From the Guidelines
Cilostazol is an effective medication for intermittent claudication in peripheral artery disease, typically prescribed at 100 mg twice daily, as recommended by the most recent guidelines 1. The standard starting and maintenance dose is 100 mg twice daily, though some patients may require a reduced dose of 50 mg twice daily if they experience side effects or take interacting medications. Cilostazol works through a dual mechanism: it inhibits phosphodiesterase type 3 (PDE3), which increases intracellular cyclic adenosine monophosphate (cAMP) levels, leading to vasodilation and improved blood flow to ischemic limbs. Additionally, it inhibits platelet aggregation, which helps prevent thrombosis formation. Some key points to consider when prescribing cilostazol include:
- Clinical improvement typically takes 2-12 weeks to manifest, with patients experiencing increased walking distance and reduced claudication symptoms 1.
- Patients should be advised that cilostazol is contraindicated in heart failure due to its potential to increase mortality in these patients 1.
- Common side effects include headache, diarrhea, palpitations, and dizziness, which often improve with continued use 1.
- For optimal results, cilostazol should be used as part of a comprehensive approach that includes smoking cessation, exercise therapy, and management of other cardiovascular risk factors 1. It is essential to weigh the potential benefits of cilostazol against its potential risks and consider alternative treatments, such as pentoxifylline or chelation therapy, although these have been shown to be less effective or not recommended for claudication treatment 1.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Mechanism of Action: The mechanism of the effects of cilostazol on the symptoms of intermittent claudication is not fully understood Cilostazol and several of its metabolites are cyclic AMP (cAMP) phosphodiesterase III inhibitors (PDE III inhibitors), inhibiting phosphodiesterase activity and suppressing cAMP degradation with a resultant increase in cAMP in platelet and blood vessels, leading to inhibition of platelet aggregation and vasodilation, respectively INDICATIONS AND USAGE Cilostazol tablets are indicated for the reduction of symptoms of intermittent claudication, as indicated by an increased walking distance.
Cilostazol Mechanism and Dosing:
- Cilostazol is a phosphodiesterase 3 inhibitor (PDE III inhibitor) that inhibits phosphodiesterase activity, leading to an increase in cAMP in platelets and blood vessels.
- This results in inhibition of platelet aggregation and vasodilation.
- The dosing of cilostazol for intermittent claudication is 100 mg b.i.d. (twice a day) as indicated by the reduction of symptoms of intermittent claudication, with an increased walking distance 2, 2.
- Key Effects:
- Inhibition of platelet aggregation
- Vasodilation
- Increased walking distance in patients with intermittent claudication.
From the Research
Mechanism of Action
- Cilostazol is a phosphodiesterase 3 inhibitor that works by increasing cyclic adenosine monophosphate (cAMP) levels, leading to antiplatelet, antiproliferative, vasodilatory, and ischemic-reperfusion protective properties 3.
- It inhibits vascular smooth muscle cell proliferation, mitigating restenosis, and has been shown to be effective in improving walking distance in patients with intermittent claudication secondary to peripheral artery disease (PAD) 4, 5, 6.
Dosing
- The typical dosing of cilostazol for intermittent claudication is 100 mg twice daily, with some studies also using 50 mg and 150 mg twice daily 4, 6.
- The dosage of cilostazol may vary depending on the specific clinical application, with some studies using doses ranging from 100 mg to 300 mg per day 6, 7.
Clinical Applications
- Cilostazol has been primarily used in the treatment of intermittent claudication, with studies showing significant improvements in walking distance and quality of life 4, 5, 6.
- It has also been investigated for use in other clinical settings, including as an adjunctive therapy for reduction of restenosis after coronary and peripheral endovascular interventions, and in the prevention of secondary stroke 7, 3.
- Cilostazol may be a useful alternative in patients who are allergic or intolerant to classical antithrombotic agents, such as aspirin or clopidogrel 7.