Names and pronunciation
(dye-peer-id′a-mole) Persantine
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Drug reference
(dye-peer-id′a-mole) Persantine
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Func. class.: Coronary vasodilator, antiplatelet agent
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Chem. class.: Nonnitrate
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ACTION: Inhibits adenosine uptake, which produces coronary vasodilation; increases oxygen saturation in coronary tissues, coronary blood flow; acts on small resistance vessels with little effect on vascular resistance; may increase development of collateral circulation; decreases platelet aggregation by the inhibition of phosphodiesterase (an enzyme)
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USES: Prevention of transient ischemic attacks, inhibition of platelet adhesion to prevent myocardial reinfarction, thrombo- embolism, with warfarin in prosthetic heart valves, prevention of coronary bypass graft occlusion with aspirin; IV form used to evaluate CAD; used as alter- native to exercise with thallium myocar- dial perfusion imaging to evaluate CAD
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Unlabeled uses: Cardiomyopathy, MI prophylaxis, proteinuria, TIA, valvular heart disease
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CONTRAINDICATIONS: Hyper sensitivity Precautions: Pregnancy, breastfeeding, hypotension, unstable angina, asthma, hepatic disease, labor
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SIDE EFFECTS CNS: Headache, dizziness, weakness, fainting, syncope; IV: transient cerebral ischemia, weakness CV: Postural hypotension; IV: MI GI: Nausea, vomiting, anorexia, diarrhea INTEG: Rash, flushing
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INTERACTIONS • Prevention of coronary vasodilation: theophylline, other xanthines; do not use together, causes a false-negative thallium imaging result Increase: digoxin effect—digoxin Increase: bleeding risk—NSAIDs, cefo- TEtan, valproic acid, salicylates, sulfinpyrazole, anticoagulants, thrombo- lytics; monitor for bleeding Increase: adenosine effects Increase: myasthenia gravis effects— cholinesterase inhibitors
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DOSAGE AND ROUTES Inhibition of platelet adhesion • Adult: PO 75-100 mg qid in combina- tion with warfarin, 75 mg qid with aspirin Thallium myocardial perfusion imaging • Adult: IV 570 mcg/kg, max 60 mg/day TIA with aspirin (unlabeled) • Adult: PO 225-400 mg/day max 400 mg/day
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Available forms: Tablets 25, 50, 75 mg; injection 10 mg/2 mL
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Administer: PO route • On empty stomach: 1 hr before meals or 2 hr after; give with 8 oz water for better absorption • Store at room temperature IV route • IV after diluting to at least 1:2 ratio using D5W, 0.45% NaCl, or 0.9% NaCl to a total volume of 20-50 mL; give over 4 min; do not give undiluted • Inject thallium 201 within 5 min after product infusion • Do not admix
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Assess: • B/P, pulse during treatment until sta- ble; take B/P lying, standing; orthostatic hypotension is common • Cardiac status: chest pain; what ag- gravates, ameliorates condition • Pregnancy/breastfeeding: no well- controlled studies, use only if clearly needed; cautious use in breastfeeding, excreted in breast milk
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Evaluate: • Therapeutic response: decreased platelet adhesion
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • That medication is not a cure; may have to be taken continuously in evenly spaced doses only as directed • To avoid hazardous activities until stabi- lized on medication; dizziness may occur • To rise slowly from sitting or lying to prevent orthostatic hypotension • Not to use alcohol or OTC medications unless approved by prescriber • About cardiac stress testing, expectations
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PHARMACOKINETICS PO: Peak 75 min; IV peak 2 min, therapeu- tic response may take several months, metabolized in liver, excreted in bile, under- goes enterohepatic recirculation, protein binding 91%-99%, terminal half-life 12 hr
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• Adult: PO 75-100 mg qid in combina- tion with warfarin, 75 mg qid with aspirin Thallium myocardial perfusion imaging
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• Adult: IV 570 mcg/kg, max 60 mg/day TIA with aspirin (unlabeled)
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• Adult: PO 225-400 mg/day max 400 mg/day
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