Yes, Cilostazol Commonly Causes Dizziness
Dizziness is one of the most common side effects of cilostazol and occurs frequently enough to warrant counseling patients about this adverse effect before initiating therapy.
Evidence from Guidelines and Clinical Trials
According to the ACC/AHA 2005 Practice Guidelines for Peripheral Arterial Disease, the most common side effects of cilostazol include headache, diarrhea, abnormal stools, palpitations, and dizziness 1. This finding has been consistently replicated across multiple high-quality studies.
The 2012 American College of Chest Physicians guidelines further confirm that headache, diarrhea, palpitation, dizziness, and tachycardia were more frequent with cilostazol than with aspirin in the CSPS-2 study of 2,757 patients, contributing to an almost twofold higher rate of drug discontinuation (20% vs 12%) 2.
Clinical Significance
The 2024 ACC/AHA/AACVPR Lower Extremity PAD Guidelines emphasize that when considering cilostazol therapy, adverse effects including headache, diarrhea, dizziness, and palpitations should be weighed against potential benefit 3. Notably, in one case series, 20% of patients discontinued cilostazol within 3 months, often due to these side effects.
Mechanism
The dizziness likely results from cilostazol's vasodilatory properties as a phosphodiesterase III inhibitor, which causes non-homogeneous dilation of vascular beds and can affect blood pressure regulation 4.
Practical Management Considerations
- Assess patient tolerance at 2 to 4 weeks after initiation 3
- Evaluate benefit within 3 to 6 months to determine whether long-term therapy is justified 3
- Counsel patients that dizziness is a common, expected side effect that may improve with continued use
- Consider dose adjustment or discontinuation if dizziness significantly impairs quality of life or increases fall risk
Multiple systematic reviews confirm this adverse effect profile, with dizziness consistently reported as one of the primary reasons for treatment discontinuation 5, 6, 7, 8, 9.