cilostazol: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
cilostazol: clinical details
Prescribing considerations
- Reserve for intermittent claudication after lifestyle measures and other appropriate interventions have been insufficient.
- Initiation should be by a clinician experienced in managing intermittent claudication.
- Consider suitability alongside options such as revascularisation.
- Discontinue if improvement in walking is not clinically relevant.
- Continue smoking cessation, exercise and cardiovascular-risk management.
- Review all antiplatelet, anticoagulant and CYP3A4- or CYP2C19-interacting medicines.
- Plan perioperative management because platelet inhibition may increase procedural bleeding.
Contraindications and cautions
- Hypersensitivity to cilostazol or product excipients
- Severe renal impairment
- Moderate or severe hepatic impairment
- Congestive heart failure
- Pregnancy
- Known predisposition to bleeding
- Specified ventricular arrhythmias, QTc prolongation or history of severe tachyarrhythmia
- Two or more additional antiplatelet or anticoagulant medicines
- Unstable angina, myocardial infarction within the previous six months or coronary intervention within the previous six months
Monitoring
- Assess improvement in walking symptoms and continued need for treatment.
- Monitor for bleeding, easy bruising, palpitations, tachyarrhythmia, hypotension and angina.
- Obtain a full blood count if fever, sore throat, infection or other evidence of blood-cell abnormality develops; discontinue if a haematological abnormality is confirmed.
- Consider closer cardiac monitoring in stable coronary disease, atrial fibrillation or atrial or ventricular ectopy.
- Review renal and hepatic status and interacting medicines.
Clinical pharmacology
Cilostazol and active metabolites inhibit phosphodiesterase-3, increasing intracellular cyclic AMP in platelets and vascular tissue. It reversibly inhibits platelet aggregation and has vasodilator effects. Metabolism is mainly through CYP3A4 and CYP2C19, with a smaller CYP1A2 contribution.
Formulation and product differences
- The selected product is a conventional oral tablet.
- Tablet appearance and excipients are product-specific and should be checked when identification, allergy or intolerance matters.
cilostazol preparations and strengths
Tablet
Route: Oral
Strengths: 50 mg, 100 mg
cilostazol interactions
A full medicines review is important because cilostazol affects platelets and is extensively metabolised by CYP enzymes.
Aspirin, clopidogrel and other antiplatelets
Bleeding risk may increase. Cilostazol is contraindicated with two or more additional antiplatelet or anticoagulant medicines.
Warfarin, heparins and direct oral anticoagulants
The combination can increase bleeding risk and requires prescriber review. Two or more additional antithrombotic medicines are contraindicated.
Strong CYP3A4 inhibitors, including some macrolides, azole antifungals and protease inhibitors
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.