Cilostazol (Cilostazol) - Side Effects and Adverse Reactions

ADVERSE REACTIONS

Adverse events were assessed in eight placebo-controlled clinical trials involving 2274 patients exposed to either 50 or 100 mg b.i.d. cilostazol (n = 1301) or placebo (n = 973), with a median treatment duration of 127 days for patients on cilostazol and 134 days for patients on placebo.

The only adverse event resulting in discontinuation of therapy in ≥ 3% of patients treated with cilostazol 50 or 100 mg b.i.d. was headache, which occurred with an incidence of 1.3%, 3.5%, and 0.3% in patients treated with cilostazol 50 mg b.i.d., 100 mg b.i.d., or placebo, respectively. Other frequent causes of discontinuation included palpitation and diarrhea, both 1.1% for cilostazol (all doses) versus 0.1% for placebo.

The most commonly reported adverse events, occurring in ≥ 2% of patients treated with cilostazol 50 or 100 mg b.i.d., are shown in the table (below).

Other events seen with an incidence of ≥ 2%, but occurring in the placebo group at least as frequently as in the 100 mg b.i.d. group were: asthenia, hypertension, vomiting, leg cramps, hypesthesia, paresthesia, dyspnea, rash, hematuria, urinary tract infection, flu syndrome, angina pectoris, arthritis, and bronchitis.

Most Commonly Reported AEs (Incidence ≥ 2%) in Patients on Cilostazol 50 mg b.i.d. or 100 mg b.i.d. and Occurring at a Rate in the 100 mg b.i.d. Group Higher Than in Patients on Placebo

Adverse Events (AEs) by Body System	Cilostazol 50 mg b.i.d. (N = 303) %	Cilostazol 100 mg b.i.d. (N = 998) %	Placebo (N = 973) %
BODY AS A WHOLE
Abdominal pain	4	5	3
Back pain	6	7	6
Headache	27	34	14
Infection	14	10	8
CARDIOVASCULAR
Palpitation	5	10	1
Tachycardia	4	4	1
DIGESTIVE
Abnormal stools	12	15	4
Diarrhea	12	19	7
Dyspepsia	6	6	4
Flatulence	2	3	2
Nausea	6	7	6
METABOLIC & NUTRITIONAL
Peripheral edema	9	7	4
MUSCULO-SKELETAL
Myalgia	2	3	2
NERVOUS
Dizziness	9	10	6
Vertigo	3	1	1
RESPIRATORY
Cough increased	3	4	3
Pharyngitis	7	10	7
Rhinitis	12	7	5

Less frequent adverse events (< 2%) that were experienced by patients exposed to cilostazol 50 mg b.i.d. or 100 mg b.i.d. in the eight controlled clinical trials and that occurred at a frequency in the 100 mg b.i.d. group greater than in the placebo group, regardless of suspected drug relationship, are listed below.

Body as a Whole: Chills, face edema, fever, generalized edema, malaise, neck rigidity, pelvic pain, retroperitoneal hemorrhage.

Cardiovascular: Atrial fibrillation, atrial flutter, cerebral infarct, cerebral ischemia, congestive heart failure, heart arrest, hemorrhage, hypotension, myocardial infarction, myocardial ischemia, nodal arrhythmia, postural hypotension, supraventricular tachycardia, syncope, varicose vein, vasodilation, ventricular extrasystoles, ventricular tachycardia.

Digestive: Anorexia, cholelithiasis, colitis, duodenal ulcer, duodenitis, esophageal hemorrhage, esophagitis, increased GGT, gastritis, gastroenteritis, gum hemorrhage, hematemesis, melena, peptic ulcer, periodontal abscess, rectal hemorrhage, stomach ulcer, tongue edema.

Endocrine: Diabetes mellitus.

Hemic and Lymphatic: Anemia, ecchymosis, iron deficiency anemia, polycythemia, purpura.

Metabolic and Nutritional: Increased creatinine, gout, hyperlipemia, hyperuricemia.

Musculoskeletal: Arthralgia, bone pain, bursitis.

Nervous: Anxiety, insomnia, neuralgia.

Respiratory: Asthma, epistaxis, hemoptysis, pneumonia, sinusitis.

Skin and Appendages: Dry skin, furunculosis, skin hypertrophy, urticaria.

Special Senses: Amblyopia, blindness, conjunctivitis, diplopia, ear pain, eye hemorrhage, retinal hemorrhage, tinnitus.

Urogenital: Albuminuria, cystitis, urinary frequency, vaginal hemorrhage, vaginitis.

Post-Marketing Experience

The following events have been reported spontaneously from worldwide post-marketing experience since launch of cilostazol in the US.

• Blood and Lymphatic System Disorders: agranulocytosis, granulocytopenia, thrombocytopenia, leucopenia, bleeding tendency
• Cardiac Disorders: Torsades de Pointes, QTc prolongation (Torsades de Pointes and QTc prolongation occurred in patients with cardiac disorders, e.g. complete atrioventricular block, cardiac failure and bradyarrythmia, when treated with cilostazol. Cilostazol was used "off label" due to it's positive chronotropic action.)
• Gastrointestinal Disorders: gastrointestinal hemorrhage
• General Disorders and Administrative Site Conditions: pain, chest pain, hot flushes
• Hepatobiliary Disorders: hepatic dysfunction/abnormal liver function tests, jaundice
• Injury, Poisoning and Procedural Complications: extradural hematoma and subdural hematoma
• Investigations: blood glucose increased, blood uric acid increased, platelet count decreased, white blood cell count decreased, increase in BUN (blood urea increased)
• Nervous System Disorders: intracranial hemorrhage, cerebral hemorrhage, cerebrovascular accident
• Respritory, Thoracic and Mediastinal Disorders: pulmonary hemorrhage, interstitial pneumonia
• Skin and Subcutaneous Tissue Disorders: hemorrhage subcutaneous, pruritus, skin eruptions including Stevens-Johnson syndrome, skin drug eruption (dermatitis medicamentosa)
• Vascular Disorders: subacute thrombosis (These cases of subacute thrombosis occurred in patients treated with aspirin and "off label" use of cilostazol for prevention of thrombotic complication after coronary stenting.)

REPORTS OF SIDE EFFECTS / ADVERSE REACTIONS RELATED TO CILOSTAZOL

Possible Cilostazol side effects / adverse reactions in 68 year old female

Reported by a physician from Japan on 2009-04-01

Patient: 68 year old female

Reactions: Aneurysm Ruptured, Haemobilia

Adverse event resulted in: life threatening event

Suspect drug(s):
Aspirin
    Administration route: Oral
    Indication: Myocardial Infarction

Cilostazol
    Administration route: Oral
    Indication: Myocardial Infarction

Heparin
    Indication: Drug USE FOR Unknown Indication

Other drugs received by patient: Insulin; Antibiotics; Epogen; RED Blood Cells; Proton Pump Inhibitors

Possible Cilostazol side effects / adverse reactions in 64 year old female

Reported by a physician from Germany on 2009-05-06

Patient: 64 year old female

Reactions: Cardiac Death, Myocardial Infarction, Cardiac Disorder

Adverse event resulted in: death

Suspect drug(s):
Prostavasin /00501501/ (Prostavasin)
    Dosage: (1 vial once intra-arterial), (2 vials ocne intravenous)), (2 df bid intravenous))
    Indication: Peripheral Arterial Occlusive Disease

Clexane (Clexane) (Not Specified)

Heparin
    Dosage: (5000ie once)

ASS (Ass) (Not Specified)
    Dosage: (100 mg, 100 mg once), (100 mg qd, 100mg daily)

Clopidogrel
    Dosage: (75 mg, 75mg once)

Cilostazol
    Dosage: (100 mg bid)

Possible Cilostazol side effects / adverse reactions in 68 year old male

Reported by a physician from Germany on 2009-05-06

Patient: 68 year old male

Reactions: Post Procedural Haemorrhage

Suspect drug(s):
Prostavasin /00501501/ (Prostavasin)
    Dosage: (1 vial once intra-arterial), (2 vials once intravenous)), (2 df bid intravenous))
    Indication: Peripheral Arterial Occlusive Disease

Clexane (Clexane) (Not Specified)

Heparin
    Dosage: (5000ie once)

ASS (Ass) (Not Specified)
    Dosage: (100 mg, 100 mg once), (100 mg qd, 100mg daily)

Clopidogrel
    Dosage: (75 mg, 75mg once)

Cilostazol
    Dosage: (100 mg bid)