Pletaal Drug Interactions

Cilostazol is extensively metabolized by hepatic cytochrome P450 (CYP) enzymes, mainly CYP3A4 and, to a lesser extent, CYP2D6 and CYP2C19.
Anticoagulants (e.g., warfarin), antiplatelet drugs (e.g., aspirin and ticlopidine), thrombolytic drugs (e.g., urokinase and alteplase), prostaglandin E, or its derivatives (e.g., alprostadil and limaprost alfadex) may cause a tendency to bleed, and frequent monitoring such as a blood coagulation test is required.
Coadministration of CYP3A4 and CYP2C19 inhibitors (cimetidine, diltiazem, erythromycin, ketoconazole, lansoprazole, itraconazole, miconazole, omeprazole, HIV-1 protease inhibitors, etc) may increase the blood concentration and potentiate the effects of cilostazol. Cilostazol should be reduced in dosage or started in a lower dose when coadministered with these drugs. Patients should be cautioned not to drink grapefruit juice when receiving cilostazol.
Caution is needed when co-administering cilostazol with any other agent which has the potential to reduce blood pressure or vasodilators that cause reflex tachycardia (e.g., dihydropyridine calcium channel blockers) due to the possibility that there may be an additive hypotensive effect with a reflex tachycardia.