cilostazol

cilostazol /cil·o·sta·zol/ (sĭ-lo´stah-zol) a phosphodiesterase inhibitor that inhibits platelet aggregation and causes vasodilation; used in the treatment of intermittent claudication.

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cilostazol,

a platelet aggregation inhibitor.

indication It is used to treat intermittent claudication.

contraindications Known hypersensitivity to this drug, congestive heart failure, active liver disease, blood dyscrasias, and active bleeding prohibits its use.

adverse effects Life-threatening effects include atrial fibrillation/flutter, cerebral infarct, cerebral ischemia, congestive heart failure, cardiac arrest, myocardial infarction, nodal dysrhythmias, bleeding (epistaxis, hematuria, conjunctival hemorrhage, GI bleeding), agranulocytosis, neutropenia, and thrombocytopenia. Serious adverse effects include palpitations, tachycardia, vomiting, colitis, cholelithiasis, ulcer, and diabetes mellitus. Common side effects include vertigo, diarrhea, rash, back pain, headache, infection, myalgia, peripheral edema, cough, pharyngitis, and rhinitis.

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claudication [klaw″dĭ-ka´shun]

limping or lameness.

intermittent claudication see intermittent claudication.

jaw claudication a complex of symptoms like those of intermittent claudication but seen in the muscles of mastication, occurring in giant cell arteritis.

venous claudication intermittent claudication caused by venous stasis.

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intermittent [in″ter-mit´ent]

marked by alternating periods of activity and inactivity.

intermittent claudication a group of symptoms characterized by pain, cramping, and weakness in the calf muscles of one or both lower limbs, brought on by walking and relieved by resting for a few minutes. It is a form of arterial occlusive disease and is caused by atherosclerotic lesions of the limbs, which diminish blood supply to the muscles of the lower leg. Called also angina cruris.

Treatment has traditionally involved vascular reconstructive surgery to bypass the diseased portion of the vessel. Modification of risk factors has also proved beneficial, such as smoking cessation, weight loss, and introduction of a graduated program of walking and exercise.

intermittent explosive disorder a rare impulse control disorder in which a periodic loss of control of aggressive impulses results in serious assault or destruction of property; the outbursts are totally out of proportion to any apparent stress.

intermittent positive pressure breathing (IPPB) a form of respiratory therapy using a ventilator for the treatment of selected patients with atelectasis, those needing occasional assistance breathing, or those requiring some types of aerosol medications. As the name implies, this involves application of pressure only during the inspiratory phase, in order to help the patient breathe more deeply. It is used when other less expensive, less invasive forms of respiratory care have not been effective. Called also intermittent positive pressure ventilation.

Because of their compact size and capability of operating independently of an electrical current, IPPB machines are used widely. Similar treatment can also be delivered with a volume-, pressure-, or time-limited ventilator or manual resuscitation device. The American Association for Respiratory Care has published detailed and comprehensive clinical practice guidelines for the use of intermittent positive pressure breathing, which are available online at http://www.rcjournal.com/online_resources/cpgs/ippbcpg.hotmail.

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cilostazol

Pletal

Pharmacologic class: Quinolone derivative

Therapeutic class: Antiplatelet agent

Pregnancy risk category C

FDA Boxed Warning

• Drug and several of its metabolites inhibit phosphodiesterase III. Several drugs with this effect decreased survival in patients with class III-IV congestive heart failure (CHF). Drug is contraindicated in patients with CHF of any severity.

Action

Unclear. Thought to inhibit phosphodiesterase III by increasing cyclic adenosine monophosphate in platelets and blood vessels, causing vasodilation and enhancing cardiac contractility and coronary blood flow

Availability

Tablets: 50 mg, 100 mg

⊘Indications and dosages

➣ Intermittent claudication

Adults: 100 mg P.O. b.i.d. at least 30 minutes before or 2 hours after breakfast and dinner

Dosage adjustment

• Concurrent use of diltiazem, erythromycin, itraconazole, ketoconazole, or omeprazole

Contraindications

• Hypersensitivity to drug
• Heart failure

Precautions

Use cautiously in:
• cardiovascular disorders
• patients receiving other antiplatelet agents concurrently
• pregnant or breastfeeding patients
• children (safety and efficacy not established).

Administration

• Give with water 30 minutes before or 2 hours after patient consumes food or milk.
• Don't give with grapefruit juice.
• Be aware that although response may occur within 2 to 3 weeks, patient should continue therapy for up to 12 weeks or as prescribed.

Route	Onset	Peak	Duration
P.O.	Gradual	4-6 hr	Unknown

Adverse reactions

CNS: dizziness, headache, vertigo

CV: tachycardia

GI: abdominal pain, abnormal stools, dyspepsia, flatulence

EENT: rhinitis, pharyngitis

Musculoskeletal: back pain, myalgia

Respiratory: increased cough

Other: infection

Interactions

Drug-drug. CYP3A4 and CYP2C19 inhibitors, diltiazem, erythromycin, macrolides, omeprazole: increased cilostazol blood level

Drug-food. Grapefruit juice, high-fat meals: increased cilostazol blood level

Drug-behaviors. Smoking: decreased exposure to cilostazol

Patient monitoring

• Monitor cardiovascular status.
• Closely monitor patient if he's receiving other antiplatelet drugs.

Patient teaching

• Instruct patient to take drug with full glass of water, 30 minutes before or 2 hours after food or milk.
• Advise patient to report nausea, vomiting, or abdominal pain.
• Instruct patient not to smoke, because smoking impedes drug effects.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs, foods, and behaviors mentioned above.

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cilostazol

Pletal^® Cardiology An antiplatelet vasodilator used to manage intermittent claudication due to peripheral vascular disease by ↑ blood flow to affected limbs, per improved ankle/brachial index Contraindications CHF