Cilostazol
Indications
Cilostazol is used for:
Peripheral vascular disease, Intermittent claudication
Adult Dose
Oral
Peripheral vascular disease
Adult: 100 mg bid.
May reduce dose in patients taking enzyme inhibitors concurrently.
Hepatic Impairment
Moderate to severe: Use caution
Child Dose
Renal Dose
Renal Impairment
CrCl< 25 mL/min: Use caution
Administration
Should be taken on an empty stomach. Take at least ½ hr before or 2 hr after meals.
Contra Indications
Heart failure; known predisposition to bleeding; history of ventricular arrhythmias; QT interval prolongation; severe renal impairment; moderate to severe hepatic impairment.
Precautions
Congestive heart disease. Concurrent therapy with clopidogrel has not been studied for safety or efficacy. Pregnancy and lactation.
Lactation: Excretion in milk unknown; not recommended
Pregnancy-Lactation
Pregnancy category: C
Lactation: Excretion in milk unknown; not recommended
Interactions
Co-admin with drugs that affect CYP3A4 (erythromycin, other macrolides, diltiazem) or CYP2C19 (omeprazole) may influence the pharmacokinetics of cilostazol.
Adverse Effects
Side effects of Cilostazol :
>10%
Headache (27-34%), Diarrhea (12-19%), Abnormal stools (12-15%), Infection (10-14%), Rhinitis (7-12%), Pharyngitis (7-10%)
1-10%
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
Frequency Not Defined
Decreased platelet aggregation, Agranulocytosis, Aplastic anemia, Leukopenia, Thrombocytopenia, Stevens-Johnson syndrome
Mechanism of Action
Cilostazol is a reversible, selective inhibitor of phosphodiesterase-III (PDE-III), thereby suppressing cyclic adenosine monophosphate (cAMP) degradation. Increase in cAMP in platelets and blood vessels leads to inhibition of platelet aggregation and vasodilation. Cilostazol also inhibits adenosine uptake into cells, which augments the cAMP-elevating effect of PDE-III inhibition.