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Cilostazol

Medical and Pharmacy Editor:

Brand Name: Pletal

Generic Name: cilostazol

Drug Class: Antiplatelet Agents, Hematologic; PDE-3 Inhibitors; Phospholipase A2 Inhibitors

What Is Cilostazol and How Does It Work?

Cilostazol is a quinolinone derivative used for treatment of intermittent claudication and peripheral vascular disease.

Cilostazol is available under the following different brand names: Pletal.

Dosages of Cilostazol:

Dosage Forms and Strengths

Tablet

  • 59 mg
  • 100 mg

Dosage Considerations – Should be Given as Follows:

Peripheral Vascular Disease

Postmenopausal women

  • 100 mg orally every 12 hours 30 minutes before or 2 hours after meals

Dosing considerations

  • CYP2C19 or CYP3A4 inhibitors: Reduce dosage to 50 mg orally every 12 hours

Thrombotic Complications of Coronary Angioplasty (Off-label)

  • 100 mg every 12 hours 30 minutes before or 2 hours after meals

Renal Impairment

  • CrCl less than 25 mL/min: Use caution

Hepatic Impairment

  • Moderate to severe: Use caution

Pediatric

  • Safety and efficacy not established

What Are Side Effects Associated with Using Cilostazol?

Side effects of cilostazol include:

Other side effects of cilostazol include:

Postmarketing side effects of cilostazol reported include:

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

What Other Drugs Interact with Cilostazol?

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Cilostazol has no known severe interactions with other drugs.

Cilostazol has serious interactions with at least 38 different drugs.

Cilostazol has moderate interactions with at least 111 different drugs.

Mild interactions of cilostazol include:

This information does not contain all possible interactions or adverse effects. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions, concerns or for more information about this medicine.

What Are Warnings and Precautions for Cilostazol?

Warnings

  • Cilostazol and metabolites are inhibitors of phosphodiesterase III; such activity has been shown to decrease survival of patients with class III-IV congestive heart failure (CHF); contraindicated in patients with CHF of any severity
  • This medication contains cilostazol. Do not take Pletal if you are allergic to cilostazol or any ingredients contained in this drug

Contraindications

  • Congestive heart failure of any severity
  • Hypersensitivity
  • Hemostatic disorders or active pathologic bleeding (e.g., bleeding peptic ulcer, intracranial bleeding) due to reversible platelet aggregation

Effects of Drug Abuse

  • No information available

Short-Term Effects

  • See "What Are Side Effects Associated with Using Cilostazol?"

Long-Term Effects

  • See "What Are Side Effects Associated with Using Cilostazol?"

Cautions

  • Use with caution in liver and renal disease
  • Leukopenia that progresses to agranulocytosis may occur (in which case, discontinue therapy)
  • Discontinue therapy if thrombocytopenia occurs
  • Use with caution in patients taking platelet aggregation inhibitors
  • 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
  • Dosage can be reduced or discontinued without rebound effects (e.g., platelet hyperaggregability)
  • Cilostazol may induce fast heart rate (tachycardia), palpitation, tachyarrhythmia and/or low blood pressure (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 (e.g., ketoconazole, itraconazole, erythromycin, diltiazem) and strong CYP2C19 inhibitors (e.g., ticlopidine, fluconazole, omeprazole); dose reduction to 50 mg twice daily should be considered

Pregnancy and Lactation

  • Use cilostazol with caution during pregnancy if benefits outweigh risks. Animal studies show risk and human studies are not available or neither animal nor human studies were done
  • Cilostazol excretion in milk is unknown; it is not recommended for use if breastfeeding
Reviewed on 5/1/2017

Medscape. Cilostazol.
https://reference.medscape.com/drug/pletal-cilostazol-342136
RxList. Pletal Side Effects Center.
https://www.rxlist.com/pletal-side-effects-drug-center.htm

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