cilostazol
Pharmacologic class: Quinolone derivative
Therapeutic class: Antiplatelet agent
Pregnancy risk category C
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.
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.