Cilostazol and Facial Flushing
Facial flushing is not listed among the documented side effects of cilostazol based on the available evidence.
Common Side Effects of Cilostazol
According to the ACC/AHA guidelines and FDA labeling, the most common side effects of cilostazol include 1:
- Headache (most frequent adverse effect, leading to discontinuation in 1.3-3.7% of patients depending on dose)
- Diarrhea
- Abnormal stools
- Palpitations
- Dizziness
Additional side effects reported in clinical trials include 2, 3:
- Infection
- Rhinitis
- Peripheral edema
- Pharyngitis
- Nausea
Analysis of the Safety Database
A comprehensive safety analysis of 8 phase 3 controlled clinical trials involving 2,702 patients (representing 475 patient-exposure years on cilostazol) did not identify facial flushing as a reported adverse event 4. The safety profile was consistent across multiple studies, with headache, gastrointestinal complaints, and palpitations being the predominant side effects.
Mechanism and Cardiovascular Effects
Cilostazol is a phosphodiesterase III inhibitor that causes vasodilation through increased cyclic AMP 1, 5. While the drug does produce vasodilation in vascular beds (with greater dilation in femoral beds than in vertebral, carotid, or superior mesenteric arteries), this vasodilatory effect has not been associated with facial flushing in clinical trials 5.
Clinical Caveat
While facial flushing is not a documented side effect of cilostazol, patients should be counseled about the common adverse effects, particularly headache and gastrointestinal symptoms, which occur more frequently. Headache may be severe enough to require discontinuation in approximately 2-4% of patients on the standard 100 mg twice daily dose 1, 4. It may be valuable to assess patient tolerance at 2-4 weeks and evaluate benefit within 3-6 months to determine whether long-term therapy is appropriate 1.