Inclaud (Cilostazol)

• Cilostazol is used in the management of peripheral vascular conditions that limit blood flow to the limbs.
• Intermittent claudication: cilostazol increases peripheral blood flow, which can extend walking distance by several hundred meters and lessen ischemic leg pain during activity.
• Peripheral arterial disease: the drug promotes vasodilation and inhibits platelet aggregation, helping to improve limb perfusion and support daily functional activities in affected patients.
• Exercise tolerance in PAD patients: by raising intracellular cAMP, cilostazol can raise maximal walking time and overall exercise capacity, contributing to better quality of life.

• Cilostazol selectively inhibits phosphodiesterase‑3 (PDE‑3) enzymes in vascular smooth‑muscle cells and platelets. This inhibition raises intracellular cyclic adenosine monophosphate (cAMP) levels, leading to vasodilation of peripheral arteries and a reduction in platelet aggregation. The combined effect improves blood flow to ischemic limbs and decreases the likelihood of thrombus formation, which underlies its therapeutic benefit in intermittent claudication and peripheral arterial disease.

Cilostazol may cause a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Headache: mild to moderate headache often reported during early treatment.
• Diarrhea: loose stools or increased bowel movements.
• Dizziness: sensation of light‑headedness or vertigo.
• Nausea: feeling of queasiness, sometimes with mild stomach upset.

Serious or Rare Side Effects

• Thrombocytopenia: significant drop in platelet count that may increase bleeding risk.
• Severe bleeding: gastrointestinal or intracranial hemorrhage requiring medical attention.
• Hepatic dysfunction: elevated liver enzymes or hepatitis‑like symptoms.

Before prescribing cilostazol, clinicians should evaluate several safety considerations to minimize risk.

• Cardiovascular assessment: avoid use in patients with severe heart failure (NYHA class III–IV) due to potential worsening of symptoms.
• Bleeding risk: assess for active bleeding or recent major surgery before initiating therapy.
• Hepatic function: monitor liver enzymes in patients with known hepatic impairment.
• Concomitant antiplatelet/anticoagulant therapy: use caution as combined effect may increase bleeding.
• Store at room temperature: keep tablets in the original container, protect from moisture and direct sunlight.

Cilostazol interacts with several medicines that can alter its plasma concentration or enhance its pharmacologic effects.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): may markedly increase cilostazol levels and risk of toxicity.
• CYP2C19 inhibitors (e.g., omeprazole, fluoxetine): can raise cilostazol exposure and precipitate adverse events.

Moderate Interactions (Monitor Closely)

• CYP3A4 inducers (e.g., rifampin, carbamazepine): may reduce efficacy by lowering drug concentrations.
• Anticoagulants (e.g., warfarin): enhanced antiplatelet effect may increase bleeding tendency.
• Other antiplatelet agents (e.g., clopidogrel, aspirin): combined therapy may require dose adjustment and close monitoring.