Cilostazol

Aka: Cilostazol, Pletal

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II. Indications

  1. Intermittent Claudication
    1. Adjunct while taking other antiplatelet medication (e.g. Aspirin, Clopidogrel)

III. Contraindications

  1. Congestive Heart Failure (increased mortality)
  2. Caution in severe hepatic insufficiency
  3. Caution in GFR <25 ml/min

IV. Mechanism

  1. Quinolinone derivative
  2. Inhibits phosphodiesterase 3 (PDE3) leading to higher levels of cAMP within Platelets and vessels
  3. Inhibits Platelet aggregation
  4. Also promotes vasodilation

V. Dosing

  1. Take 100 mg orally twice daily on an empty Stomach
  2. Indications for half dose (50 mg orally twice daily)
    1. Use of strong CYP3A4 Inhibitors (e.g. Itraconazole, Erythromycin)
    2. Use of strong CYP2C19 Inhibitors (e.g. Omeprazole)

VI. Adverse Effects

  1. Headache
  2. Palpitations
  3. Left Ventricular Outflow Obstruction
    1. Increased risk in patients with sigmoid shaped interventricular septum

VII. Safety

  1. Pregnancy Category C
  2. Unknown safety in Lactation

VIII. Drug Interactions

  1. CYP3A4 Inhibitors (e.g. Itraconazole, Erythromycin)
  2. CYP2C19 Inhibitors (e.g. Omeprazole)
  3. Grapefruit juice
    1. Increases Cilostazol levels

IX. Efficacy

  1. Full effect may be delayed for 12 weeks

X. Resources

  1. Cilostazol
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=9ffdb1e8-fdc8-44d4-b558-210954138b2f

XI. References

  1. Balinski (2023) Cilostazol, StatPearls, Treasure Island
    1. https://www.ncbi.nlm.nih.gov/books/NBK544363/
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Cost: Medications

cilostazol (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
CILOSTAZOL 100 MG TABLET Generic $0.13 each
CILOSTAZOL 50 MG TABLET Generic $0.11 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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