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Cilostazol

    Brands

    DEA Class; Rx

    Common Brand Names; Pletal

    • Antiplatelet Agents, Hematologic; 
    • PDE-3 Inhibitors; 
    • Phospholipase A2 Inhibitors

    Platelet aggregation inhibitor with vasodilating activity; for the reduction of the symptoms of intermittent claudication.

    Indicated for the treatment of claudication associated with peripheral vascular disease (PVD); including the treatment of peripheral arterial disease in patients with diabetic neuropathy, and for the treatment of chronic arterial occlusion due to arteriosclerosis obliterans or thromboangiitis obliterans (Buerger’s disease).

    For thromboembolism prophylaxis in recipients of a coronary artery stent† following percutaneous coronary intervention (PCI), to prevent acute coronary thrombosis (i.e., abrupt closure) and the need for revascularization.

    Congestive heart failure of any severity

    Hypersensitivity

    • Headache (27-34%)
    • Diarrhea (12-19%)
    • Abnormal stools (12-15%)
    • Infection (10-14%)
    • Rhinitis (7-12%)
    • Pharyngitis (7-10%)
    • Dizziness (9-10%)
    • Palpitations (5-10%)
    • Peripheral edema (7-9%)
    • Back pain (6-7%)
    • Dyspepsia (6%)
    • Abdominal pain (4-5%)
    • Tachycardia (4%)
    • Increased cough (3-4%)
    • Myalgia (2-3%)
    • Atrial fibrillation (<2%)
    • CHF (<2%)
    • MI (<2%)
    • Hematemesis (<2%)
    • Ecchymosis (<2%)
    • Blood in eye (<2%)
    • Epistaxis (<2%)
    • Hemoptysis (<2%)
    • Nausea
    • Decreased platelet aggregation
    • Agranulocytosis
    • Aplastic anemia
    • Leukopenia
    • Thrombocytopenia
    • Stevens-Johnson syndrome

    Use with caution in liver and renal disease

    Leukopenia that progresses to agranulocytosis may occur (in which case, discontinue therapy); monitor white blood cell counts periodically

    Discontinue therapy if thrombocytopenia occurs; monitor platelets periodically

    Use with caution in patients taking platelet aggregation inhibitors

    Avoid use in patients with hemostatic disorders or active pathologic bleeding (eg, bleeding peptic ulcer, intracranial bleeding) due to reversible platelet aggregation

    Do not administer for at least 4-6 half-lives before elective surgical procedures

    Avoid grapefruit juice

    Response may be seen as early as 2-4 weeks after initiation, but treatment may be needed for up to 12 weeks

    Left ventricular outflow tract obstruction reported in patients with sigmoid shaped interventricular septum; monitor patients for development of new systolic murmur or cardiac symptoms after initiating therapy

    Dosage can be reduced or discontinued without rebound effects (eg, platelet hyperaggregability)

    Cilostazol may induce tachycardia, palpitation, tachyarrhythmia and/or hypotension; patients with history of ischemic heart disease may be at risk for exacerbations of angina pectoris or myocardial infarction

    Plasma concentrations and overall pharmacological activity are increased when cilostazol is administered with strong or moderate CYP3A4 inhibitors (eg, ketoconazole, itraconazole, erythromycin, diltiazem) and strong CYP2C19 inhibitors (eg, ticlopidine, fluconazole, omeprazole); dose reduction to 50 mg twice daily should be considered

    Pregnancy category: C

    Lactation: Excretion in milk unknown; not recommended

    Adults

    200 mg/day PO.

    Elderly

    200 mg/day PO.

    Adolescents

    Safety and efficacy have not been established.

    Children

    Safety and efficacy have not been established.

    Cilostazol

    tablet

    • 50mg
    • 100mg