Cilostazol
Cilostazol (Pletal)
Cilostazol
(sih- LESS-tah-zohl)
Pregnancy Category: C Pletal (Rx)

Classification: Antiplatelet drug

Action/Kinetics: Inhibits cellular phosphodiesterase (PDE), especially PDE III. Cilostazol and several metabolites inhibit cyclic AMP PDE III. Suppression of this isoenzyme causes increased levels of cyclic AMP resulting in vasodilation and inhibition of platelet aggregation. Inhibits platelet aggregation caused by thrombin, ADP, collagen, arachidonic acid, epinephrine, and shear stress. High fat meals significantly increase absorption. Significantly plasma protein bound. Extensively metabolized by the liver with two of the metabolites being active. Primarily excreted through the urine (74%) with the rest in the feces.

Uses: Reduce symptoms of intermittent claudication.

Contraindications: CHF of any severity (may cause a decreased survival rate in clients with class III-IV CHF). Concurrent use of grapefruit juice. Lactation.

Special Concerns: Safety and efficacy have not been determined in children.

Side Effects: GI: Abnormal stool, diarrhea, dyspepsia, flatulence, N&V;, abdominal pain, anorexia, cholelithiasis, colitis, duodenal ulcer, duodenitis, esophageal hemorrhage, esophagitis, gastritis, gastroenteritis, gum hemorrhage, hematemesis, melena, gastric ulcer, periodontal abscess, rectal hemorrhage, stomach ulcer, tongue edema. CNS: Headache, dizziness, vertigo, anxiety, insomnia, neuralgia. CV: Palpitation, tachycardia, hypertension, angina pectoris, atrial fibrillation/flutter, cerebral infarct, cerebral ischemia, CHF, heart arrest, hemorrhage hypotension, MI, myocardial ischemia, nodal arrhythmia, postural hypotension, supraventricular tachycardia, syncope, varicose veins, vasodilation, ventricular extrasystole or ventricular tachycardia Respiratory: Rhinitis, pharyngitis, increased cough, dyspnea, bronchitis, asthma, epistaxis, hemoptysis, pneumonia, sinusitis. Musculoskeletal: Back pain, myalgia, asthenia, leg cramps, arthritis, arthralgia, bone pain, bursitis. Dermatologic: Rash, dry skin, furunculosis, skin hypertrophy, urticaria. GU: Hematuria, UTI, cystitis, urinary frequency, vaginal hemorrhage, vaginitis. Hematologic: Anemia, ecchymosis, iron deficiency anemia, polycythemia, purpura. Ophthalmic: Amblyopia, blindness, conjunctivitis, diplopia, eye hemorrhage, retinal hemorrhage. Miscellaneous: Infection, peripheral edema, hyperesthesia, paresthesia, flu syndrome, ear pain, tinnitus, chills, facial edema, fever, generalized edema, malaise, neck rigidity, pelvic pain, retroperitoneal hemorrhage diabetes mellitus.

Laboratory Test Alterations: GGT, creatinine. Albuminuria, hyperlipemia, hyperuricemia.

Overdose Management: Symptoms: Severe headache, diarrhea, hypotension, tachycardia, possible cardiac arrhythmias. Treatment: Observe client carefully and provide symptomatic treatment.

Drug Interactions: Diltiazem, erythromycin, grapefruit juice, itraconazole, ketoconazole, macrolide antibiotics, and omeprazole inhibit liver enzymes that breakdown cilostazol, resulting in plasma levels. Reduce dose of these drugs if used concomitantly.

How Supplied: Tablets: 50 mg, 100 mg

Dosage
?Tablets Intermittent claudication.
100 mg b.i.d. taken 30 min or more before or 2 hr after breakfast and dinner. Consider a dose of 50 mg b.i.d. during coadministration of diltiazem, erythromycin, itraconazole, or ketoconazole.