title: Pharmacokinetics of extended-release dipyridamole following administration through a gastrostomy tube: an open-label, case-control, two-centre study.
abstract: BACKGROUND
  Many stroke survivors have severe dysphagia and are unable to take antithrombotic medications orally.
  
  
  OBJECTIVE
  To evaluate whether dipyridamole concentrations achieved in the plasma of patients taking an extended-release formulation of the medication through a gastrostomy tube (G-tube) are therapeutic and similar to those achieved in the plasma of patients who receive the drug orally.
  
  
  METHODS
  This was an open-label, case-control, two-centre study conducted in two academic centres in a metropolitan area. Patients included were those admitted following an acute cerebral infarction, with an indication for antiplatelet therapy for secondary prevention. Twelve patients with severe dysphagia requiring G-tube placement were cases, and 12 patients who were able to swallow safely served as controls. The components of Aggrenox (extended-release dipyridamole/aspirin [acetylsalicylic acid]), suspended in water, were administered twice daily for 5 days through the G-tube. The 12 control patients without dysphagia took the medication orally. Dipyridamole plasma concentrations were compared between the groups at three different timepoints on the fifth day: 2, 6 and 12 hours after administration. The main outcome measure was dipyridamole plasma concentrations on day 5 at all three timepoints.
  
  
  RESULTS
  No significant difference in dipyridamole plasma concentrations between the groups was found at 2 hours (p = 0.18), 6 hours (p = 0.92) or 12 hours (p = 0.69).
  
  
  CONCLUSIONS
  Dipyridamole plasma concentrations obtained following administration of extended-release dipyridamole through a G-tube in dysphagic patients achieved similar therapeutic levels to those obtained in patients taking the medication orally.
authors.affiliation: J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Leonardo M
authors.initials: LM
authors.lastname: Batista
authors.forename: David
authors.initials: D
authors.lastname: Crandell
authors.forename: Fabricio O
authors.initials: FO
authors.lastname: Lima
authors.forename: David M
authors.initials: DM
authors.lastname: Greer
mesh_terms: D000368:Aged; D053674:Aggrecans / Q000008:administration & dosage*; D016022:Case-Control Studies; D002544:Cerebral Infarction / Q000150:complications* / Q000188:drug therapy; D003680:Deglutition Disorders / Q000150:complications / Q000209:etiology; D003692:Delayed-Action Preparations; D004176:Dipyridamole / Q000008:administration & dosage / Q000493:pharmacokinetics*; D005260:Female; D005774:Gastrostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000493:pharmacokinetics*; D012720:Severity of Illness Index; D020521:Stroke / Q000517:prevention & control
chemical_list: D053674:Aggrecans; D003692:Delayed-Action Preparations; D010975:Platelet Aggregation Inhibitors; D004176:Dipyridamole