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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.
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.
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.