cilostazol (Rx)

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Brand and Other Names:Pletal

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 50mg
  • 100mg
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Peripheral Vascular Disease

100 mg PO q12hr 30 minutes before or 2 hours after meals

Dosing considerations

  • CYP2C19 or CYP3A4 inhibitors: Reduce dosage to 50 mg PO q12hr

Thrombotic Complications of Coronary Angioplasty (Off-label)

100 mg q12hr 30 minutes before or 2 hours after meals

Dosing considerations

  • May be administered alone or in combination with aspirin 81 mg/day

Renal Impairment

CrCl< 25 mL/min: Use caution

Hepatic Impairment

Moderate to severe: Use caution

Safety and efficacy not established

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Interactions

Interaction Checker

and cilostazol

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
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            Adverse Effects

            >10%

            Headache (27-34%)

            Diarrhea (12-19%)

            Abnormal stools (12-15%)

            Infection (10-14%)

            Rhinitis (7-12%)

            Pharyngitis (7-10%)

            1-10%

            Dizziness (9-10%)

            Palpitations (5-10%)

            Peripheral edema (7-9%)

            Back pain (6-7%)

            Dyspepsia (6%)

            Abdominal pain (4-5%)

            Tachycardia (4%)

            Increased cough (3-4%)

            Myalgia (2-3%)

            Atrial fibrillation (<2%)

            CHF (<2%)

            MI (<2%)

            Hematemesis (<2%)

            Ecchymosis (<2%)

            Blood in eye (<2%)

            Epistaxis (<2%)

            Hemoptysis (<2%)

            Nausea

            Frequency Not Defined

            Decreased platelet aggregation

            Agranulocytosis

            Aplastic anemia

            Leukopenia

            Thrombocytopenia

            Stevens-Johnson syndrome

            Postmarketing Reports

            Blood and lymphatic system disorders: Agranulocytosis, aplastic anemia, granulocytopenia, thrombocytopenia, leukopenia, bleeding tendency

            Cardiovascular: Torsades de pointes, QTc prolongation

            GI: GI hemorrhage

            General: Pain, chest pain, hot flushes, extradural or subdural hematoma, hyperglycemia, hyperuricemia, increased BUN, elevated BP, decreased platelet or white blood cell (WBC) count

            Hepatic: Hepatic dysfunction, abnormal liver function tests, jaundice

            Neurologic: Intracranial or cerebral hemorrhage, cerebrovascular accident (CVA)

            Respiratory: Pulmonary hemorrhage, interstitial pneumonia

            Skin: Subcutaneous hemorrhage, pruritus, skin eruptions such as Stevens-Johnson syndrome, skin drug eruption (dermatitis medicamentosa)

            Vascular: Subacute thrombosis

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            Warnings

            Black Box Warnings

            Cilostazol and metabolites are inhibitors of phosphodiesterase III; such activity has been shown to decrease survival of patients with class III-IV CHF; contraindicated in patients with CHF of any severity

            Contraindications

            Congestive heart failure of any severity

            Hypersensitivity

            Hemostatic disorders or active pathologic bleeding (eg, bleeding peptic ulcer, intracranial bleeding) due to reversible platelet aggregation

            Cautions

            Use with caution in liver and renal disease

            Leukopenia that progresses to agranulocytosis may occur (in which case, discontinue therapy)

            Discontinue therapy if thrombocytopenia occurs

            Use with caution in patients taking platelet aggregation inhibitors

            Do not administer for at least 4-6 half-lives before elective surgical procedures

            Avoid grapefruit juice

            Response may be seen as early as 2-4 weeks after initiation, but treatment may be needed for up to 12 weeks

            Dosage can be reduced or discontinued without rebound effects (eg, platelet hyperaggregability)

            Cilostazol may induce tachycardia, palpitation, tachyarrhythmia and/or hypotension; patients with history of ischemic heart disease may be at risk for exacerbations of angina pectoris or myocardial infarction

            Plasma concentrations and overall pharmacological activity are increased when cilostazol is administered with strong or moderate CYP3A4 inhibitors (eg, ketoconazole, itraconazole, erythromycin, diltiazem) and strong CYP2C19 inhibitors (eg, ticlopidine, fluconazole, omeprazole); dose reduction to 50 mg twice daily should be considered

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Excretion in milk unknown; not recommended

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Inhibits phosphodiesterase III, causing cyclic adenosine monophosphate (cAMP) to increase, which in turn inhibits platelet aggregation; causes homogeneous vasodilation, especially in femoral vascular beds

            Absorption

            Onset: 2-12 weeks

            Distribution

            Protein bound: 95-98% (especially albumin)

            Metabolism

            Metabolized by CYP3A4 (major), CYP2C19

            Metabolites: 4'-trans-hydroxy-cilostazol, 3,4-dehydro-cilostazol

            Elimination

            Half-life: 11-13 hr

            Dialyzable: No

            Excretion: Urine (74%), feces (20%)

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • View the formulary and any restrictions for each plan.
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            • Compare formulary status to other drugs in the same class.
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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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