cilostazol, Pletal
GENERIC NAME: cilostazol
BRAND NAME: Pletal
DRUG CLASS AND MECHANISM: Cilostazol is a medication for
the treatment of intermittent claudication, a condition caused by
narrowing of the arteries that supply the legs with blood. Patients
with intermittent claudication develop pain when they walk because
not enough oxygen-containing blood reaches the active leg muscles.
Cilostazol reduces the pain of intermittent claudication by dilating
the arteries, thereby improving the flow of blood and oxygen to the
legs. (It does this by decreasing the action of an enzyme,
phosphodiesterase III.) It also reduces the ability of blood to
clot. Cilostazol enables patients with intermittent claudication to
walk longer and faster before developing pain. Cilostazol has a
different mechanism of action than pentoxifylline (Trental), the
other approved drug for intermittent claudication. (Pentoxifylline
improves blood flow by making it easier for red blood cells to pass
through vessels. It also decreases the viscosity of blood.)
GENERIC AVAILABLE: No
PRESCRIPTION: Yes
PREPARATIONS: 50 mg tablets, white, triangular and marked
Pletal 50; 100 mg tablets, white, round and marked Pletal 100.
STORAGE: Tablets should be stored below 25°C (77°F). Brief trips to 30°C (86°F) are allowed.
PRESCRIBED FOR: Cilostazol improves walking speed and
walking distance among patients with intermittent claudication. It
does not cure intermittent
claudication. Cilostazol has not been studied in patients with leg
pain at rest, leg ulcers due to reduced flow of blood, gangrene or
rapidly progressing claudication.
DOSING: The dose is 100 mg twice daily. Cilostazol should
be taken at
least half an hour before or two hours after dinner and breakfast to
prevent food from affecting its absorption.
DRUG INTERACTIONS: Erythromycin (E.E.S, Erythrocin),
omeprazole
(Prilosec) and diltiazem (Cardizem) increase the concentration of
cilostazol by blocking the action of enzymes that destroy cilostazol.
Though not specifically studied, a similar interaction could occur
with ketoconazole (Nizoral), itraconazole (Sporanox), fluconazole
(Diflucan), miconazole (Monistat), fluvoxamine (Luvox), fluoxetine
(Prozac), nefazodone (Serzone) and sertraline (Zoloft). Higher
concentrations of cilostazol could increase the possibility of toxic
effects. Therefore, a dose of 50 mg twice daily should be considered
when drugs that may increase the concentration of cilostazol also are
being used.
In pre-marketing studies, cilostazol did not increase the occurrence
of bleeding
in individuals who were also taking aspirin.
A high fat meal increases the absorption of cilostazol. Grapefruit
juice could
increase the concentration of cilostazol. Therefore, grapefruit juice
should not be taken by patients on cilostazol.
PREGNANCY: The use of cilostazol in pregnancy has not been
adequately
studied.
NURSING MOTHERS: Cilostazol has not been adequately
studied in
nursing mothers.
SIDE EFFECTS:The most common adverse effects are
headache,
abdominal pain, diarrhea, nausea, fluid retention, dizziness and an
abnormal
heartbeat.
Cilostazol inhibits the enzyme phosphodiesterase III. Other drugs
that inhibit this enzyme
have caused death in individuals with heart failure. Therefore,
individuals with heart failure should not use cilostazol.
Reference: FDA Prescribing Information
Last Editorial Review: 5/25/1999
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