Dipyridamole and paracetamol overdose resulting in multi-organ failure.

Dipyridamole intoxication is rare and few reports exist amongst the current literature. A case of dipyridamole and paracetamol overdose is described in a previously healthy 58-year-old woman, which resulted in multi-organ failure requiring dialysis, inotropic support, ventilation and extensive surgical intervention for small bowel ischaemia. This case highlights the dangers of an unusually large overdose of a commonly prescribed drug, and reviews current knowledge of dipyridamole intoxication.

Toxicokinetics of a dipyridamole (Persantin) intoxication: case report.

We report a case of a 51-year-old woman who was admitted to the hospital after ingestion of large doses of dipyridamole (12 g), temazepam (1 g) and oxazepam (0.2 g) with suicidal intent. The highest dipyridamole concentration that was measured in serum was 9.2 mg/L, which was paralleled by impaired platelet activation. For temazepam and oxazepam, peak serum concentrations were 8.5 and 1.3 mg/L, respectively. The patient was treated with activated charcoal, magnesium sulfate and aminophylline and could be discharged in good physical condition within 17 hours. This is the first report that provides toxicokinetic data and a corresponding pharmacodynamic effect after an intoxication with dipyridamole.

[Myocardial infarction after voluntary intoxication by drug interaction between dipyridamole and aspirin]. / Infarctus du myocarde après intoxication volontaire par l'association acide acétylsalicylique et dipyridamole.

A 60-year-old male presented a myocardial infarction after a voluntary overdose of Asasantine(®) started after strokes. He took chronically this association and some psychotropic drugs with vasodilator effects. After an intake of 40 tablets, he presented a cardiogenic shock with a myocardial infarction confirmed by biological samples, EKG, echocardiography and angiocoronarographie. No recent change of his treatment was found and symptoms regressed when dipyridamole was stopped while other vasodilators drugs were continued. Chronological analysis of events led us to suspect dipyridamole as a starter of the myocardial infarction secondary to a coronary artery steal reinforced by the vasodilator effect of combined treatments, in a patient at risk of ischemia. This case shows that, in such particular conditions, a change in dipyridamole dosage can induce a myocardial infarction even if its blood level remains in the therapeutic range.

[Characteristics of dipyridamol isolation from biological material].

Acetone is proposed as an isolating agent for extraction of dipyridamolum from biological material. Optimal conditions of isolating dipyridamolum from human cadaveric liver tissue with acetone are determined and quantitative estimation of isolation results is provided.

[A case report. Unconscious patient with neon yellow skin was intoxicated with dipyridamole]. / Fallbeskrivning. Medvetslös patient med neongul hud var intoxikerad med dipyridamol.

A 66-year old man called for an ambulance from his home because of acute chest pain. When the crew arrived he was unresponsive and hypotensive. Sublingual nitroglycerine was given and subsequently the patient collapsed into circulatory failure and respiratory arrest. He was intubated and transported to the nearest hospital. The severe hypotension was combated with fluids and norepinephrine. During the next few hours his skin gradually turned intensely yellow, as did the urine. Acute myocardial infarction also occurred and renal failure developed. The cause of the neon-yellow colour was a complete mystery until a police patrol sent to his apartment found several empty packages of dipyridamole (Persantin Depot) corresponding to 34 g, an overdose seven times higher than any previous case reported in the literature. This drug has a distinct yellowish colour. The patient's condition gradually improved and he could be extubated within a week. Haemodialysis was needed for two weeks because of acute tubular necrosis after the prolonged period of hypotension, but thereafter he recovered.

Profound shock resulting from a large dose of dipyridamole.

Acute ingestion of more than 200 mg dipyridamole may result in minor symptoms. The reported highest dosage of acute ingestion was 1250 mg. Most experiences of acute ingestion come from dipyridamole thallium image, oral application of 300-400 mg or intravenous 0.56 mg/kg. The systemic or cardiovascular complication could be rapidly reversed by intravenous use of aminophylline, 50-240 mg. We report an experience in dealing with the highest ever dose, 1750 mg, of dipyridamole overdose by usual dose of aminophylline.

Myocardial infarction secondary to dipyridamole overdose.

A case of myocardial infarction secondary to dipyridamole overdose is described in a 62-year-old woman with longstanding angina. Therapeutic doses of dipyridamole are associated with reversible myocardial ischaemia in a proportion of patients but serious adverse events are rare (Homma et al., 1987). To our knowledge this is the first reported case of dipyridamole overdose in the literature.

Prolonged myocardial ischemia after intravenous dipyridamole thallium imaging.

Intravenous dipyridamole thallium imaging is reported to be a safe test with minimal side effects. It has been proposed by some that the test simply dilates the coronary vessels without actually producing myocardial ischemia. In this report, we describe a patient who, following intravenous dipyridamole thallium imaging, developed severe myocardial ischemia which persisted for 90 minutes, requiring emergency coronary angioplasty to alleviate the ischemic insult. Sequential electrocardiograms and cardiac isoenzyme levels following coronary angioplasty were within normal limits. Thus, severe myocardial ischemia following intravenous dipyridamole testing can occur and emphasizes the importance of careful monitoring of these patients, particularly when the pretest risk of coronary disease is high.