CILOSTAZOL Drug Interactions
Also known as: Cilostazol
Cilostazol is a medication that belongs to a class of drugs called phosphodiesterase III inhibitors. It is primarily used to help people with a condition called intermittent claudication, which causes leg pain during exercise due to poor blood flow. By improving blood flow and preventing blood clots, cilostazol helps reduce these symptoms and allows patients to walk further without pain.CILOSTAZOL has 10 documented drug interactions in our database, including 0 contraindicated, 10 major, 0 moderate, and 0 minor interactions.
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Contraindicated
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Major
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Moderate
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Minor
Combining naproxen with cilostazol greatly increases your risk of bleeding, especially in the stomach or intestines. This combination should generally be avoided due to severe bleeding potential.
Mechanism
Naproxen, a non-selective NSAID, inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis and impairing platelet aggregation. Cilostazol is a phosphodiesterase-3 inhibitor that also directly inhibits platelet aggregation. The concurrent use of these agents results in additive antiplatelet effects and increased gastrointestinal mucosal damage, significantly elevating bleeding risk.
Clinical Management
The primary clinical effect is a substantially increased risk of serious bleeding, particularly gastrointestinal hemorrhage, which can manifest as black, tarry stools, vomiting blood, or severe abdominal pain. The risk of major bleeding can be several-fold higher compared to either drug alone, potentially leading to anemia, hospitalization, or even death. This combination should generally be avoided. If both drugs are deemed absolutely necessary, close monitoring for signs and symptoms of bleeding is critical, including regular blood counts and stool occult blood tests. Consider alternative pain management strategies that do not involve NSAIDs, such as acetaminophen, or alternative antiplatelet agents if appropriate. If an NSAID is unavoidable, a COX-2 selective inhibitor might be considered with extreme caution and gastric protection, but the overall risk remains high.
Combining Etodolac and Cilostazol significantly increases your risk of bleeding, especially in the stomach or intestines. This combination should generally be avoided.
Mechanism
Etodolac, a non-steroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis and impairing platelet aggregation. Cilostazol is an antiplatelet agent that inhibits phosphodiesterase-3, leading to increased cyclic AMP and further inhibition of platelet aggregation. The concurrent use of these drugs results in additive antiplatelet effects, significantly increasing the risk of bleeding.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, particularly gastrointestinal bleeding (e.g., ulcers, hemorrhage), but also epistaxis, bruising, and other hemorrhagic events. The risk of serious GI bleeding can be 3-15 times higher when NSAIDs are combined with other antiplatelet agents or anticoagulants. This combination should generally be avoided due to the high risk of bleeding. If concurrent use is unavoidable, patients must be closely monitored for signs of bleeding (e.g., black/tarry stools, blood in vomit, easy bruising). Consider alternative pain management strategies that do not involve NSAIDs, or alternative antiplatelet agents if clinically appropriate. Proton pump inhibitors may be considered for gastroprotection if short-term use is absolutely necessary.
Combining aspirin and cilostazol significantly increases your risk of bleeding, especially from the stomach or intestines. This combination should generally be avoided unless specifically recommended and closely monitored by your doctor.
Mechanism
Both aspirin and cilostazol exert antiplatelet effects through different mechanisms, leading to an additive inhibition of platelet aggregation. Aspirin irreversibly inhibits cyclooxygenase-1 (COX-1), reducing thromboxane A2 production, while cilostazol inhibits phosphodiesterase III (PDE3), increasing cyclic AMP and thereby reducing platelet activation. The combined effect profoundly impairs hemostasis.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding. This includes gastrointestinal bleeding (e.g., ulcers, hemorrhage), which can be severe and life-threatening, as well as increased risk of epistaxis, bruising, hematuria, and other bleeding events. The risk of major bleeding can be several-fold higher compared to monotherapy. This combination should generally be avoided due to the high bleeding risk. If concurrent use is deemed absolutely necessary by a specialist (e.g., for specific cardiovascular indications), patients must be monitored extremely closely for any signs of bleeding. Consider alternative therapies or dose adjustments if possible, and ensure a proton pump inhibitor (PPI) is prescribed for gastroprotection.
Combining ibuprofen with cilostazol significantly increases your risk of bleeding, especially in the stomach or intestines. This combination should generally be avoided.
Mechanism
Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase (COX) enzymes, leading to reduced prostaglandin synthesis and impaired platelet aggregation. Cilostazol is a phosphodiesterase-3 inhibitor that directly inhibits platelet aggregation and causes vasodilation. The additive antiplatelet effects of both drugs lead to a synergistic increase in bleeding risk.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, particularly gastrointestinal bleeding, which can manifest as stomach pain, black or tarry stools, or vomiting blood. Other bleeding events like bruising, nosebleeds, or prolonged bleeding from cuts are also more likely. The risk of serious GI bleeding can be significantly elevated, potentially several-fold higher than with either drug alone. This combination should generally be avoided due to the high risk of bleeding. If concurrent use is unavoidable, patients must be closely monitored for signs of bleeding, and the lowest effective doses for the shortest duration should be used. Consider alternative pain management strategies that do not increase bleeding risk, such as acetaminophen. Proton pump inhibitors may be considered for gastroprotection if NSAID use is essential, but this does not mitigate the antiplatelet interaction.
Combining indomethacin with cilostazol significantly increases your risk of bleeding, especially in the stomach and intestines. This combination should generally be avoided.
Mechanism
Indomethacin, an NSAID, inhibits cyclooxygenase (COX) enzymes, leading to reduced prostaglandin synthesis and impaired platelet aggregation. Cilostazol is a phosphodiesterase-3 inhibitor that also reduces platelet aggregation and causes vasodilation. The concurrent use of these two drugs results in additive antiplatelet effects, significantly increasing the risk of bleeding.
Clinical Management
The primary clinical effect is an increased risk of bleeding, which can manifest as gastrointestinal bleeding (e.g., ulcers, melena, hematemesis), bruising, epistaxis, or prolonged bleeding from minor cuts. The risk of serious GI bleeding with NSAID plus antiplatelet therapy can be several-fold higher compared to either drug alone. This combination should generally be avoided due to the high risk of bleeding. If concurrent use is absolutely necessary, it should be done with extreme caution, close monitoring for signs of bleeding, and consideration of gastroprotective agents (e.g., PPIs). Alternative pain management strategies or alternative antiplatelet therapies should be explored.
Combining celecoxib with cilostazol significantly increases your risk of bleeding, especially in the stomach and intestines. This combination should generally be avoided.
Mechanism
Celecoxib, an NSAID, inhibits prostaglandin synthesis, which can impair gastric mucosal protection and platelet aggregation. Cilostazol is a phosphodiesterase-3 inhibitor that directly inhibits platelet aggregation and causes vasodilation. The additive antiplatelet effects and gastrointestinal mucosal damage lead to a substantially increased risk of hemorrhage.
Clinical Management
The primary clinical effect is a significantly increased risk of bleeding, including gastrointestinal hemorrhage, intracranial hemorrhage, and other serious bleeding events. Patients may experience symptoms such as black, tarry stools, blood in vomit, easy bruising, or prolonged bleeding from cuts. The risk of serious GI bleeding can be several-fold higher with this combination. This combination should generally be avoided due to the high risk of serious bleeding. If co-administration is unavoidable, patients must be closely monitored for signs and symptoms of bleeding, and the lowest effective doses should be used for the shortest possible duration. Consider alternative pain management strategies or antiplatelet agents if clinically appropriate.
Combining piroxicam with cilostazol significantly increases your risk of bleeding, especially in the stomach or intestines. This combination should generally be avoided.
Mechanism
Piroxicam, a non-steroidal anti-inflammatory drug (NSAID), inhibits prostaglandin synthesis, which can impair gastric mucosal protection and inhibit platelet aggregation. Cilostazol is a phosphodiesterase-3 inhibitor that directly inhibits platelet aggregation and causes vasodilation. The concurrent use of these agents results in additive antiplatelet effects and increased gastrointestinal toxicity, leading to a substantially elevated bleeding risk.
Clinical Management
The primary clinical effect is a significantly increased risk of bleeding, including gastrointestinal bleeding (e.g., ulcers, hemorrhage), intracranial hemorrhage, and other systemic bleeding events. Patients may experience symptoms such as black, tarry stools, blood in vomit, easy bruising, or prolonged bleeding from minor cuts. The risk of serious GI bleeding can be several-fold higher compared to either drug alone. This combination should generally be avoided due to the high risk of bleeding. If concurrent use is deemed absolutely necessary, closely monitor for signs and symptoms of bleeding, and consider gastroprotective agents (e.g., proton pump inhibitors). Evaluate alternative pain management strategies that do not involve NSAIDs, or consider alternative antiplatelet agents if appropriate. Discuss with the prescribing physician to weigh risks versus benefits.
Combining meloxicam with cilostazol significantly increases your risk of serious bleeding, including stomach or intestinal bleeding. This combination should generally be avoided.
Mechanism
Meloxicam, a non-steroidal anti-inflammatory drug (NSAID), inhibits prostaglandin synthesis, which can impair platelet function and damage the gastrointestinal mucosa. Cilostazol is a phosphodiesterase-3 inhibitor that directly inhibits platelet aggregation and causes vasodilation. The co-administration of these agents results in additive antiplatelet effects and increased gastrointestinal mucosal damage, leading to a synergistic increase in bleeding risk.
Clinical Management
The primary clinical effect is a substantially increased risk of bleeding, particularly gastrointestinal bleeding (e.g., ulcers, hemorrhage). Other potential bleeding sites include intracranial, genitourinary, and skin/soft tissue. Patients may experience symptoms like black, tarry stools, vomiting blood, or unusual bruising. This combination should generally be avoided due to the high risk of serious bleeding. If co-administration is absolutely necessary, use the lowest effective doses for the shortest duration possible, and monitor closely for signs of bleeding. Consider alternative pain management strategies or alternative antiplatelet agents if appropriate. Proton pump inhibitor prophylaxis may be considered to reduce GI bleeding risk if no alternatives exist.
Combining diclofenac with cilostazol significantly increases your risk of bleeding, especially from the stomach or intestines. Your doctor will likely recommend avoiding this combination due to the heightened risk of serious bleeding events.
Mechanism
Diclofenac, an NSAID, inhibits cyclooxygenase (COX) enzymes, leading to reduced prostaglandin synthesis and impaired platelet aggregation. Cilostazol is a phosphodiesterase-3 inhibitor that also directly inhibits platelet aggregation and causes vasodilation. The co-administration results in additive antiplatelet effects, significantly increasing the risk of hemorrhage.
Clinical Management
This combination substantially increases the risk of serious bleeding, including gastrointestinal bleeding (e.g., ulcers, hemorrhage), intracranial hemorrhage, and other systemic bleeding. Symptoms may include black, tarry stools, vomiting blood, unusual bruising, or prolonged bleeding from cuts. The risk of GI bleeding with NSAIDs alone is increased 2-4 fold, and this risk is further amplified when combined with antiplatelets. This combination should generally be avoided due to the high risk of bleeding. If concurrent use is absolutely necessary, patients must be closely monitored for signs of bleeding, and the lowest effective doses for the shortest duration should be used. Consider alternative pain management strategies or antiplatelet agents with lower interaction potential if possible, or a proton pump inhibitor for GI protection.
Combining ketorolac with cilostazol significantly increases your risk of bleeding, especially in the stomach or intestines. This combination should generally be avoided.
Mechanism
Ketorolac, a non-steroidal anti-inflammatory drug (NSAID), inhibits cyclooxygenase enzymes, reducing prostaglandin synthesis and impairing platelet aggregation. Cilostazol is a phosphodiesterase-3 inhibitor that directly inhibits platelet aggregation and causes vasodilation. The concurrent use of these agents leads to an additive antiplatelet effect, significantly increasing the risk of hemorrhage.
Clinical Management
Patients are at a substantially increased risk of serious bleeding events, including gastrointestinal hemorrhage, intracranial hemorrhage, and other forms of major bleeding. The risk of GI bleeding with NSAIDs alone can be significant, and this risk is amplified when combined with antiplatelet agents like cilostazol. This combination should generally be avoided due to the high risk of bleeding. If an NSAID is absolutely necessary, consider alternative analgesics or use a gastroprotective agent (e.g., proton pump inhibitor) and monitor closely for signs of bleeding. Consider alternative antiplatelet agents or adjust cilostazol dosage under strict medical supervision if no other option is available.
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