Cilosol Drug Interactions

Cytochrome P450 Effect: Substrate of CYP1A2 (minor), 2C19 (minor), 2D6 (minor), 3A4 (major).
Increased Effect/Toxicity: Cilostazol serum concentrations may be increased by antifungal agents (midazole), macrolide antibiotics, and omeprazole. Increased concentrations of cilostazol may be anticipated during concurrent therapy with other inhibitors of CYP3A4 (eg, clarithromycin, diclofenac, doxycycline, erythromycin, imatinib, isoniazid, nefazodone, nicardipine, propofol, protease inhibitors, quinidine, telithromycin, and verapamil) or inhibitors of CYP2C19 (eg, delavridine, fluconazole, fluvoxamine, gemfibrozil, isoniazid, omeprazole, and ticlopidine). Aspirin-induced inhibition of platelet aggregation is potentiated by concurrent cilostazol. Concurrent use of anticoagulants, dasatinib, drotrecogin alfa, NSAIDs, or treprostinil may cause increased bleeding.
Decreased Effect: CYP3A4 inducers may decrease the levels/effects of cilostazol. Example inducers include aminoglutethimide, carbamaze­pine, nafcillin, nevirapine, phenobarbital, phenytoin, and rifamycins.
Ethanol/Nutrition/Herb Interactions: Food: Taking cilostazol with a high-fat meal may increase peak concentration by 90%. Avoid concur­rent ingestion of grapefruit juice due to the potential to inhibit CYP3A4.
Herb/Nutraceutical: St. John's wort may decrease the levels/effects of cilostazol. Avoid alfalfa, anise, bilberry, bladderwrack, bromelain, cat's claw, chamomile, coleus, cordyceps, dong quai, evening primrose oil, fenugreek, feverfew, garlic, ginger, ginkgo biloba, ginseng (American), ginseng (Panax), ginseng (Siberian), grape seed, green tea, guggul, horse chestnut seed, horseradish, licorice, prickly ash, red clover, reishi, SAMe (S-adenosylmethionine), sweet clover, turmeric, white willow (all have additional antiplatelet activity).