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Drug Interactions between Aspir 81 and cilostazol

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

aspirin cilostazol

Applies to: Aspir 81 (aspirin) and cilostazol

MONITOR: Coadministration of cilostazol with other antiplatelet agents may produce additive pharmacodynamic effects resulting in increased inhibition of platelet function. In 12 healthy male volunteers, coadministration of cilostazol (100 mg twice a day for 10 days) and aspirin (325 mg once a day for the last 5 days of cilostazol administration) resulted in a 23% to 35% increase in inhibition of adenosine diphosphate (ADP)-induced ex vivo platelet aggregation compared to aspirin plus placebo. However, there was no additive or synergistic effect on arachidonic acid-induced platelet aggregation. Cilostazol, with or without aspirin, caused no changes in PT, aPTT, or bleeding time. Drug-related adverse events were generally mild, the most frequent being headache. Another study involving 21 patients with peripheral arterial disease also found no increase in bleeding time when cilostazol (100 mg twice a day) was added to clopidogrel (75 mg once a day), aspirin (325 mg once a day), or clopidogrel and aspirin combined, each for two weeks. The investigators concluded that cilostazol may be used with other platelet inhibitors. However, effects of long-term coadministration in the general population are unknown. During clinical trials, there was no apparent increase in the incidence of hemorrhagic adverse effects in 201 patients who received cilostazol with aspirin (75 to 325 mg daily for up to 137 days) compared to those who received placebo and equivalent doses of aspirin.

MANAGEMENT: Because of theoretical concerns regarding increased inhibition of platelet aggregation, cilostazol should be used cautiously with other antiplatelet agents.

References

  1. (2001) "Product Information. Pletal (cilostazol)." Otsuka American Pharmaceuticals Inc
  2. Mallikaarjun S, Forbes WP, Bramer SL (1999) "Interaction potential and tolerability of the coadministration of cilostazol and aspirin." Clin Pharmacokinet, 37, p. 87-93
  3. Wilhite DB, Comerota AJ, Schmieder FA, Throm RC, Gaughan JP, Rao AK (2003) "Managing PAD with multiple platelet inhibitors: the effect of combination therapy on bleeding time." J Vasc Surg, 38, p. 710-3

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Drug and food interactions

Moderate

cilostazol food

Applies to: cilostazol

GENERALLY AVOID: Grapefruit juice may increase the plasma concentrations of cilostazol. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. The extent and clinical significance are unknown. Moreover, pharmacokinetic alterations associated with interactions involving grapefruit juice are often subject to a high degree of interpatient variability.

MANAGEMENT: Until more information is available, the manufacturer recommends avoiding consumption of grapefruit juice during cilostazol therapy. Orange juice is not expected to interact with cilostazol.

References

  1. (2001) "Product Information. Pletal (cilostazol)." Otsuka American Pharmaceuticals Inc

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Moderate

aspirin food

Applies to: Aspir 81 (aspirin)

GENERALLY AVOID: The concurrent use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) and ethanol may lead to gastrointestinal (GI) blood loss. The mechanism may be due to a combined local effect as well as inhibition of prostaglandins leading to decreased integrity of the GI lining.

MANAGEMENT: Patients should be counseled on this potential interaction and advised to refrain from alcohol consumption while taking aspirin or NSAIDs.

References

  1. (2002) "Product Information. Motrin (ibuprofen)." Pharmacia and Upjohn

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Minor

aspirin food

Applies to: Aspir 81 (aspirin)

One study has reported that coadministration of caffeine and aspirin lead to a 25% increase in the rate of appearance and 17% increase in maximum concentration of salicylate in the plasma. A significantly higher area under the plasma concentration time curve of salicylate was also reported when both drugs were administered together. The exact mechanism of this interaction has not been specified. Physicians and patients should be aware that coadministration of aspirin and caffeine may lead to higher salicylate levels faster.

References

  1. Yoovathaworn KC, Sriwatanakul K, Thithapandha A (1986) "Influence of caffeine on aspirin pharmacokinetics." Eur J Drug Metab Pharmacokinet, 11, p. 71-6

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.