What is the use of Cilostazol (Pletal)?

From the Guidelines

Cilostazol is recommended as a first-line treatment for intermittent claudication in patients with lower extremity peripheral artery disease, at a standard dose of 100 mg taken twice daily, due to its effectiveness in improving symptoms and increasing walking distance, as supported by the most recent guidelines from the American College of Cardiology and American Heart Association 1.

Key Points

• Cilostazol works by inhibiting phosphodiesterase type 3, which prevents platelet aggregation and causes vasodilation, improving blood flow to the legs.
• It is contraindicated in patients with heart failure, as it can worsen this condition.
• Common side effects include headache, diarrhea, dizziness, and palpitations.
• Patients should take cilostazol consistently for at least 12 weeks to evaluate its effectiveness, as symptom improvement may take time.
• For optimal results, cilostazol should be combined with lifestyle modifications such as smoking cessation, regular exercise, and proper diet.

Considerations

• Potential adverse effects, risks, and cost should be weighed against potential benefit when considering cilostazol therapy.
• It may be valuable to assess patient tolerance of cilostazol at 2 to 4 weeks and to evaluate benefit within 3 to 6 months to determine whether long-term therapy will be beneficial.
• Cilostazol has also shown potential benefit in prevention of in-stent restenosis in patients who have undergone stenting of the femoropopliteal segment, as supported by recent data 1.

Important Interactions

• Patients should inform healthcare providers about all medications they're taking, as cilostazol interacts with several drugs including certain antibiotics, antifungals, and medications metabolized by CYP3A4 or CYP2C19 enzymes.
• Patients should not abruptly discontinue cilostazol, and healthcare providers should monitor for potential side effects and interactions.

From the FDA Drug Label

INDICATIONS AND USAGE Cilostazol tablets are indicated for the reduction of symptoms of intermittent claudication, as indicated by an increased walking distance.

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

• Main Use: Cilostazol is used for the reduction of symptoms of intermittent claudication.
• Key Mechanism: It works by inhibiting phosphodiesterase III (PDE III), leading to inhibition of platelet aggregation and vasodilation.
• The exact mechanism of how cilostazol reduces symptoms of intermittent claudication is not fully understood 2 2.

From the Research

Overview of Cilostazol

• Cilostazol is a phosphodiesterase III inhibitor used to treat intermittent claudication and increase walking distance in patients with peripheral arterial disease (PAD) 3.
• It has antiplatelet and vasodilatory effects, and has been shown to improve walking distance and quality of life in patients with intermittent claudication 4.

Efficacy of Cilostazol

• Cilostazol has been shown to improve initial and absolute claudication distances in patients with intermittent claudication 5, 6.
• It has been compared to pentoxifylline, another medication used to treat intermittent claudication, and has been found to be more effective in improving walking distance 5, 6.
• Cilostazol has also been shown to improve quality of life in patients with intermittent claudication, although the evidence is limited 5, 6.

Safety of Cilostazol

• Cilostazol has been found to be generally safe, with common adverse events including headache, diarrhea, and palpitations 3, 5, 6.
• There is no evidence to suggest that cilostazol increases the risk of serious adverse events, such as cardiovascular events or mortality 3, 5, 6.
• However, the evidence is limited, and further studies are needed to fully assess the safety of cilostazol 5, 6.

Comparison to Other Treatments

• Cilostazol has been compared to pentoxifylline, and has been found to be more effective in improving walking distance 5, 6.
• It has also been compared to placebo, and has been found to be effective in improving walking distance and quality of life 3, 5, 6.
• Other classes of drugs, such as platelet antiaggregants, are being studied for the treatment of intermittent claudication, but little efficacy has been shown 7.