What other drugs will affect cilostazol Pletal? Before taking cilostazol, tell your doctor if you are using any of the following drugs: This list is not complete and there may be other drugs that can interact with cilostazol. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors.
Do not start using a new medication without telling your doctor. Effects on circulating plasma lipids have been examined in patients taking Cilostazol. However, short-term coadministration of aspirin with Cilostazol had no clinically significant impact on PT, aPTT, or bleeding time compared to aspirin alone. Effects of long-term coadministration in the general population are unknown. In eight randomized, placebo-controlled, double-blind clinical trials, aspirin was coadministered with Cilostazol to patients.
The most frequent doses and mean durations of aspirin therapy were 75 to 81 mg daily for days patients and mg daily for 54 days 85 patients. There was no apparent increase in frequency of hemorrhagic adverse effects in patients taking Cilostazol and aspirin compared to patients taking placebo and equivalent doses of aspirin.
Warfarin Cilostazol did not inhibit the pharmacologic effects PT, aPTT, bleeding time, or platelet aggregation of R- and S-warfarin after a single mg dose of warfarin. The effect of concomitant multiple dosing of warfarin and Cilostazol on the pharmacodynamics of both drugs is unknown. Absolute bioavailability is not known. Cilostazol is extensively metabolized by hepatic cytochrome P enzymes, mainly 3A4, and, to a lesser extent, 2C19, with metabolites largely excreted in urine.
Pharmacokinetics are approximately dose proportional. Cilostazol and its active metabolites have apparent elimination half-lives of about 11 to 13 hours. Cilostazol and its active metabolites accumulate about 2-fold with chronic administration and reach steady state blood levels within a few days.
The pharmacokinetics of Cilostazol and its two major active metabolites were similar in healthy subjects and patients with intermittent claudication due to peripheral arterial disease PAD. Figure 1 shows the mean plasma concentration-time profile at steady state after multiple dosing of Cilostazol mg twice daily. The binding for 3,4-dehydro-Cilostazol is Mild hepatic impairment did not affect protein binding. Take cilostazol on an empty stomach, at least 30 minutes before or 2 hours after food.
What should I discuss with my healthcare provider before taking cilostazol Pletal? Before using cilostazol, tell your doctor if you have: If you have any of these conditions, you may need a dose adjustment or special tests to safely take this medication. FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.
The name of your medicine is Cilostazol mg Tablets but will be referred to as Cilostazol throughout the leaflet. If you are taking such medicines with Cilostazol your doctor may perform some routine blood tests.
Read all of this leaflet carefully before you start taking this medicine. You may need to read it again. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours. Certain medicines may interfere with the effect of Cilostazol when taken together. They may either increase the side effects of Cilostazol or make Cilostazol less effective. Cilostazol may do the same to other medicines.
Before you start taking Cilostazol, please tell your doctor if you are taking: The authors concluded that fish oil supplementation in doses of 36 grams per day does not have a statistically significant effect on the INR of patients receiving chronic warfarin therapy. However, an increase in INR from 2. This implies that a dose-related effect of fish oil on warfarin may be possible. Patients receiving warfarin that initiate concomitant icosapent ethyl therapy should have their INR monitored more closely and the dose of warfarin adjusted accordingly.
Moderate An additive risk of bleeding may occur when platelet inhibitors are used with agents that cause clinically significant thrombocytopenia including antineoplastic agents, such as ifosfamide. Moderate When used concurrently with platelet inhibitors, inhaled iloprost may increase the risk of bleeding. Major Imatinib is a potent inhibitor of cytochrome P CYP 3A4 and may increase concentrations of other drugs metabolized by this enzyme, inlcuding cilostazol. The combination may also cause an additive risk of bleeding.
Moderate Concomitant use of isavuconazonium with cilostazol may result in increased serum concentrations of cilostazol. Cilostazol is a substrate of the hepatic isoenzyme CYP3A4; isavuconazole, the active moiety of isavuconazonium, is a moderate inhibitor of this enzyme.
Caution and close monitoring are advised if these drugs are used together. Minor Cilostazol is metabolized by the cytochrome P 2C19 hepatic isoenzyme and may interact with medications that are inhibitors of CYP2C19 including isoniazid. Co-administration of these agents with cilostazol may increase the incidence of adverse effects, such as headache.
Major Decrease cilostazol dose to one half of the recommended dosage when coadministered with itraconazole. Minor Use caution when administering ivacaftor and cilostazol concurrently. Co-administration of ivacaftor with CYP3A substrates, such as cilostazol, can theoretically increase cilostazol exposure leading to increased or prolonged therapeutic effects and adverse events; however, the clinical impact of this has not yet been determined.
Major Decrease cilostazol dose to one half of the recommended dosage when coadministered with ketoconazole. Moderate Lesinurad may decrease the systemic exposure and therapeutic efficacy of cilostazol; monitor for potential reduction in efficacy. Major Reduce the dose of cilostazol to 50 mg PO twice daily if coadministered with letermovir due to increased cilostazol exposure and risk for adverse events. The magnitude of this interaction may be increased in patients who are also receiving cyclosporine.
Cilostazol is a substrate of CYP3A4. Letermovir is a moderate CYP3A4 inhibitor. Patients should be closely monitored for signs and symptoms of bleeding when a platelet inhibitor is administered with an SNRI. Major Concomitant use of lomitapide and cilostazol may significantly increase the serum concentration of lomitapide.
Moderate An additive risk of bleeding may occur when platelet inhibitors are used with agents that cause clinically significant thrombocytopenia including antineoplastic agents, such as lomustine.
Moderate Cilostazol may interact with lovastatin, but it is not clear if the interaction could be clinically significant. In healthy volunteers, peak plasma concentrations of lovastatin did not change with co-administration of cilostazol.
However, peak plasma concentrations and the AUC of lovastatin's active metabolite did increase. Monitor patients for adverse effects of cilostazol, such as increased bleeding.
In vitro, therapeutic doses of luliconazole inhibit the activity of CYP2C19 and CYP3A4 and small systemic concentrations may be noted with topical application, particularly when applied to patients with moderate to severe tinea cruris.
No in vivo drug interaction trials were conducted prior to the approval of luliconazole. Major Lumacaftor; ivacaftor may reduce the efficacy of cilostazol by decreasing its systemic exposure; caution and close monitoring are advised if these drugs are used together. Minor Agents that affect platelet function, such as platelet inhibitors, could decrease the efficacy of methoxsalen when used during photodynamic therapy.
Use of mifepristone may lead to an increase in serum levels of drugs that are CYP3A4 substrates, such as cilostazol. Due to the slow elimination of mifepristone from the body, such interactions may be observed for a prolonged period after mifepristone administration.
If use together is medically necessary, use the lowest dose of cilostazol necessary e. Side effects of cilostazol may include unusual bleeding or bruising, diarrhea, dizziness, edema such as swelling of the ankles or legs , headache, or upset stomach.
Moderate Use caution if mitotane and cilostazol are used concomitantly, and monitor for decreased efficacy of cilostazol and a possible change in dosage requirements. Mitotane is a strong CYP3A4 inducer and cilostazol is a CYP3A4 substrate in vitro; coadministration may result in decreased plasma concentrations of cilostazol.
Moderate Platelet Inhibitors inhibit platelet aggregation and should be used cautiously in patients with thrombocytopenia, as mycophenolate can also cause thrombocytopenia. Major Decrease cilostazol dose to one half of the recommended dosage when coadministered with nefazodone.
Moderate Due to the thrombocytopenic effects of nelarabine, an additive risk of bleeding may be seen in patients receiving concomitant platelet inhibitors. Co-administration with nicardipine may lead to an increase in serum levels of drugs that are CYP3A4 substrates, such as cilostazol. A cilostazol dose reduction may be necessary if these drugs are used together. The manufacturer of clopidogrel advises that caution be used when used in combination with NSAIDs as an increase in occult GI blood loss occurred when clopidogrel was used concomitantly with naproxen Obinutuzumab: Moderate Fatal hemorrhagic events have been reported in patients treated with obinutuzumab; all events occured during cycle 1.
Monitor all patients for thrombocytopenia and bleeding, and consider withholding concomitant medications which may increase bleeding risk i. Plasma concentrations and efficacy of cilostazol may be reduced if these drugs are administered concurrently. Coadministration of pazopanib and cilostazol, a CYP3A4 substrate, may cause an increase in systemic concentrations of cilostazol. Use caution when administering these drugs concomitantly.
Moderate Due to the risk of bleeding and coagulopathy during pegaspargase therapy, patients should receive other agents that may increase the risk of bleeding e. Moderate A potential additive risk for bleeding exists if platelet inhibitors are given in combination with other agents that affect hemostasis such as pentoxifylline. Moderate Concurrent use of topiramate and drugs that affect platelet function such as cilostazol may increase the risk of bleeding.
In a pooled analysis of placebo-controlled trials, bleeding was more frequently reported in patients receiving topiramate 4. In those with severe bleeding events, patients were often taking drugs that cause thrombocytopenia or affect platelet function or coagulation.
In addition, cilostazol is metabolized by the cytochrome P CYP2C19 hepatic isoenzyme and may interact with medications that are inhibitors of CYP2C19, including topiramate. Minor Agents, such as platelet inhibitors, that decrease clotting could decrease the efficacy of photosensitizing agents used in photodynamic therapy.
Minor Agents that affect platelet function, such as drug inhibitors, could decrease the efficacy of methoxsalen when used during photodynamic therapy. Mitotane is a strong CYP3A4 inducer and cilostazol is a CYP3A4 pletal in vitro; coadministration may result in decreased plasma concentrations of cilostazol, pletal 100mg drug. Before you start taking Cilostazol please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, pletal 100mg drug, including medicines obtained without a prescription. Cilostazol is a CYP3A4 substrate. In those with severe bleeding events, patients pletal often taking drugs that cause thrombocytopenia or affect platelet function or coagulation. It is possible that cilostazol induced side effects could be increased in some individuals. Long-term coadminstration is not recommended. If you stop taking Cilostazol If you stop taking Cilostazol the pain in your legs may come back or 100mg worse. In a pooled analysis of placebo-controlled trials, bleeding was 100mg frequently reported in patients receiving topiramate 4, pletal 100mg drug. Patients receiving this combination should be monitored for drugs and symptoms of bleeding. Moderate Lesinurad may decrease the systemic exposure 100mg therapeutic efficacy of cilostazol; monitor for potential reduction in efficacy. Remember to take the pack with you so that it is clear what medicine you have taken. Moderate An additive risk of bleeding may occur when platelet inhibitors are used with agents that cause clinically significant thrombocytopenia including bexarotene. Major Cilostazol is extensively metabolized by the CYP3A4 drug isoenzyme and appears to have pletal interactions with many medications that are potent inhibitors of CYP3A4, including fluoxetine.
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