Pletal (cilostazol) is a prescription medication classified as a quinolinone derivative phosphodiesterase III inhibitor, specifically formulated to manage the symptoms of intermittent claudication. This condition, characterized by pain and cramping in the legs due to inadequate blood flow, significantly impairs walking ability and quality of life. By inhibiting platelet aggregation and producing vasodilation, Pletal increases blood circulation to the extremities, enabling patients to walk longer distances with reduced discomfort. It represents a cornerstone in the pharmacological management of peripheral arterial disease, offering a well-tolerated option for symptomatic relief when lifestyle modifications alone are insufficient.

Features

• Active pharmaceutical ingredient: cilostazol 50 mg or 100 mg per tablet
• Selective inhibition of phosphodiesterase type III (PDE3)
• Dual mechanism of action: antiplatelet and vasodilatory effects
• Oral administration with twice-daily dosing regimen
• Available in film-coated tablets for ease of swallowing
• Manufactured under strict pharmaceutical quality control standards
• Typically supplied in bottles of 60 or 100 tablets
• Requires prescription and regular medical supervision

Benefits

• Significantly increases pain-free walking distance in patients with intermittent claudication
• Improves maximal walking distance and overall physical functioning
• Enhances quality of life by reducing lower extremity discomfort during daily activities
• Provides alternative therapy for patients who cannot tolerate or have contraindications to other antiplatelet agents
• Demonstrates consistent efficacy across various patient demographics when used as directed
• Offers convenient oral administration without need for frequent monitoring in stable patients

Common use

Pletal is primarily indicated for the reduction of symptoms of intermittent claudication, a manifestation of peripheral arterial disease (PAD). It is prescribed for patients who experience leg pain, cramping, or weakness during physical activity that resolves with rest. The medication is typically recommended after a trial of conservative measures, including smoking cessation, exercise training, and lipid management, has proven insufficient. Healthcare providers may consider Pletal for patients with moderate to severe symptoms who are not candidates for surgical revascularization procedures. The drug is used as part of a comprehensive management approach that includes risk factor modification and regular follow-up assessments.

Dosage and direction

The recommended adult 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, an initial dose of 50 mg twice daily is recommended. Tablets should be swallowed whole with water and not crushed or chewed. Consistency in timing administration relative to meals is important to maintain stable plasma concentrations. Treatment response typically becomes evident within 4-12 weeks, though some patients may require up to 3 months of continuous therapy to experience maximal benefit. Dosage adjustments may be necessary for patients with hepatic impairment or those taking concomitant medications that affect cilostazol metabolism.

Precautions

Patients should undergo thorough cardiovascular assessment before initiating therapy, as PDE3 inhibitors have been associated with decreased survival in patients with congestive heart failure. Regular monitoring of cardiovascular status is recommended throughout treatment. Caution is advised in patients with bleeding tendencies or those taking anticoagulants or other antiplatelet agents. Hepatic function should be assessed periodically, as cilostazol is extensively metabolized by the liver. Patients should be advised about the potential for dizziness or palpitations and cautioned against activities requiring mental alertness until they know how the medication affects them. Smoking cessation and management of other cardiovascular risk factors should be encouraged concurrently with therapy.

Contraindications

Pletal is contraindicated in patients with known hypersensitivity to cilostazol or any component of the formulation. It must not be used in patients with congestive heart failure of any severity classification, based on theoretical concerns regarding decreased survival observed with other PDE3 inhibitors. The medication is contraindicated in patients with active pathological bleeding such as bleeding peptic ulcer or intracranial hemorrhage. Concomitant administration with strong inhibitors of CYP3A4 (e.g., ketoconazole, itraconazole) or CYP2C19 (e.g., omeprazole, esomeprazole) is contraindicated due to significantly increased cilostazol exposure. Use during pregnancy is contraindicated unless potential benefits justify potential risks to the fetus.

Possible side effects

The most common adverse reactions include headache (27-34%), diarrhea (12-19%), abnormal stools (12-15%), palpitations (9-14%), and dizziness (9-12%). Less frequently reported effects include peripheral edema, nausea, rhinitis, pharyngitis, and infection. Cardiovascular effects such as tachycardia, palpitations, and hypotension may occur due to the drug’s vasodilatory properties. Gastrointestinal disturbances are generally mild to moderate and often diminish with continued therapy. Rare but serious adverse effects include thrombocytopenia, leukopenia, pancytopenia, and severe bleeding events. Any signs of unusual bleeding or bruising should be promptly reported to healthcare providers.

Drug interaction

Cilostazol is metabolized primarily by CYP3A4 and CYP2C19 enzymes, creating significant interaction potential. Strong CYP3A4 inhibitors (ketoconazole, itraconazole, erythromycin, clarithromycin) and strong CYP2C19 inhibitors (omeprazole, esomeprazole) may substantially increase cilostazol concentrations, necessitating dose reduction or alternative therapy. Concomitant use with other antiplatelet agents (aspirin, clopidogrel) or anticoagulants (warfarin, dabigatran) may increase bleeding risk. Medications that affect heart rate or blood pressure may have additive effects with cilostazol’s cardiovascular actions. Grapefruit juice should be avoided due to inhibition of CYP3A4 metabolism. Healthcare providers should conduct thorough medication reconciliation before initiation and during therapy.

Missed dose

If a dose is missed, patients should take it 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 twice-daily dosing is important for maintaining therapeutic effects, so patients should establish routines to minimize missed doses. If multiple doses are missed, patients should contact their healthcare provider for guidance on resuming therapy. Use of pill organizers or medication reminders may help improve adherence to the prescribed regimen.

Overdose

Symptoms of overdose may include severe headache, diarrhea, hypotension, tachycardia, and cardiac arrhythmias. Management should include supportive care with close monitoring of vital signs and cardiac rhythm. Gastric lavage may be considered if presentation is early after ingestion. Activated charcoal may be administered if the patient presents within one hour of ingestion. There is no specific antidote for cilostazol overdose. Hemodialysis is unlikely to be effective due to high protein binding. Symptomatic treatment for specific manifestations should be provided, with particular attention to cardiovascular effects. Patients should be monitored for bleeding complications due to the drug’s antiplatelet effects.

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 the container tightly closed and protect from moisture and light. Tablets should be kept in their original packaging until time of administration. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Proper disposal of unused medication should follow local regulations, typically through medication take-back programs or by mixing with undesirable substances before disposal in household trash.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Individual patient responses to Pletal may vary based on numerous factors including age, renal function, hepatic function, concomitant medications, and underlying medical conditions. Healthcare providers should exercise professional judgment when prescribing this medication, considering individual patient characteristics and current clinical guidelines. Patients should not initiate, discontinue, or modify dosage without consulting their healthcare provider. The complete prescribing information should be reviewed before administration.

Reviews

Clinical studies demonstrate that approximately 40-50% of patients experience a 50% or greater improvement in pain-free walking distance after 12-24 weeks of therapy. Many patients report significantly improved ability to perform daily activities and enhanced quality of life. Some users note initial side effects such as headache or gastrointestinal discomfort that often diminish with continued use. Healthcare providers generally consider Pletal an effective option for symptomatic management of intermittent claudication when prescribed to appropriate candidates without contraindications. Long-term users frequently report maintained efficacy with stable dosing, though regular follow-up remains important to assess continued appropriateness of therapy.