Pletal (cilostazol) is a phosphodiesterase III inhibitor specifically indicated to improve walking distance in patients with intermittent claudication, a symptom of peripheral artery disease. This prescription medication works by inhibiting platelet aggregation and producing vasodilation, effectively addressing both the circulatory and symptomatic components of this condition. Clinical studies demonstrate significant improvement in maximal and pain-free walking distances compared to placebo, making it a cornerstone in the pharmacological management of exercise-limiting claudication. Proper patient selection and adherence to dosing guidelines are essential for optimizing therapeutic outcomes while minimizing potential adverse effects.

Features

• Contains cilostazol as the active pharmaceutical ingredient
• Available in 50 mg and 100 mg oral tablet formulations
• Phosphodiesterase III inhibitor with dual antiplatelet and vasodilatory effects
• Typically administered twice daily on an empty stomach
• Manufactured under strict pharmaceutical quality standards
• Requires prescription and appropriate medical supervision

Benefits

• Significantly increases pain-free and maximal walking distances in claudication patients
• Improves functional capacity and quality of life through enhanced mobility
• Reduces platelet aggregation, potentially decreasing thrombotic complications
• Provides vasodilation to improve peripheral blood flow
• Offers predictable pharmacokinetics with steady-state achievement within 4 days
• Enables non-invasive pharmacological management before considering surgical interventions

Common use

Pletal is primarily prescribed for the symptomatic treatment of intermittent claudication in patients with peripheral artery disease. This condition manifests as pain, cramping, or fatigue in the legs during physical activity, particularly walking, due to inadequate blood flow. The medication is indicated for patients whose symptoms significantly limit mobility and quality of life, and who have not responded adequately to exercise therapy and risk factor modification. It is typically used as part of a comprehensive treatment approach that includes smoking cessation, lipid management, hypertension control, and supervised exercise programs.

Dosage and direction

The recommended dosage of Pletal is 100 mg taken orally twice daily, at least 30 minutes before or 2 hours after breakfast and dinner. For patients who may not tolerate this dose, a reduced dosage of 50 mg twice daily may be prescribed. Treatment should be initiated under medical supervision, and dosage adjustments should be made based on therapeutic response and tolerability. The medication should be taken at consistent times each day to maintain stable blood levels. Clinical improvement in walking distance may be observed within 4-12 weeks of treatment, though some patients may require longer duration to achieve maximum benefit.

Precautions

Patients should be carefully monitored for cardiovascular status during treatment, as phosphodiesterase inhibitors may increase heart rate. Regular assessment of walking distance and symptom improvement is recommended to evaluate therapeutic response. Caution is advised in patients with moderate to severe hepatic impairment or severe renal impairment (creatinine clearance <25 mL/min). Patients should be advised that Pletal may cause dizziness or palpitations and should exercise caution when driving or operating machinery until they know how the medication affects them. Regular ophthalmic examinations are recommended due to potential ocular effects.

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, as phosphodiesterase III inhibitors have been shown to decrease survival in patients with class III-IV heart failure. Concurrent administration with strong inhibitors of CYP3A4 (such as ketoconazole, itraconazole, erythromycin, clarithromycin) or CYP2C19 inhibitors (such as omeprazole) is contraindicated. The medication is also contraindicated in patients with active pathological bleeding, such as bleeding peptic ulcer or intracranial hemorrhage.

Possible side effects

The most common adverse reactions include headache (27-34%), diarrhea (12-19%), abnormal stools (12-15%), palpitations (10-14%), and dizziness (9-12%). Other frequently reported side effects include peripheral edema (7-9%), nausea (6-7%), rhinitis (6-7%), and pharyngitis (5-6%). Less common but potentially serious adverse effects include tachycardia, hypotension, bleeding complications, and thrombocytopenia. Ocular effects including conjunctivitis and retinal hemorrhage have been reported in some patients. Most side effects are dose-related and may diminish with continued treatment or dose reduction.

Drug interaction

Pletal interacts significantly with medications that inhibit CYP3A4 or CYP2C19 enzymes, potentially increasing cilostazol concentrations and adverse effects. Concurrent use with aspirin may increase bleeding risk, though studies have shown this combination to be manageable with appropriate monitoring. Caution is advised when co-administering with other antiplatelet agents, anticoagulants, or NSAIDs due to increased bleeding potential. Medications that affect heart rate or cardiac contractility may have additive effects with Pletal. Grapefruit juice should be avoided as it may increase cilostazol concentrations through CYP3A4 inhibition.

Missed dose

If a dose of Pletal is missed, it should be taken 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 take double or extra doses to make up for a missed dose. Maintaining consistent dosing is important for therapeutic efficacy, but occasional missed doses are unlikely to significantly impact overall treatment effectiveness. Patients should be advised to establish a routine to minimize missed doses and to inform their healthcare provider if multiple doses are missed.

Overdose

Symptoms of Pletal overdose may include severe headache, diarrhea, hypotension, tachycardia, and cardiac arrhythmias. In case of suspected overdose, symptomatic and supportive treatment should be initiated immediately. Gastric lavage may be considered if presentation is early after ingestion. Hemodialysis is unlikely to be effective due to high protein binding of cilostazol. Cardiovascular monitoring should be implemented, particularly for heart rate and blood pressure abnormalities. There is no specific antidote for cilostazol overdose, and management should focus on maintaining vital functions and providing appropriate supportive care.

Storage

Pletal tablets should be stored 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). The medication should be kept in its original container with the lid tightly closed to protect from moisture and light. Tablets should not be stored in bathroom cabinets or other areas with high humidity. Keep all medications out of reach of children and pets. Properly discard any expired or unused medication according to local regulations, typically through medication take-back programs or following specific disposal instructions.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Pletal is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual response to treatment may vary, and the benefits and risks should be carefully discussed with a physician. Patients should not discontinue or modify their dosage without medical consultation. The complete prescribing information should be reviewed before initiating therapy, and patients should report any adverse effects or concerns to their healthcare provider promptly.

Reviews

Clinical studies demonstrate that Pletal significantly improves maximal walking distance by 28-50% compared to placebo, with pain-free walking distance increasing by 38-59%. In randomized controlled trials, approximately 60-70% of patients experienced clinically meaningful improvement in walking ability. Many patients report enhanced quality of life and increased ability to perform daily activities. Some patients note that side effects, particularly headache and gastrointestinal symptoms, may be bothersome initially but often diminish with continued treatment. Healthcare providers generally consider Pletal an effective option for appropriately selected patients who have not responded to conservative management, though they emphasize the importance of comprehensive cardiovascular risk factor modification alongside pharmacotherapy.