Cilostazol and Hypotension

Yes, cilostazol can cause blood pressure to drop due to its vasodilatory properties as a phosphodiesterase type 3 (PDE III) inhibitor. 1, 2

Mechanism of Action and Cardiovascular Effects

Cilostazol is a PDE III inhibitor that increases intracellular cyclic AMP (cAMP), which accounts for both its vasodilatory effects and potential cardiovascular side effects 1, 2
It produces non-homogeneous dilation of vascular beds, with greater dilation in femoral beds than in vertebral, carotid, or superior mesenteric arteries 2
The vasodilatory effect is one of the primary mechanisms by which cilostazol improves symptoms in patients with intermittent claudication 1

Common cardiovascular side effects include:
- Palpitations 1, 3
- Tachycardia 3
- Dizziness 1
- Peripheral edema 4
In clinical studies, heart rate increased in a dose-proportional manner by a mean of 5.1 and 7.4 beats per minute in patients treated with 50 and 100 mg twice daily, respectively 2

Cilostazol is absolutely contraindicated in patients with heart failure of any severity due to the increased risk of ventricular tachycardia 1, 3
The FDA has mandated a black-box warning that cilostazol should not be used in patients with heart failure 1
Patients with pre-existing hypotension may be at higher risk for symptomatic drops in blood pressure 2

Approximately 20% of patients discontinue cilostazol within the first 3 months due to side effects, including cardiovascular effects 3
For patients requiring long-term cilostazol therapy, evaluate tolerance at 2-4 weeks after initiation 3
Assess clinical benefit within 3-6 months of starting therapy 3
Consider dose reduction to 50 mg twice daily if the standard dose of 100 mg twice daily causes intolerable hypotension or other cardiovascular side effects 1

Significant drug interactions are observed when cilostazol is coadministered with other agents that inhibit cytochrome P450 (CYP) 3A4 or CYP2C19, which may increase cilostazol levels and potentially exacerbate hypotensive effects 4
In Europe, cilostazol is contraindicated in patients receiving CYP3A4 or CYP2C19 inhibitors 4
In the US, dosage reduction for cilostazol should be considered during coadministration with CYP3A4 or CYP2C19 inhibitors 4

Monitor blood pressure after initiating therapy, particularly in patients with pre-existing cardiovascular conditions 2
Be vigilant for symptoms of hypotension such as dizziness, lightheadedness, or syncope 1
If significant hypotension occurs, consider dose reduction or discontinuation of the medication 3