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Cilostazol

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Cilostazol, Pletal

  • See Also
  1. Peripheral Arterial Disease
  2. Antiplatelet Therapy for Vascular Disease
  3. Dipyridamole
  4. Pentoxifylline
  • Indications
  1. Intermittent Claudication
    1. Adjunct while taking other antiplatelet medication (e.g. Aspirin, Clopidogrel)
  • Contraindications
  1. Congestive Heart Failure (increased mortality)
  2. Caution in severe hepatic insufficiency
  3. Caution in GFR <25 ml/min
  • Mechanism
  1. Quinolinone derivative
  2. Inhibits phosphodiesterase 3 (PDE3) leading to higher levels of cAMP within Platelets and vessels
  3. Inhibits Platelet aggregation
  4. Also promotes vasodilation
  • Dosing
  1. Take 100 mg orally twice daily on an empty Stomach
  2. Indications for half dose (50 mg orally twice daily)
    1. Use of strong CYP3A4 Inhibitors (e.g. Itraconazole, Erythromycin)
    2. Use of strong CYP2C19 Inhibitors (e.g. Omeprazole)
  • Adverse Effects
  1. Headache
  2. Palpitations
  3. Left Ventricular Outflow Obstruction
    1. Increased risk in patients with sigmoid shaped interventricular septum
  • Safety
  1. Pregnancy Category C
  2. Unknown safety in Lactation
  • Drug Interactions
  1. CYP3A4 Inhibitors (e.g. Itraconazole, Erythromycin)
  2. CYP2C19 Inhibitors (e.g. Omeprazole)
  3. Grapefruit juice
    1. Increases Cilostazol levels
  • Efficacy
  1. Full effect may be delayed for 12 weeks
  • Resources
  1. Cilostazol
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=9ffdb1e8-fdc8-44d4-b558-210954138b2f
  • References
  1. Balinski (2023) Cilostazol, StatPearls, Treasure Island
    1. https://www.ncbi.nlm.nih.gov/books/NBK544363/
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia