Cilostan CR Special Precautions

Patients who are using anticoagulant such as warfarin; platelet aggregation inhibitor including aspirin, ticlopidine, etc.; and thrombolytic including urokinase and alteplase since it may cause bleeding.
Patients who are using prostaglandin E1 or derivative (alprostadile, rimaprodex, alphadex, etc) since bleeding may also occur.
Patients with menstruation.
Severe renal impairment: creatinine clearance of ≤25 mL/min.
Moderate or severe hepatic impairment.
Patients with any known predisposition to bleeding (e.g., active peptic ulceration, recent (within six months) haemorrhagic stroke, proliferative diabetic retinopathy, poorly controlled hypertension).
Patients with any history of ventricular tachycardia, ventricular fibrillation or multifocal ventricular ectopics, whether or not adequately treated, and in patients with prolongation of the QTc interval.
General Precautions: Cilostazol (Cilostan CR) may cause dizziness and patients should be warned to exercise caution before they drive or operate machinery.
Taking cilostazol with food has been shown to increase the maximum plasma concentrations (C_max) of cilostazol, which may be associated with an increased incidence of adverse effects.
Cilostazol is an inhibitor of PDE III. It has been reported that in long term administration, comparative experiment of congestive heart failure patient (NYHA class III-IV), survival rate of cardiotonic inhibiting PDE III is lower than placebo as for cardiotonic inhibiting PDE III.
Patients should be warned to report any episode of bleeding or easy bruising whilst on therapy. In case of retinal bleeding, administration of cilostazol should be stopped.
In addition to reporting episodes of bleeding and easy bruising, patients should be warned to promptly report any other signs which might also suggest the early development of blood dyscrasia such as pyrexia and sore throat. A full blood count should be performed if infection is suspected or there is any other clinical evidence of blood dyscrasia. Cilostazol should be discontinued promptly if there is clinical or laboratory evidence of haematological abnormalities.
Use in Children: Safety and efficacy in children have not been established.
Use in the Elderly: Particular care should be taken in the elderly since usually their physiologic function may be lowered.