Pletax tablets 100mg, No. 60

• Symptomatic treatment of intermittent claudication. Cilostazol is used to increase the maximum distance and distance traveled without pain in patients with intermittent claudication who do not have pain at rest and do not have signs of peripheral tissue necrosis (chronic lower limb ischemia, grade II according to Fontaine's classification).

• Cilostazol is intended for use as a second-line therapy in patients with intermittent claudication in whom lifestyle changes (including smoking cessation and physical rehabilitation programs) and other appropriate interventions have not been sufficient to reduce symptoms of intermittent claudication

Inside.

The recommended dosage of cilostazol is 100 mg twice a day. Cilostazol should be taken 30 minutes before meals. When taking cilostazol with food, there is an increase in the maximum concentration (Cmax) in the blood plasma, which may be associated with an increase in the frequency of adverse events. If you miss taking the drug, you must take the next pill at the usual time. Do not take a double dose of Cilostazol. Cilostazol therapy should be initiated under the supervision of a physician experienced in the treatment of intermittent claudication. The physician should re-evaluate the patient's condition after 3 months of treatment.

If therapy with cilostazol does not have an adequate effect or there is no decrease in the severity of symptoms of intermittent claudication, cilostazol should be discontinued and other treatments should be considered.

Patients receiving cilostazol treatment should continue to follow recommendations for lifestyle changes (smoking cessation, exercise) and drug therapy (taking lipid-lowering and antiplatelet drugs) aimed at reducing the risk of cardiovascular complications. Cilostazol is not a substitute for this treatment.

Application in special patient groups

Elderly age

There are no special requirements for changing the dosage of cilostazol in elderly patients.

Renal failure

In patients with creatinine clearance> 25 ml / min, dosage changes are not required. Cilostazol is contraindicated in patients with creatinine clearance <25 ml / min.

Liver failure

No dosage change is required in patients with mild hepatic impairment. There is no experience with the use of cilostazol in patients with moderate to severe hepatic impairment. Since cilostazol is largely metabolized by enzymes of liver microsomal oxidation, the use of the drug is contraindicated in patients with moderate to severe hepatic impairment.

Concomitant use of potent inhibitors of CYP3A4 or CYP2C19

In patients receiving drugs that have a potent inhibitory effect on CYP3A4 (for example, some macrolides), or drugs that have a potent inhibitory effect on CYP2C19 (for example, omeprazole), the dose of cilostazol should be reduced to 50 mg twice a day.

1 tablet contains:

Active ingredient: Cilostazol 50.0 mg / 100.0 mg.

Excipients: pregelatinized potato starch 81.8 mg / 84.0 mg, microcrystalline cellulose 26.0 mg / 35.0 mg; carmellose calcium 1.5 mg / 2.2 mg; magnesium stearate 1.7 mg / 2.3 mg; hypromellose 19.0 mg / 26.5 mg.

• hypersensitivity to cilostazol, severe renal failure (CC? 25 ml / min);

• moderate or severe hepatic impairment;

• chronic heart failure;

• predisposition to bleeding (for example, peptic ulcer of the stomach or duodenal ulcer in the acute phase, recently (within the last 6 months) suffered a hemorrhagic stroke, proliferative diabetic retinopathy, poorly controlled arterial hypertension);

• history of ventricular tachycardia, ventricular fibrillation or polytopic ventricular premature beats (regardless of the presence or absence of adequate antiarrhythmic therapy);

• prolonged QT interval on the ECG;

• history of severe tachyarrhythmia;

• unstable angina or myocardial infarction within the past 6 months;

• invasive coronary artery intervention in the past 6 months;

• taking two or more antiplatelet or anticoagulant drugs at the same time (eg, acetylsalicylic acid, clopidogrel, heparin, warfarin, acenocoumarol, dabigatran, rivaroxaban, or apixaban);

• concomitant use of potent inhibitors of CYP3A4 or CYP2C19 (for example, cimetidine, diltiazem, erythromycin, ketoconazole, lansoprazole, omeprazole and HIV-1 protease inhibitors);

• pregnancy;

• breastfeeding period;

• age under 18.

• With care: mild hepatic impairment; chronic ischemic heart disease (in particular, stable exertional angina); atrial or ventricular premature beats, atrial fibrillation and atrial flutter; diabetes; simultaneous use of drugs that lower blood pressure; simultaneous use of drugs that reduce blood clotting; concomitant use of CYP3A4 or CYP2C19 substrates (eg, cisapride, midazolam, nifedipine, verapamil); elderly patients.

Pharmacodynamics

The main mechanism of the pharmacological action of Cilostazol is the inhibition of type 3 phosphodiesterase and, therefore, an increase in the intracellular content of cyclic adenosine monophosphate (cAMP) in various organs and tissues. In experimental and small clinical studies, it was found that cilostazol has a vasodilating effect. Cilostazol dilates mainly the femoral arteries, to a lesser extent - the vertebral, carotid and superior mesenteric arteries. The renal arteries are not sensitive to the effects of cilostazol. Cilostazol inhibits the proliferation of human and rat smooth muscle cells in vitro. In experimental and clinical studies in vivo and ex vivo, it was found that cilostazol increases the content of cAMP in platelets and causes a reversible antiplatelet effect.Cilostazol reversibly inhibits platelet aggregation caused by various stimuli, such as thrombin, adenosine diphosphate, collagen, arachidonic acid, adrenaline and mechanical stress (hemodynamic shock). In addition, cilostazol blocks the release of platelet growth factor and platelet factor 4 (PF-4) by human platelets. Additional potentially beneficial effects of cilostazol, found in experimental and clinical studies, were a decrease in serum triglycerides and an increase in high-density lipoprotein (HDL) cholesterol. In a clinical study, taking cilostazol at a dose of 100 mg 2 times a day for 12 weeks, compared with placebo, reduced blood triglycerides by an average of 0,33 mmol / L (by 15%) and increased the content of HDL cholesterol in the blood by an average of 0.10 mmol / L (by 10%). Cilostazol has a positive inotropic effect. In experimental studies, cilostazol had a species-specific damaging effect on the cardiovascular system (found in dogs, but not found in rats and monkeys). Cilostazol does not increase the duration of the QT interval in dogs and monkeys. The efficacy of cilostazol in patients with intermittent claudication has been confirmed in 9 placebo-controlled clinical trials. It was found that therapy with cilostazol at a dose of 100 mg 2 times a day for 24 weeks approximately doubles the maximum distance traveled (from 60.4 m to 129.1 m; the average absolute increase in the maximum distance traveled is 42 meters) and the distance,passable until pain appears (from 47.3 m to 93.6 m). The efficacy of cilostazol in patients with diabetes mellitus was found to be lower than in those without impaired carbohydrate metabolism. In a prospective, double-blind clinical study, it was found that cilostazol does not increase mortality in patients with intermittent claudication.

Pharmacokinetics

Cilostazol is readily absorbed when taken orally. Compared with taking the drug on an empty stomach, the maximum concentration (Cmax) is 16% higher after taking the drug 30 minutes after eating and by 93% when taken 2 hours after eating. The maximum concentration (Cmax) of cilostazol and its main metabolites increases in less than proportional to the dose increase. At the same time, the area under the concentration-time curve (AUC) of cilostazol and its main metabolites increases in approximately proportion to the dose increase. In patients with occlusive diseases of peripheral arteries, when taken regularly at a dose of 100 mg 2 times a day, the equilibrium concentration of cilostazol in the blood is reached after 4 days. Cilostazol has two pharmacologically active metabolites (dehydrocylostazol and 4'-trans-hydroxycylostazol).Dehydrocylostazol is 4-7 times superior to cilostazol in its ability to inhibit platelet aggregation. 4`-trans-hydroxycilostazol, which has five times less pronounced ability to inhibit platelet aggregation compared to unchanged cilostazol. The plasma concentration (measured by the value of AUC) of dehydrocylostazol and 4`-trans-hydroxycylostazol is, respectively, ~ 41% and ~ 12% of the concentration of cilostazol. The connection of cilostazol with blood plasma proteins (mainly with albumin) is 95-98%. Dehydrocylostazol and 4`-trans-hydroxycylostazol bind to blood plasma proteins by 97.4% and 66%, respectively. Cilostazol is actively metabolized mainly by the action of the CYP3A4 isoenzyme, to a lesser extent by the CYP2C19 isoenzyme, and to an even lesser extent by the CYP1A2 isoenzyme.Cilostazol is not an inducer of liver enzymes of microsomal peroxidation. Cilostazol is excreted from the body mainly in the urine (74%), the remaining drug is excreted in the feces. In urine, unchanged cilostazol is practically not detected. Less than 2% of the dose taken is excreted in the urine in the form of dehydrocylostazol. Approximately 30% of the dose taken is excreted in the urine in the form of 4'-trans-hydroxycilostazol. The remaining drug is excreted in the form of a variety of metabolites, each of which is no more than 5% of the dose taken. The observed half-life of cilostazol is 10.5 hours. The two major metabolites (dehydrocylostazol and 4'-trans-hydroxycylostazol) have similar observed half-lives. Special patient groups Renal failure Foundthat in patients with severe renal failure, the free fraction of cilostazol is 27% higher, and the Cmax and AUC of unchanged cilostazol are, respectively, 29% and 39% lower than in those with normal renal function. Cmax and AUC of dehydrocylostazol in patients with severe renal failure are 41% and 47% lower, respectively, than in patients with normal renal function. At the same time, the Cmax and AUC indicators of 4'-trans-hydroxycylostazol (the main metabolite excreted in the urine) in patients with severe renal failure increase by 173% and 209%, respectively, compared with patients without renal dysfunction. The use of cilostazol is contraindicated in patients with severe renal insufficiency (creatinine clearance ? 25 ml / min). Hepatic impairment In patients with moderate hepatic impairment,peak plasma concentration and AUC increased by 25 and 10%, respectively, compared with healthy people. In patients with moderate renal impairment, peak plasma concentration and AUC increased by 50 and 16%, respectively, compared with healthy people. There are no data on the use of Cilostazol in patients with moderate to severe hepatic impairment. Since cilostazol is largely metabolized by hepatic microsomal oxidation enzymes, its use is contraindicated in patients with moderate or severe hepatic impairment.There are no data on the use of Cilostazol in patients with moderate to severe hepatic impairment. Since cilostazol is largely metabolized by hepatic microsomal oxidation enzymes, its use is contraindicated in patients with moderate or severe hepatic impairment.There are no data on the use of Cilostazol in patients with moderate to severe hepatic impairment. Since cilostazol is largely metabolized by hepatic microsomal oxidation enzymes, its use is contraindicated in patients with moderate or severe hepatic impairment.

Age and gender

In studies involving healthy volunteers aged 50-80 years, it was found that age and gender do not significantly affect the pharmacokinetics of cilostazol.

Application during pregnancy and during breastfeeding

Pregnancy

There are no data on the use of Cilostazol in pregnant women. In experimental studies on animals, it was found that cilostazol has reproductive toxicity. The use of cilostazol during pregnancy is contraindicated.

Breastfeeding period

In experimental studies on animals, it was found that cilostazol passes into milk. It is not known whether cilostazol passes into human breast milk. Due to the possible adverse effect on the newborn, the use of cilostazol during breastfeeding is contraindicated.

Fertility

In experimental studies, it was found that cilostazol did not adversely affect the fertility of laboratory animals.

Side effect

The most frequently reported adverse events in clinical trials were headache (> 30%), diarrhea, and stool disturbances (> 15% each). These side effects were mild to moderate in intensity. Adverse reactions by frequency of occurrence were classified as follows: very often (? 1/10), often (? 1/100 and <1/10), infrequently (? 1 / 1,000 and <1/100), rarely (? 1 / 10,000 and <1/1000), very rare (<1 / 10,000), frequency unknown (cannot be determined from available data). Blood and lymphatic system disorders Often: ecchymosis. Uncommon: anemia. Rarely: increased bleeding time, thrombocytosis. Frequency unknown: bleeding tendency, thrombocytopenia, granulocytopia, agranulocytosis, leukopenia, pancytopenia, aplastic anemia. Immune system disorders Uncommon:allergic reactions. Metabolic and nutritional disorders Often: edema (peripheral edema, facial edema), anorexia. Uncommon: hyperglycemia, diabetes mellitus. Mental disorders Uncommon: anxiety. Nervous system disorders Very common: headache Common: dizziness. Uncommon: insomnia, sleep disturbance (unusual dreams), intracranial hemorrhage. Frequency unknown: paresis, hypesthesia. Disturbances from the organ of vision Often: intraocular hemorrhage. Frequency unknown: conjunctivitis. Hearing disorders and labyrinthine disorders Frequency unknown: ringing in the ears. Heart disorders Often: palpitations, tachycardia, angina pectoris, arrhythmias, ventricular extrasystoles. Uncommon: myocardial infarction, atrial fibrillation, chronic heart failure, supraventricular tachycardia,ventricular tachycardia, syncope. Vascular disorders Often: orthostatic hypotension. Infrequently: hot flashes, arterial hypertension, arterial hypotension. Respiratory, chest and mediastinal disorders Common: rhinitis, pharyngitis. Uncommon: shortness of breath (dyspnea), pneumonia, cough, pulmonary hemorrhage, bleeding from the respiratory tract. Frequency unknown: interstitial pneumonia. Disorders from the gastrointestinal tract Very often: diarrhea, stool disorders. Often: nausea, vomiting, dyspepsia, flatulence, abdominal pain, gastrointestinal bleeding. Uncommon: gastritis. Liver and biliary tract disorders Frequency unknown: hepatitis, deviation of liver function from normal values, jaundice. Skin and subcutaneous tissue disorders Often: skin rash,itchy skin. Uncommon: eczema, skin rashes, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria, subcutaneous hemorrhage. Musculoskeletal and connective tissue disorders Uncommon: myalgia, intramuscular hematomas. Renal and urinary tract disorders Rarely: renal failure, impaired renal function. Frequency unknown: hematuria, pollacuria. General disorders and disorders at the injection site Often: chest pain, asthenia. Uncommon: chills, malaise. Frequency unknown: pyrexia, pain. Laboratory and instrumental data The frequency is unknown: an increase in the content of uric acid in the blood, an increase in the content of urea in the blood, an increase in the content of creatinine in the blood.An increase in the frequency of heartbeat and peripheral edema has been observed with the use of Cilostazol in combination with other vasodilators that cause reflex tachycardia (for example, with dihydropyridine blockers of 'slow' calcium channels). Cilostazol itself increases the risk of bleeding, and this risk may be further increased by concomitant use of Cilostazol with any other drug with the same potential. The risk of intraocular hemorrhage may be increased in patients with diabetes mellitus. A higher incidence of diarrhea and palpitations was found in patients over 70 years of age.and this risk can be further increased by the concomitant use of cilostazol with any other drug with the same potential. The risk of intraocular hemorrhage may be increased in patients with diabetes mellitus. A higher incidence of diarrhea and palpitations was found in patients over 70 years of age.and this risk can be further increased by the concomitant use of cilostazol with any other drug with the same potential. The risk of intraocular hemorrhage may be increased in patients with diabetes mellitus. A higher incidence of diarrhea and palpitations was found in patients over 70 years of age.

Overdose

Symptoms Information on acute overdose of cilostazol in humans is limited. Expected overdose symptoms: severe headache, diarrhea, tachycardia, arterial hypotension, cardiac arrhythmias. Treatment Symptomatic. If an overdose occurs, careful observation and examination of the patient is necessary. It is necessary to empty the stomach by inducing vomiting, or perform a gastric lavage according to generally accepted recommendations. Due to the high degree of binding to plasma proteins, hemodialysis and peritoneal dialysis are practically ineffective.

Interaction with other medicinal products

Acetylsalicylic acid

Short-term (within? 4 days) simultaneous use of cilostazol and acetylsalicylic acid leads to a 23-25% increase in ADP-induced platelet aggregation in ex vivo compared with acetylsalicylic acid monotherapy. Due to the increased risk of bleeding when used concomitantly with cilostazol, careful monitoring is necessary.

Clopidogrel and other antiplatelet drugs

In a study in healthy volunteers, the simultaneous use of cilostazol with clopidogrel had no effect on platelet count, prothrombin time (PT) and activated partial thromboplastin time (APTT). When clopidogrel was used both as monotherapy and in combination with cilostazol, the bleeding time increased in healthy volunteers. Taking cilostazol did not lead to an additional significant lengthening of bleeding time. However, caution is advised when using Cilostazol concomitantly with any drug that inhibits platelet aggregation. It is recommended to regularly monitor the bleeding time. The use of cilostazol is contraindicated in patients receiving simultaneously two or more antiplatelet and / or anticoagulant drugs.

Oral anticoagulants

In a clinical study, a single dose of cilostazol did not inhibit the metabolism of warfarin and did not affect blood coagulation parameters (PT, APTT, bleeding time). However, caution is advised when using Cilostazol concomitantly with any anticoagulant drug. The use of cilostazol is contraindicated in patients receiving simultaneously two or more antiplatelet and / or anticoagulant drugs.

Inhibitors of cytochrome P450 isoenzymes

In the liver, cilostazol is mainly metabolized under the influence of cytochrome P450 enzymes, mainly CYP3A4 and CYP2C19 and, to a lesser extent, CYP1A2. It is believed that dehydrocylostazol, which is 4-7 times superior to cilostazol in its ability to inhibit platelet aggregation, is formed mainly with the participation of CYP3A4. 4`-trans-hydroxycilostazol, which has a five times less pronounced ability to inhibit platelet aggregation, is formed mainly by the action of CYP2C19. Accordingly, drugs that inhibit CYP3A4 (eg, some macrolides [erythromycin, clarithromycin], azole antifungals [ketoconazole, itraconazole], HIV protease inhibitors) and CYP2C19 (eg, proton pump inhibitors [omeprazole,esomeprazole]) increase the general pharmacological activity of cilostazol and may enhance its undesirable effects. Accordingly, patients receiving potent inhibitors of CYP3A4 or CYP2C19 are advised to prescribe Cilostazol at a dose of 50 mg 2 times a day.

Erythromycin

With the simultaneous administration of cilostazol with erythromycin (a powerful inhibitor of CYP3A4), the AUC values ??of cilostazol, dehydrocylostazol and 4`-trans-hydroxycilostazol increase by 72%, 6% and 119%, respectively. On the basis of changes in AUC indicators, it was found that the total pharmacological activity of Cilostazol, when used simultaneously with erythromycin, increases by 34%. It is recommended to reduce the dose of Cilostazol to 50 mg 2 times a day when used simultaneously with erythromycin and other drugs of this group (for example, with clarithromycin).

Ketoconazole

With the simultaneous administration of cilostazol with ketoconazole (a powerful inhibitor of CYP3A4), the AUC of cilostazol increases by 117%, the AUC of dehydrocylostazol decreases by 15%, the AUC of 4`-trans-hydroxycylostazol increases by 87%. On the basis of changes in AUC indicators, it was found that the total pharmacological activity of Cilostazol, when used simultaneously with ketoconazole, increases by 34%. It is recommended to reduce the dose of cilostazol to 50 mg 2 times a day when used simultaneously with ketoconazole and other drugs of this group (for example, with itraconazole).

Diltiazem

With the simultaneous administration of cilostazol with diltiazem (a weak inhibitor of CYP3A4), the AUC values ??of cilostazol, dehydrocylostazol and 4`-trans-hydroxycilostazol increase by 44%, 4% and 43%, respectively. On the basis of changes in AUC indicators, it was found that the total pharmacological activity of Cilostazol, when used simultaneously with diltiazem, increases by 19%. No dose adjustment of Cilostazol is required when used concomitantly with diltiazem.

Grapefruit juice

With a single dose of 100 mg of cilostazol simultaneously with 240 ml of grapefruit juice (an inhibitor of intestinal CYP3A4), there was no significant change in the pharmacokinetic parameters of cilostazol. No dose adjustment of cilostazol is required. However, taking more grapefruit juice may affect the pharmacokinetics of cilostazol.

Omeprazole

With the simultaneous administration of cilostazol with omeprazole (a potent inhibitor of CYP2C19), the AUC values ??of cilostazol and dehydrocylostazol increase by 22% and 68%, respectively, while the AUC value of 4`-trans-hydroxycylostazol decreases by 36%. On the basis of changes in AUC indicators, it was found that the total pharmacological activity of Cilostazol, when used simultaneously with omeprazole, increases by 47%. It is recommended to reduce the dose of cilostazol to 50 mg 2 times a day while using it with omeprazole. Substrates of cytochrome P450 isoenzymes Cilostazol increases the AUC values ??of lovastatin (CYP3A4 substrate) and its beta-hydroxyl metabolite by 70%. Caution is advised when using Cilostazol concomitantly with CYP3A4 substrates that have a narrow therapeutic range (such as cisapride, halofantrine, pimozide,ergot alkaloids). It is also recommended to be careful while using Cilostazol with HMG-CoA reductase inhibitors (statins), which metabolize with the participation of CYP3A4 (simvastatin, atorvastatin and lovastatin).

»ндукторы изоферментов цитохрома –450

¬оздействие препаратов, увеличивающих активность CYP3A4 и CYP2C19 (таких, как карбамазепин, фенитоин, рифампицин, препараты «веробо¤ продыр¤вленного), на фармакокинетику цилостазола не изучалось. ѕри одновременном приеме теоретически возможно снижение антиагрегантного эффекта цилостазола, поэтому необходимо регул¤рно контролировать врем¤ кровотечени¤. ¬ клинических исследовани¤х установлено, что курение (фактор, усиливающий активность CYP1A2) уменьшает концентрацию цилостазола в плазме крови на 18%.

ѕрочие препараты

Ќеобходимо соблюдать осторожность при одновременном применении цилостазола с любыми препаратами, снижающими артериальное давление (в т.ч. с нитратами и ингибиторами фосфодиэстеразы-5), поскольку возможен аддитивный эффект с развитием артериальной гипотензии и рефлекторной тахикардии.

ќсобые указани¤

ѕеред началом терапии цилостазолом следует оценить возможность назначени¤ других способов лечени¤, таких как хирургическа¤ реваскул¤ризаци¤ или консервативна¤ терапи¤. «а счет механизма фармакологического действи¤ цилостазол может вызвать тахикардию, сердцебиение, тахиаритмию и/или артериальную гипотензию. ѕри приеме цилостазола частота сердечных сокращений может увеличиватьс¤ на 5-7 ударов в минуту, что может спровоцировать приступ стенокардии у пациентов из группы риска (например, у пациентов со стабильной стенокардией). ѕациенты, имеющие повышенный риск развити¤ т¤желых сердечно-сосудистых осложнений вследствие увеличени¤ частоты сердечного ритма (например, пациенты со стабильной »Ѕ—), нуждаютс¤ в тщательном наблюдении во врем¤ лечени¤ цилостазолом. ѕрименение цилостазола противопоказано у пациентов с нестабильной стенокардией или инфарктом миокарда/инвазивным вмешательством на коронарных артери¤х в течение последних 6 мес¤цев, а также у пациентов с т¤желой тахиаритмией в анамнезе. Ќеобходимо соблюдать осторожность при назначении цилостазола пациентам с предсердной или желудочковой экстрасистолией, а также пациентам с фибрилл¤цией предсердий или трепетанием предсердий. —ледует предупредить пациента о необходимости сообщать о любом случае кровотечени¤ или по¤влени¤ Ђсин¤каї (подкожной гематомы) при небольшом ушибе. ¬ случае развити¤ кровоизли¤ни¤ в сетчатку глаза прием цилостазола необходимо прекратить. ѕоскольку цилостазол ¤вл¤етс¤ ингибитором агрегации тромбоцитов, повышаетс¤ риск кровотечени¤ при хирургических вмешательствах (включа¤ малые инвазивные процедуры, такие как удаление зуба). ѕри планируемых хирургических вмешательствах (если антиагрегантное действие нежелательно) цилостазол следует отменить за 5 дней до операции. —ообщалось о редких или очень редких случа¤х гематологических нарушени¤х, включа¤ тромбоцитопению, лейкопению, агранулоцитоз, панцитопению или аплатическую анемию. ¬ большинстве случаев эти нарушени¤ проходили после прекращени¤ приема цилостазола. ќднако в нескольких случа¤х панцитопени¤ и апластическа¤ анеми¤ привели к летальному исходу. ѕациента следует предупредить о необходимости немедленно сообщать врачу о любых симптомах, которые могут быть ранними про¤влени¤ми гематологических осложнений, таких как высока¤ лихорадка (пирекси¤) и ангина. —ледует выполнить развернутый анализ крови при подозрении на инфекцию или при по¤влении клинических симптомов гематологических осложнений. Ќеобходимо немедленно прекратить прием цилостазола в случае по¤влени¤ клинических симптомов или лабораторных признаков гематологических осложнений. —ледует соблюдать осторожность при одновременном применении цилостазола с лекарственными препаратами, снижающими артериальное давление (возможность аддитивного действи¤ с развитием артериальной гипотензии и рефлекторной тахикардии) а также снижающими свертываемость крови или ингибирующими агрегацию тромбоцитов.

Influence on the ability to drive vehicles, mechanisms

Cilostazol may cause dizziness. It is recommended to be careful when driving or operating machinery during the treatment period.