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cilostazol (Pletal)

Tradename: Pletal. Indications: - intermittent claudication [5] - improves pain-free walking & overall walking distance [6] - more effective than pentoxifylline (Trental) [2] - studies have NOT demonstrated benefit for intermittent claudication relative to placebo [1] - secondary prevention of ischemic stroke [3,4] - for use in combination with aspirin or clopidogrel [7] - cilostazol may help to preserve general cognitive function, including preservation in category fluency [8] Contraindications: - congestive heart failure or LVEF < 40% Dosage: - 100 mg PO BID - for secondary stroke prevention start 15-180 days after index stroke in combination with aspirin or clopidogrel [7] Pharmacokinetics: - metabolized by cyt P450 3A4 & to a lesser extent 2C19 Adverse effects: 1) headache (34%) 2) diarrhea (19%) 3) palpitations (10%) 4) dizziness (10%) Drug interactions: 1) inhibitors of cyt P450 3A4 a) ketoconazole b) itraconazole c) erythromycin d) diltiazem 3) grapefruit juice 2) inhibitors of cyt P450 2C19 - omeprazole Mechanism of action: 1) inhibition of platelet aggregation a) inhibits phosphodiesterase-3 b) inhibits production of thromboxane B2 c) inhibits release of platelet-derived growth factor 2) vasodilation

Interactions

drug interactions drug adverse effects (more general classes)

General

antiplatelet agent enzyme inhibitor

Properties

INHIBITS: phosphodiesterase :ENGLISH phosphodiesterase-3

Database Correlations

PUBCHEM cid=2754

References

  1. Kaiser Permanente Northern California Regional Drug Formulary, Update 9/99
  2. Prescriber's Letter 7(12):69 2000
  3. Huang Y et al for the CASISP cooperation investigators. Cilostazol as an alternative to aspirin after ischaemic stroke: A randomized, double-blind, pilot study. Lancet Neurol 2008, 7:494 PMID: 18456558 - Hankey GJ Cilostazol shows promise as alternative to aspirin for patients with ischaemic stroke. Lancet Neurol 2008, 7:469 PMID: 18456559 (industry-sponsored)
  4. Shinohara Y et al, Cilostazol for prevention of secondary stroke (CSPS 2): an aspirin-controlled, double-blind, randomised non-inferiority trial The Lancet Neurology, Early Online Publication, 11 September 2010doi:10.1016/S1474-4422(10)70198-8C PMID: 20833591 http://www.thelancet.com/journals/laneur/article/PIIS1474-4422%2810%2970198-8/abstract
  5. Pande RL, Hiatt WR, Zhang P, Hittel N, Creager MA A pooled analysis of the durability and predictors of treatment response of cilostazol in patients with intermittent claudication. Vasc Med. 2010 Jun;15(3):181-8 PMID: 20385711
  6. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17, 18. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2018.
  7. Toyoda K et al. Association of timing for starting dual antiplatelet treatment with cilostazol and recurrent stroke: A CSPS.com trial post hoc analysis. Neurology 2022 Jan 24; [e-pub]. PMID: 35074890 https://n.neurology.org/content/early/2022/01/24/WNL.0000000000200064
  8. Chien CG, Huang LC, Li KY, Yang YH. Cognitive effects of cilostazol in Alzheimer's dementia patients with peripheral arterial occlusive disease: A case-control study. Geriatrics Gerontology International. 2023. Jan 23 PMID: 36682741 https://onlinelibrary.wiley.com/doi/abs/10.1111/ggi.14542

Component-of

cilostazol/isosorbide mononitrate