Adenosine 5'-triphosphate (ATP) has a dual effect on cochlear blood flow (CBF). It induces on initial, transient decrease, which is followed by a long-lasting increase in CBF. Dilazep dihydrochloride (DZ) is a unique vasoactive agent, which increases CBF as well as decreases systemic blood pressure (BP). This agent is thought to keep the concentration of extracellular adenosine higher than normal by preventing the absorption of adenosine into the intracellular space. Thus, it may potentiate the effect of ATP on CBF. In this study, the effects are reported of ATP on CBF in the presence of DZ as measured with a laser Doppler flowmeter in the guinea pig cochlea. In the presence of DZ, the effect of ATP on CBF was amplified and prolonged. Specifically, the mean value of CBF initially decreased to 30.0% of the baseline, determined prior to administration of any agent, and increased gradually up to 287.8% of the baseline. This pharmaceutical effect of DZ might involve a longer activation of both P2x- and P2y-purinoceptors.