From the Research
Cilostazol may be prescribed off-label for Raynaud's phenomenon at a dose of 100 mg twice daily, as this dose has been shown to increase brachial artery diameter in patients with primary and secondary Raynaud's syndrome 1.
Key Considerations
- The typical starting dose is 50 mg twice daily, taken at least 30 minutes before or 2 hours after meals, as food affects absorption.
- If well-tolerated, the dose may be increased to 100 mg twice daily.
- Cilostazol works by inhibiting phosphodiesterase III, which leads to vasodilation and reduced platelet aggregation, potentially improving blood flow to the extremities affected by Raynaud's.
- Patients should be aware that it may take 2-4 weeks to see clinical improvement.
Important Safety Information
- Common side effects include headache, diarrhea, and dizziness.
- Cilostazol is contraindicated in patients with heart failure, and caution should be exercised in patients taking other medications that inhibit CYP3A4 or CYP2C19 enzymes, as drug interactions may occur.
- Regular follow-up with a healthcare provider is necessary to monitor effectiveness and adjust dosing as needed.
Evidence Summary
- A study published in 2003 found that cilostazol 100 mg twice daily increased brachial artery diameter in patients with primary and secondary Raynaud's syndrome 1.
- More recent studies have focused on the use of cilostazol for intermittent claudication, but the dose of 100 mg twice daily has been consistently shown to be effective and well-tolerated 2, 3.
- The most recent and highest quality study, a 2021 Cochrane review, found that cilostazol improved walking distance in people with intermittent claudication, but noted that the evidence for its use in Raynaud's phenomenon is limited 2.