Cilostazol
PLETAL
What it isPDE3 inhibitor with antiplatelet and vasodilator effects; intermittent claudication.
Why this oneIt is the only oral drug with consistent walking-distance benefit in claudication; pentoxifylline is ineffective.
What limits itContraindicated in heart failure of any severity — PDE3 inhibitors raised mortality. Headache is common; CYP3A4 and CYP2C19 dependent.
FDA-approved for
- intermittent claudication (1999)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Intermittent claudication | Adults | 100 mg BID | 100 mg BID | 100 mg BID |
| Intermittent claudication — with CYP3A4 or CYP2C19 inhibitors | Adults | 50 mg BID | 50 mg BID | 50 mg BID |
Renal Undefined
Hepatic Undefined
Reduce to 50 mg BID with strong/moderate CYP3A4 inhibitors (ketoconazole, itraconazole, erythromycin, diltiazem) or CYP2C19 inhibitors (ticlopidine, fluconazole, omeprazole)
Instructions
- Take at least 30 min before or 2 hours after breakfast and dinner
- Beneficial effect may take up to 12 weeks; discontinue if no improvement after 3 months
Contraindications
- Heart failure of any severity
Cautions
- Tachycardia, palpitation, tachyarrhythmia, hypotension; may exacerbate angina/MI in ischemic heart disease
- Left ventricular outflow tract obstruction in patients with sigmoid interventricular septum
- Thrombocytopenia/leukopenia progressing to agranulocytosis — monitor platelets and WBC
- Avoid in hemostatic disorders or active pathologic bleeding
Adverse reactions
- Headache
- Diarrhea, abnormal stools
- Palpitation
Pregnancy Category C; teratogenic/fetotoxic in animals — no adequate human studies
Lactation Transferred into milk in animals — discontinue nursing or the drug
⚠ BOXED WARNING
- Contraindicated in heart failure of any severity
Cost, est. cash$4–$300/month
Generic entry2004
Classes and tags
Clinical profile
Legacy pregnancy categoryB
Defining liabilityGI or intracranial bleeding, especially with anticoagulants, NSAIDs or serotonergic antidepressants.
Mechanism of action: Cilostazol ballicule
Open Cilostazol in the interactive console ↗
Memory aids: mascots and interaction avatars
Plate-lets
