Pharmacokinetics of extended-release dipyridamole following administration through a gastrostomy tube: an open-label, case-control, two-centre study.
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.
Batista
Leonardo M
LM
J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Crandell
David
D
Lima
Fabricio O
FO
Greer
David M
DM
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
D053674:Aggrecans; D003692:Delayed-Action Preparations; D010975:Platelet Aggregation Inhibitors; D004176:Dipyridamole