Rapid development of tolerance to dipyridamole-associated headaches.
OBJECTIVE
In the Second European Stroke Prevention Study headaches associated with dipyridamole frequently (8% of patients taking dipyridamole or dipyridamole plus acetylsalicylic acid (ASA) vs 2% of patients taking ASA or placebo) led to discontinuation of therapy. We have now used data from a recent trial comparing the bioequivalence of two formulations of the fixed combination of 200 mg dipyridamole in an extended release formulation and 25 mg ASA to explore predicting factors for headaches associated with this drug combination.


METHODS
The bioequivalence trial employed a two-way crossover, randomised, open design. Trial medication was given for two periods of five days separated by a 72 h washout period. Statistical methods were employed to explore the prevalence, the time course, and the relation to individual pharmacokinetic parameters of treatment associated headaches.


RESULTS
Headache episodes, being mostly mild and transient, rapidly declined from 67% of the volunteers on the first day of treatment to 3% on the final days of treatment (days 4-5 of the second period). During the first days the prevalence of the headaches peaked 2-3 h after the morning administration, which coincided with the peak of the plasma concentrations of dipyridamole. The occurrence of headaches was not related to interindividual differences of the pharmacokinetic parameters.


CONCLUSIONS
The rapid decrease in the incidence of headaches over time implies that most patients quickly develop tolerance to dipyridamole-associated headaches. Appropriate information given to the patient when prescribing and dispensing dipyridamole/ASA may reduce early withdrawals from treatment and increase compliance.
Theis
J G
JG
Department of Clinical Research, Boehringer Ingelheim Pharma KG, Biberach, Germany. jochen.theis@bc.boehringer-ingelheim.com
Deichsel
G
G
Marshall
S
S
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D001241:Aspirin / Q000009:adverse effects; D018592:Cross-Over Studies; D004176:Dipyridamole / Q000009:adverse effects* / Q000493:pharmacokinetics; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D006261:Headache / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013810:Therapeutic Equivalency; D013997:Time Factors; D014665:Vasodilator Agents / Q000009:adverse effects* / Q000493:pharmacokinetics
D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations; D014665:Vasodilator Agents; D004176:Dipyridamole; D001241:Aspirin