Pletal (cilostazol) is a selective phosphodiesterase III inhibitor prescribed for the reduction of intermittent claudication symptoms in patients with peripheral artery disease (PAD). By improving blood flow through vasodilation and inhibition of platelet aggregation, it enhances walking distance and quality of life. This medication is indicated for use in conjunction with lifestyle modifications such as smoking cessation and exercise programs. Clinical studies demonstrate its efficacy in increasing pain-free and maximal walking distances in affected individuals.

Features

• Active ingredient: Cilostazol 50 mg or 100 mg
• Mechanism: Phosphodiesterase III inhibition with antiplatelet and vasodilatory effects
• Formulation: Oral tablets
• Bioavailability: Approximately 90% with high fat meal
• Half-life: 11-13 hours with active metabolites
• Metabolism: Hepatic via CYP3A4 and CYP2C19 enzymes

Benefits

• Significantly increases pain-free walking distance in peripheral artery disease patients
• Improves maximal walking distance by enhancing blood flow to affected limbs
• Reduces symptoms of intermittent claudication including pain, cramping, and weakness
• Provides antiplatelet activity to help prevent thrombotic events
• Enhances overall quality of life and functional capacity
• Offers twice-daily dosing convenience for improved compliance

Common use

Pletal is primarily indicated for the symptomatic treatment of intermittent claudication, a condition characterized by pain, cramping, or weakness in the legs during physical activity due to reduced blood flow from peripheral artery disease. It is used when exercise therapy and risk factor modification alone provide insufficient relief. The medication is typically prescribed for patients without heart failure who require pharmacological intervention to improve walking capacity and reduce lower extremity symptoms.

Dosage and direction

The recommended dosage is 100 mg taken orally twice daily, approximately 30 minutes before or 2 hours after breakfast and dinner. For patients who may not tolerate this dose, a reduced dosage of 50 mg twice daily may be prescribed. Treatment response usually becomes evident within 4-12 weeks, though some patients may require up to 12 weeks of therapy to experience significant benefit. Dosage adjustment is necessary in patients taking concomitant CYP3A4 or CYP2C19 inhibitors.

Precautions

Patients should be monitored for cardiovascular status, particularly those with pre-existing cardiac conditions. Regular assessment of bleeding parameters is recommended due to antiplatelet effects. Hepatic function should be evaluated before and during treatment, with dosage adjustments considered for impaired liver function. Caution is advised in patients with moderate to severe renal impairment. Ophthalmological examinations may be warranted as visual disturbances have been reported. Patients should be advised about the potential for dizziness and cautioned about activities requiring mental alertness.

Contraindications

Pletal is contraindicated in patients with congestive heart failure of any severity class. Additional contraindications include known hypersensitivity to cilostazol or any component of the formulation, active pathological bleeding such as bleeding peptic ulcer or intracranial hemorrhage, and severe hepatic impairment. The medication should not be used in combination with other phosphodiesterase inhibitors or strong CYP3A4 and CYP2C19 inhibitors.

Possible side effects

Common adverse reactions include headache (27-34%), diarrhea (12-19%), abnormal stools (12-15%), palpitations (10-14%), and dizziness (9-12%). Less frequent side effects may include tachycardia, peripheral edema, nausea, rhinitis, and pharyngitis. Serious but rare adverse events include thrombocytopenia, pancytopenia, agranulocytosis, and severe bleeding events. Visual disturbances including blurred vision have been reported in approximately 3% of patients.

Drug interaction

Significant interactions occur with strong CYP3A4 inhibitors (ketoconazole, itraconazole, erythromycin), strong CYP2C19 inhibitors (omeprazole), and grapefruit juice, requiring dosage reduction. Concurrent use with aspirin increases bleeding risk. Combination with other antiplatelet agents or anticoagulants may potentiate bleeding tendency. Caution is advised with medications that affect heart rate or cardiac conduction. CYP3A4 inducers may decrease cilostazol concentrations.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed administration. Consistent timing of doses is important for maintaining stable plasma concentrations and optimal therapeutic effect.

Overdose

Symptoms of overdose may include severe headache, diarrhea, hypotension, tachycardia, and cardiac arrhythmias. Management involves supportive care including monitoring of vital signs and ECG. Gastric lavage may be considered if ingestion occurred recently. Hemodialysis is not expected to be effective due to high protein binding. There is no specific antidote; treatment should focus on symptomatic management and supportive measures.

Storage

Store at controlled room temperature between 20°C to 25°C (68°F to 77°F) with excursions permitted between 15°C to 30°C (59°F to 86°F). Keep in the original container with the lid tightly closed to protect from moisture and light. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Properly discard any unused medication according to local regulations.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions should be made in consultation with a qualified healthcare professional based on individual patient characteristics and medical history. The prescribing physician should be familiar with complete prescribing information including warnings, precautions, and contraindications. Dosage and administration should follow healthcare provider recommendations.

Reviews

Clinical studies demonstrate that approximately 40-50% of patients experience a 50% or greater improvement in maximal walking distance after 12-24 weeks of treatment. Patient-reported outcomes indicate significant improvements in walking capacity and quality of life measures. Many patients report reduced leg pain and increased ability to perform daily activities. Some users note side effects including headache and gastrointestinal symptoms, though these often diminish with continued therapy. Overall satisfaction rates are generally positive among patients who respond to therapy and tolerate the medication well.