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.