Dipyridamole Risk Summary

Last Updated on Wed, 16 Feb 2022 | Drug Safety

Risk Factor: C
Class: Cardiovascular drugs / Vasodilators

Fetal Risk Summary

No reports linking the use of dipyridamole with congenital defects have been located. The drug has been used in pregnancy as a vasodilator and to prevent thrombus formation in patients with prosthetic heart valves (1,2,3,4,5,6,7 and 8). A single IV 30-mg dose of dipyridamole was shown to increase uterine perfusion in the 3rd trimester in 10 patients (9). In one pregnancy, a malformed infant was delivered, but the mother was also taking warfarin (1). The multiple defects in the infant were consistent with the fetal warfarin syndrome (see Coumarin Derivatives).



In a randomized, nonblinded study to prevent preeclampsia, 52 high-risk patients treated from the 13th week of gestation through delivery with daily doses of 300 mg of dipyridamole plus 150 mg of aspirin were compared to 50 high-risk controls (10). Four treated patients were excluded from analysis (spontaneous abortions before 16 weeks) vs. five controls (two lost to follow-up plus three spontaneous abortions). Hypertension occurred in 41 patients19 treated and 22 controls. The outcome of pregnancy was significantly better in treated patients in three areas: preeclampsia (none vs. 6,p<0.01), fetal and neonatal loss (none vs. 5,p<0.02), and severe intrauterine growth retardation (none vs. 4,p<0.05). No fetal malformations were observed in either group. Other reports and reviews have documented the benefits of this therapy, namely a reduction in the incidence of stillbirth, placental infarction, and intrauterine growth retardation (11,12,13,14,15,16 and 17).

Breast Feeding Summary

Dipyridamole is excreted into breast milk, but in levels too low to measure with current techniques (P.A. Bowers, personal communication, Boehringer Ingelheim Ltd, 1981). The manufacturer knows of no problems in breast-fed infants whose mothers were taking this drug (P.A. Bowers, personal communication, Boehringer Ingelheim Ltd, 1981).

References

  1. Tejani N. Anticoagulant therapy with cardiac valve prosthesis during pregnancy. Obstet Gynecol 1973;42:78593.
  2. Del Bosque MR. Dipiridamol and anticoagulants in the management of pregnant women with cardiac valvular prosthesis. Ginecol Obstet Mex 1973;33:1918.
  3. Littler WA, Bonnar J, Redman CWG, Beilin LJ, Lee GD. Reduced pulmonary arterial compliance in hypertensive patients. Lancet 1973;1:12748.
  4. Biale Y, Lewenthal H, Gueron M, Beu-Aderath N. Caesarean section in patient with mitral-valve prosthesis. Lancet 1977;1:907.
  5. Taguchi K. Pregnancy in patients with a prosthetic heart valve. Surg Gynecol Obstet 1977;145:2068.
  6. Ahmad R, Rajah SM, Mearns AJ, Deverall PB. Dipyridamole in successful management of pregnant women with prosthetic heart valve. Lancet 1976;2:14145.
  7. Biale Y, Cantor A, Lewenthal H, Gueron M. The course of pregnancy in patients with artificial heart valves treated with dipyridamole. Int J Gynaecol Obstet 1980;18:12832.
  8. Salazar E, Zajarias A, Gutierrez N, Iturbe I. The problem of cardiac valve prostheses, anticoagulants, and pregnancy. Circulation 1984;70(Suppl 1):I169I77.
  9. Lauchkner W, Schwarz R, Retzke U. Cardiovascular action of dipyridamole in advanced pregnancy. Zentralbl Gynaekol 1981;103:2207.
  10. Beaufils M, Uzan S, Donsimoni R, Colau JC. Prevention of pre-eclampsia by early antiplatelet therapy. Lancet 1985;1:8402.
  11. Beaufils M, Uzan S, Donsimoni R, Colau JC. Prospective controlled study of early antiplatelet therapy in prevention of preeclampsia. Adv Nephrol 1986;15:8794.
  12. Wallenburg HCS, Rotmans N. Prevention of recurrent idiopathic fetal growth retardation by low-dose aspirin and dipyridamole. Am J Obstet Gynecol 1987;157:12305.
  13. Uzan S, Beaufils M, Bazin B, Danays T. Idiopathic recurrent fetal growth retardation and aspirin-dipyridamole therapy. Am J Obstet Gynecol 1989;160:763.
  14. Wallenburg HCS, Rotmans N. Idiopathic recurrent fetal growth retardation and aspirin-dipyridamole therapy. Reply. Am J Obstet Gynecol 1989;160:7634.
  15. Wallenburg HCS, Rotmans N. Prophylactic low-dose aspirin and dipyridamole in pregnancy. Lancet 1988;1:939.
  16. Capetta P, Airoldi ML, Tasca A, Bertulessi C, Rossi E, Polvani F. Prevention of pre-eclampsia and placental insufficiency. Lancet 1986;1:919.
  17. Romero R, Lockwood C, Oyarzun E, Hobbins JC. Toxemia: new concepts in an old disease. Semin Perinatol 1988;12:30223.

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