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BRAND NAME: Pletal
DRUG CLASS AND MECHANISM: Cilostazol is a medication for the treatment of intermittent claudication, a condition caused by narrowing of the arteries that supply the legs with blood. Patients with intermittent claudication develop pain when they walk because not enough oxygen-containing blood reaches the active leg muscles. Cilostazol reduces the pain of intermittent claudication by dilating the arteries, thereby improving the flow of blood and oxygen to the legs. (It does this by decreasing the action of an enzyme, phosphodiesterase III.) It also reduces the ability of blood to clot. Cilostazol enables patients with intermittent claudication to walk longer and faster before developing pain. Cilostazol has a different mechanism of action than pentoxifylline (Trental), the other approved drug for intermittent claudication. (Pentoxifylline improves blood flow by making it easier for red blood cells to pass through vessels. It also decreases the viscosity of blood.)
GENERIC AVAILABLE: No
PRESCRIPTION: Yes
PREPARATIONS: 50 mg tablets, white, triangular and marked Pletal 50; 100 mg tablets, white, round and marked Pletal 100.
STORAGE: Tablets should be stored below 25C (77F). Brief trips to 30C (86F) are allowed.
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PRESCRIBED FOR: Cilostazol improves walking speed and walking distance among patients with intermittent claudication. It does not cure intermittent claudication. Cilostazol has not been studied in patients with leg pain at rest, leg ulcers due to reduced flow of blood, gangrene or rapidly progressing claudication.
DOSING: The dose is 100 mg twice daily. Cilostazol should be taken at least half an hour before or two hours after dinner and breakfast to prevent food from affecting its absorption.
DRUG INTERACTIONS: Erythromycin (E.E.S, Erythrocin), omeprazole (Prilosec) and diltiazem (Cardizem) increase the concentration of cilostazol by blocking the action of enzymes that destroy cilostazol. Though not specifically studied, a similar interaction could occur with ketoconazole (Nizoral), itraconazole (Sporanox), fluconazole (Diflucan), miconazole (Monistat), fluvoxamine (Luvox), fluoxetine (Prozac), nefazodone (Serzone) and sertraline (Zoloft). Higher concentrations of cilostazol could increase the possibility of toxic effects. Therefore, a dose of 50 mg twice daily should be considered when drugs that may increase the concentration of cilostazol also are being used.
In pre-marketing studies, cilostazol did not increase the occurrence of bleeding in individuals who were also taking aspirin.
A high fat meal increases the absorption of cilostazol. Grapefruit juice could increase the concentration of cilostazol. Therefore, grapefruit juice should not be taken by patients on cilostazol.
PREGNANCY: The use of cilostazol in pregnancy has not been adequately studied.
NURSING MOTHERS: Cilostazol has not been adequately studied in nursing mothers.
SIDE EFFECTS:The most common adverse effects are headache, abdominal pain, diarrhea, nausea, fluid retention, dizziness and an abnormal heartbeat.
Cilostazol inhibits the enzyme phosphodiesterase III. Other drugs that inhibit this enzyme have caused death in individuals with heart failure. Therefore, individuals with heart failure should not use cilostazol.
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