Cilostazol

Administration

• Type: Antiplatelet
• Dosage Forms: 50 mg, 100 mg
• Routes of Administration: Oral
• Common Trade Names: Pletal

Adult Dosing

Intermittent claudication

• 100 mg PO bid

Pediatric Dosing

Safety/efficacy not established in pediatric patients

Special Populations

Pregnancy Rating

• Caution advised during pregnancy
• No risk of fetal harm, teratogenicity, or death
• Increased risk of maternal bleeding during delivery

Lactation risk

• Caution advised while breastfeeding

Renal Dosing

• Adult: No adjustment
• Pediatric: Unavailable

Hepatic Dosing

• Adult: No adjustment
• Pediatric: Unavailable

Contraindications

• Allergy to class/drug
• CHF
• Hemostatic disorders
• Active bleeding

Adverse Reactions

Serious

• Bleeding
• Angina, MI
• Tachyarrhythmia
• Thrombocytopenia
• Leukopenia, Agranulocytosis
• Anaphylaxis
• Stevens-Johnson Syndrome

Common

• Headache
• Diarrhea, Abnormal stools, abdominal pain
• Palpitations, dizziness, tachycardia
• Peripheral edema
• Dyspepsia

Pharmacology

• Half-life: 11-13 hours; active metabolites
• Metabolism: Liver; CYP450: 2C19, 3A4
• Excretion: Urine 74%, feces 20%

Mechanism of Action

• Inhibits phosphodiesterase type 3, reducing platelet aggregation
• Suppresses cAMP degradation, producing vasodilation

See Also

• Antiplatelet medications
• Antiplatelet agent reversal

References

• Lexicomp
• Bramer SL, Forbes WP. Effect of hepatic impairment on the pharmacokinetics of a single dose of cilostazol. Clin Pharmacokinet. 1999;37 S(suppl 2):25-32. [PubMed 10702884]
• Douglas JS Jr, Holmes DR Jr, Kereiakes DJ, et al, “Coronary Stent Restenosis in Patients Treated With Cilostazol,” Circulation, 2005, 112(18 ):2826-32. [PubMed 16246948]
• Ferraris VA, Saha SP, Oestreich JH, et al, “2012 Update to the Society of Thoracic Surgeons Guideline on Use of Antiplatelet Drugs in Patients Having Cardiac and Noncardiac Operations,” Ann Thorac Surg, 2012, 94(5):1761-81. [PubMed 23098967]
• Frontera JA, Lewin JJ 3rd, Rabinstein AA, et al; Guideline for reversal of antithrombotics in intracranial hemorrhage: a statement for healthcare professionals from the Neurocritical Care Society and Society of Critical Care Medicine. Neurocrit Care. 2016;24(1):6-46. [PubMed 26714677]
• Guyatt GH, Akl EA, Crowther M, et al, “Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines,” Chest, 2012, 141(2 Suppl):7-47. [PubMed 22315257]
• Hirsch AT, Haskal ZJ, Hertzer NR, et al, “ACC/AHA Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): Executive Summary. A Collaborative Report of the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease),” Circulation , 2006, 113(11):e463-654. Available at http://www.acc.org/clinical/guidelines/pad/index.pdf16549646
• Kim JS, Lee KS, Kim YI, Tamai Y, Nakahata R, Takami H. A randomized crossover comparative study of aspirin, cilostazol and clopidogrel in normal controls: analysis with quantitative bleeding time and platelet aggregation test. J Clin Neurosci. 2004;11(6):600-602. [PubMed 15261228]