cilostazol (Pletal)
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Introduction
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
- headache (34%)
- diarrhea (19%)
- palpitations (10%)
- dizziness (10%)
Drug interactions
- inhibitors of cyt P450 3A4
- grapefruit juice
- inhibitors of cyt P450 2C19
- drug interaction(s) of anti-platelet agents with SSRIs
- drug interaction(s) of antiplatelet agents with proton pump inhibitors
- drug interaction(s) of warfarin with antiplatelet agents
Mechanism of action
- inhibition of platelet aggregation
- inhibits phosphodiesterase-3
- inhibits production of thromboxane B2
- inhibits release of platelet-derived growth factor
- vasodilation
More general terms
Component of
References
- ↑ 1.0 1.1 Kaiser Permanente Northern California Regional Drug Formulary, Update 9/99
- ↑ 2.0 2.1 Prescriber's Letter 7(12):69 2000
- ↑ 3.0 3.1 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: https://www.ncbi.nlm.nih.gov/pubmed/18456558
Hankey GJ Cilostazol shows promise as alternative to aspirin for patients with ischaemic stroke. Lancet Neurol 2008, 7:469 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18456559 (industry-sponsored) - ↑ 4.0 4.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20833591 <Internet> http://www.thelancet.com/journals/laneur/article/PIIS1474-4422%2810%2970198-8/abstract
- ↑ 5.0 5.1 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: https://www.ncbi.nlm.nih.gov/pubmed/20385711
- ↑ 6.0 6.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17, 18. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2018.
- ↑ 7.0 7.1 7.2 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: https://www.ncbi.nlm.nih.gov/pubmed/35074890 https://n.neurology.org/content/early/2022/01/24/WNL.0000000000200064
- ↑ 8.0 8.1 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: https://www.ncbi.nlm.nih.gov/pubmed/36682741 https://onlinelibrary.wiley.com/doi/abs/10.1111/ggi.14542