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Pharmacologic class: Quinolone derivative
Therapeutic class: Antiplatelet agent
Pregnancy risk category C
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.
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
• Concurrent use of diltiazem, erythromycin, itraconazole, ketoconazole, or omeprazole
• Hypersensitivity to drug
• Heart failure
Use cautiously in:
• cardiovascular disorders
• patients receiving other antiplatelet agents concurrently
• pregnant or breastfeeding patients
• children (safety and efficacy not established).
• 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.
CNS: dizziness, headache, vertigo
GI: abdominal pain, abnormal stools, dyspepsia, flatulence
EENT: rhinitis, pharyngitis
Musculoskeletal: back pain, myalgia
Respiratory: increased cough
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
• Monitor cardiovascular status.
• Closely monitor patient if he's receiving other antiplatelet drugs.
• 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.
ClassificationTherapeutic: antiplatelet agents
Pharmacologic: platelet aggregation inhibitors
Time/action profile (symptom reduction)
|PO||2–4 wk||up to 12 wk||unknown|
Adverse Reactions/Side Effects
Central nervous system
- headache (most frequent)
Drug-Drug interactionConcurrent administration of ketoconazole, itraconazole, erythromycin, diltiazem, fluconazole, miconazole, fluvoxamine, fluoxetine, nefazodone, sertraline, or omeprazole decreases metabolism and increases levels and activity of cilostazol (use lower doses).Concurrent use with aspirin has additive effects on platelet function.Grapefruit juice inhibits metabolism and increases effects; concurrent use should be avoided.
Availability (generic available)
- Assess patient for intermittent claudication before and periodically during therapy.
- Lab Test Considerations: May occasionally cause anemia, hyperlipemia, hyperuricemia, and albuminuria. May prolong bleeding time.
Potential Nursing DiagnosesActivity intolerance (Indications)
- Oral: Administer on an empty stomach, 1 hr before or 2 hr after meals.
- Do not administer with grapefruit juice. May increase cilostazol levels.
- Instruct patient to take cilostazol on an empty stomach, exactly as directed.
- May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
- Advise patient to avoid smoking; nicotine constricts blood vessels.
- Relief from cramping in calf muscles, buttocks, thighs, and feet during exercise.
- Improvement in walking endurance. Therapeutic effects may be seen in 2–4 wk.