Cilostazol and Simvastatin

[amox]

Both are substrates of CYP3A4, competing for the same site.

Are there any interactions between these two medications? Upon my review I found that Clinical Pharmacology and Micromedex claim no interactions.

The monograph of cilostazol claims research was only done with lovastatin. The end result was that it is not clinically significant.

Pubmed search of cilostazol and lovastatin yielded the following.

http://www.ncbi.nlm.nih.gov/pubmed/10702889

The study seems too small to affirm anything. If it is significant then the increase in statin dose if tolerated is okay. If the LDL is already undercontrol then we can consider reducing the dose.

I see simvastatin and cilostazol prescribed together all day long.

The reason I am asking is not for homework, but because in my therapeutics course this came up. I won't say my opinion as to not bias anyone.

It is understandable that the receptors may be saturated yielding an increase or decrease of one drug. However I am looking for clinical experience and research.

Thank you for your time.

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[Lubeckd]

Sorry to go off topic here, but speaking of cilostazol, which therapy do we use in people with intermittent claudication? Aspirin with exercise or jump straight to cilostazol?

 

[bacillus1]

I don't believe that either is a strong or moderate inhibitor/inducer. Therefore, if there is an interaction, it is not clinically significant. A lot of things they teach you in school tends to be deemed as overkill in the real world.

 

[Lubeckd]

Can someone answer my question? How do you tell the difference between pad and ic? And which therapy should we use?

 

[amox]

Aspirin first line or plavix or dipyridamole for asymptomatic PAD or with slight IC.

Also diet/exercise, ldl goal <70 HTN to 130/85, A1C to <7

PDEI (cilostazol) if severe IC as first line. Pentoxifylline as 2nd line.

If I interpreted book/notes correctly 🙂 Please correct me if wrong, its too early!


I agree with the overkill, some of the things we learn interaction wise always get override codes or don't even flag.

simvastatin vs fenofibrates.. for example

 

[Ackj]

Can someone answer my question? How do you tell the difference between pad and ic?

PAD is the disease, IC is a symptom of it. Sort of like CAD and angina.

 

[Lubeckd]

I realize severe ic is when you can't walk any distance at all, and if you are at rest; you will feel pain too. Or if the abi falls below 0.4 right?

 

[amox]

I realize severe ic is when you can't walk any distance at all, and if you are at rest; you will feel pain too. Or if the abi falls below 0.4 right?

Normal 1.0-1.3
Borderline 0.9-0.99
Moderate/Mild 0.41-0.9
Severe 0-0.4

PAD can be asymptomatic, whereas IC is the symptoms associated with PAD.

Sorry I didn't see the question asking the difference.

Anyone have further comments on the drug reaction? I agree with bacillus1