaxar

  Monitor Closely (1)dipyridamole, vorapaxar. Either increases effects of the other by anticoagulation. Use Caution/Monitor. Coadministration of anticoagulants, antiplatelets, or other drug affecting coagulation should be monitored periodically due to potential increased risk of bleeding.

• vortioxetine

  Monitor Closely (1)dipyridamole increases effects of vortioxetine by anticoagulation. Use Caution/Monitor.

• warfarin

  Monitor Closely (1)dipyridamole, warfarin. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Drugs with antiplatelet properties may increase anticoagulation effect of warfarin.