Pletal (cilostazol) is a selective phosphodiesterase III inhibitor prescribed for the symptomatic management of intermittent claudication, a condition characterized by pain and cramping in the legs due to reduced blood flow. By inhibiting platelet aggregation and promoting vasodilation, Pletal improves walking distance and functional capacity in patients with peripheral arterial disease. It represents a cornerstone in pharmacologic management for those who have not achieved adequate symptom relief through exercise and lifestyle modifications alone. This medication requires careful patient selection and monitoring due to its specific mechanism and potential interactions.

Features

• Active ingredient: Cilostazol 50 mg or 100 mg tablets
• Selective phosphodiesterase type III (PDE3) inhibitor with vasodilatory and antiplatelet properties
• Dual mechanism: inhibits platelet aggregation and promotes arterial dilation
• Standard dosing: twice daily administration
• Prescription-only medication requiring healthcare supervision
• Manufactured under strict pharmaceutical quality standards

Benefits

• Significantly increases pain-free walking distance in patients with intermittent claudication
• Improves maximal walking distance and overall functional capacity
• Reduces symptoms of leg pain, cramping, and fatigue during physical activity
• Enhances quality of life by enabling greater mobility and daily activity participation
• Provides pharmacologic alternative for patients unsuitable for surgical intervention
• Demonstrates consistent efficacy in clinical trials with proper patient selection

Common use

Pletal is primarily indicated for the reduction of symptoms of intermittent claudication, a manifestation of peripheral arterial disease (PAD). It is prescribed for patients who experience exercise-induced cramping, pain, or fatigue in the lower extremities due to inadequate blood flow. The medication is typically considered when lifestyle modifications—including smoking cessation, exercise training, and dietary changes—have proven insufficient. Healthcare providers may recommend Pletal for patients who are not candidates for surgical revascularization procedures or who prefer pharmacologic management. The drug is used as part of a comprehensive treatment approach that includes risk factor modification and ongoing monitoring.

Dosage and direction

The recommended dosage of Pletal is 100 mg taken orally twice daily, approximately 30 minutes before or 2 hours after breakfast and dinner. For patients who may not tolerate this dosage, a reduced dose of 50 mg twice daily may be prescribed. Treatment should be initiated under medical supervision, and dosage adjustments should be made based on individual tolerance and response. The medication should be taken at consistent times each day to maintain stable blood levels. Patients should not crush or chew tablets; they should be swallowed whole with water. Clinical improvement in walking distance may be observed within 2-4 weeks of initiation, but up to 12 weeks of treatment may be required for maximal therapeutic benefit.

Precautions

Patients with congestive heart failure of any severity should not use Pletal due to increased mortality risk observed with other PDE3 inhibitors. Regular monitoring of cardiovascular status is recommended throughout treatment. Pletal may cause tachycardia, palpitations, or arrhythmias in some patients, requiring careful assessment of heart rate and rhythm. Caution is advised in patients with hepatic impairment or severe renal impairment (creatinine clearance <25 mL/min). The medication may increase the risk of bleeding, particularly in patients taking concomitant anticoagulants or antiplatelet agents. Ophthalmologic examinations are recommended periodically as PDE inhibitors have been associated with visual disturbances. Patients should be advised that Pletal may cause dizziness and should use caution when operating machinery or driving.

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 class. The medication is contraindicated in patients with hemostatic disorders or active pathological bleeding, such as bleeding peptic ulcer or intracranial hemorrhage. Concomitant administration with strong inhibitors of CYP3A4 (e.g., ketoconazole, itraconazole) or CYP2C19 (e.g., omeprazole, fluvoxamine) is contraindicated due to significantly increased cilostazol exposure. Use is contraindicated in patients with severe hepatic impairment (Child-Pugh Class C) and should be avoided in those with severe renal impairment.

Possible side effects

Common adverse reactions (≥2% incidence) include headache, diarrhea, abnormal stools, palpitations, tachycardia, dizziness, and peripheral edema. Less frequent side effects may include nausea, vomiting, abdominal pain, flatulence, infection, back pain, myalgia, and cough. Serious but rare adverse effects include thrombocytopenia, neutropenia, pancytopenia, agranulocytosis, and bleeding manifestations. Cardiovascular effects may include supraventricular tachycardia, atrial fibrillation, ventricular tachycardia, and syncope. Allergic reactions including rash, pruritus, and Stevens-Johnson syndrome have been reported. Patients should report any unusual bleeding, bruising, palpitations, or severe headache to their healthcare provider promptly.

Drug interaction

Pletal interacts significantly with medications that inhibit CYP3A4 and CYP2C19 enzymes, potentially increasing cilostazol concentrations and adverse effects. Concomitant use with strong CYP3A4 inhibitors (ketoconazole, itraconazole, clarithromycin) or strong CYP2C19 inhibitors (omeprazole, lansoprazole) is contraindicated. Caution is advised with moderate inhibitors of these enzymes. Concurrent administration with other antiplatelet agents (clopidogrel, aspirin) or anticoagulants (warfarin, dabigatran) may increase bleeding risk. Pletal may potentiate the effects of antihypertensive medications, possibly requiring dosage adjustment. Grapefruit juice may increase cilostazol exposure and should be avoided during treatment. Healthcare providers should conduct comprehensive medication reviews before initiation and during therapy.

Missed dose

If a dose of Pletal is missed, patients should take it as soon as they remember, 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 affect overall treatment outcomes. Patients should establish routines to support regular medication administration and consider using pill organizers or reminder systems if missing doses becomes a pattern.

Overdose

Symptoms of Pletal overdose may include severe headache, diarrhea, hypotension, tachycardia, cardiac arrhythmias, and bleeding manifestations. In case of suspected overdose, immediate medical attention should be sought. Management is primarily supportive and symptomatic, including monitoring of vital signs, ECG, and hematological parameters. Gastric lavage may be considered if ingestion occurred recently. Activated charcoal may be administered to reduce absorption. There is no specific antidote for cilostazol overdose. Hemodialysis is unlikely to be effective due to high protein binding. Treatment should focus on maintaining cardiovascular stability and managing bleeding complications if they occur.

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 subject to high humidity. Pletal should be kept out of reach of children and pets. Unused medication should be properly disposed of according to local regulations or medication take-back programs. Patients should not use tablets beyond the expiration date printed on the packaging.

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 only a healthcare provider can determine the appropriate therapy based on a patient’s specific medical condition, history, and current medications. Patients should not initiate, discontinue, or change dosage without consulting their healthcare provider. The complete prescribing information should be reviewed before initiating therapy.

Reviews

Clinical studies demonstrate that Pletal significantly improves maximal walking distance compared to placebo, with average increases of 40-50% from baseline. Many patients report meaningful improvement in daily activities and quality of life measures. Healthcare providers note that patient selection is crucial, with best results observed in motivated patients who concurrently participate in supervised exercise programs. Some patients discontinue therapy due to side effects, particularly headache and palpitations, though these often diminish with continued use. The twice-daily dosing regimen is generally well-accepted, though some patients report difficulty with timing requirements. Overall, Pletal is considered an valuable option in the pharmacologic management of intermittent claudication when appropriately prescribed and monitored.