Pletal (cilostazol) is a prescription medication specifically formulated to improve walking distance in patients with intermittent claudication, a symptom of peripheral artery disease. By inhibiting phosphodiesterase III, it functions as a vasodilator and platelet aggregation inhibitor, enhancing blood flow to the legs. This results in significantly increased pain-free walking and overall physical functionality, enabling a more active lifestyle. Clinical studies demonstrate its efficacy in improving both initial and absolute claudication distance, making it a cornerstone of pharmacological management for this condition. It is intended for use as part of a comprehensive treatment plan that includes lifestyle modifications.

Features

• Active Pharmaceutical Ingredient: Cilostazol
• Pharmacologic Class: Phosphodiesterase III (PDE3) Inhibitor
• Available Dosage Forms: Oral tablets (50 mg and 100 mg)
• Mechanism of Action: Dual-action as a vasodilator and antiplatelet agent
• Prescription Status: Rx-only medication
• Standard Dosing: Twice daily administration, taken 30 minutes before or 2 hours after breakfast and dinner

Benefits

• Significantly increases the distance you can walk without experiencing leg pain (claudication).
• Improves overall blood circulation in the limbs, enhancing tissue perfusion.
• Supports a more active and independent lifestyle by reducing exercise-limiting symptoms.
• Functions as part of a comprehensive management strategy for peripheral artery disease.
• Offers a well-tolerated pharmacological option with a established efficacy and safety profile.

Common use

Pletal is primarily indicated for the reduction of symptoms of intermittent claudication, a condition characterized by pain, cramping, or weakness in the legs that is induced by exercise and relieved by rest. This symptom is most commonly caused by peripheral artery disease (PAD), where atherosclerotic plaques narrow the arteries, reducing blood flow to the extremities. It is used to improve walking distance and is not intended to cure the underlying PAD. Treatment is typically considered for patients whose symptoms are not adequately managed through exercise and lifestyle changes alone. The goal of therapy is to enhance functional capacity and quality of life.

Dosage and direction

The recommended adult dosage of Pletal is 100 mg taken orally twice daily. It is crucial to administer the dose 30 minutes before or 2 hours after breakfast and dinner to ensure consistent absorption and minimize potential gastrointestinal side effects. A lower dosage of 50 mg twice daily may be recommended for patients who are also taking medications that inhibit the CYP3A4 or CYP2C19 enzyme pathways (e.g., certain antifungals, macrolide antibiotics, omeprazole). Treatment response is usually observed within 4 to 12 weeks, though the full benefits may take up to 3 months of consistent therapy. Do not adjust the dosage without consulting your physician.

Precautions

Prior to initiating therapy, a thorough cardiovascular assessment is essential. Pletal and other drugs in its class (PDE3 inhibitors) are contraindicated in patients with any degree of heart failure. Patients should be monitored for tachycardia and palpitations. Use with caution in patients with known bleeding tendencies, active pathological bleeding, or severe underlying hematological disorders. It may cause hypotension; caution is advised in patients already taking antihypertensive agents. Pletal has the potential to cause headaches, which are often dose-related and may subside with continued use. Inform your healthcare provider of all medications you are taking, including over-the-counter drugs and supplements.

Contraindications

Pletal is contraindicated in patients with known hypersensitivity to cilostazol or any component of the formulation. Its use is absolutely prohibited in patients with congestive heart failure of any severity class. This contraindication is due to the increased risk of mortality observed with other PDE3 inhibitors in heart failure populations. It is also contraindicated in patients with active pathological bleeding, such as active peptic ulcer disease or intracranial hemorrhage.

Possible side effect

The most common side effects (>10% incidence) are headache, diarrhea, and abnormal stools. Common side effects (2-10% incidence) include palpitations, tachycardia, rhinitis, pharyngitis, infection, dizziness, nausea, peripheral edema, dyspepsia, abdominal pain, flatulence, and rash. Less frequent but more serious adverse reactions can include thrombocytopenia, neutropenia, agranulocytosis, pancytopenia, and bleeding manifestations (e.g., subcutaneous hemorrhage, epistaxis, gastrointestinal bleeding). Tachycardia and palpitations are pharmacologically predictable side effects due to the drug’s mechanism of action. Any severe or persistent side effect should be reported to a physician immediately.

Drug interaction

Pletal is metabolized primarily by the hepatic enzymes CYP3A4 and, to a lesser extent, CYP2C19. Concomitant use with strong inhibitors of these enzymes can significantly increase cilostazol plasma concentrations and is not recommended.

• Strong CYP3A4 Inhibitors: Ketoconazole, itraconazole, voriconazole, clarithromycin, erythromycin, diltiazem, verapamil, nefazodone, fluvoxamine, saquinavir, ritonavir, atazanavir, grapefruit juice.
• Strong CYP2C19 Inhibitors: Omeprazole, esomeprazole, ticlopidine, fluvoxamine.
• Anticoagulants & Antiplatelets: Aspirin, clopidogrel, warfarin, apixaban, rivaroxaban. Concomitant use may potentiate the risk of bleeding.
• Other Blood Pressure-Lowering Agents: May potentiate hypotensive effects.

Missed dose

If you miss a dose of Pletal, take it as soon as you remember, unless it is nearly time for your next scheduled dose. In that case, skip the missed dose and resume your usual dosing schedule. Do not take a double dose to make up for a missed one. Maintaining a consistent schedule is important for therapeutic efficacy, but occasional missed doses are not typically cause for alarm. If you are unsure, contact your pharmacist or physician for guidance.

Overdose

In the event of a suspected overdose, symptoms are likely to be extensions of the drug’s known pharmacological effects. These may include severe headache, diarrhea, hypotension, tachycardia, and cardiac arrhythmias. Due to its antiplatelet effects, there is also a potential risk of severe bleeding. There is no specific antidote for cilostazol overdose. Management involves immediate discontinuation of the drug and provision of supportive and symptomatic care. Gastric lavage or administration of activated charcoal may be considered if ingestion was recent. It is critical to seek immediate emergency medical attention or contact a poison control center.

Storage

Store Pletal tablets at room temperature, between 20°C to 25°C (68°F to 77°F). Excursions are permitted between 15°C and 30°C (59°F and 86°F). Keep the medication in its original container, tightly closed, and out of reach of children and pets. Protect from excessive moisture, light, and heat. Do not store in bathrooms or kitchen cabinets near sinks. Properly discard any medication that is outdated or no longer needed. Consult your pharmacist for the best disposal method, as take-back programs are often the preferred option.

Disclaimer

This information is intended for educational and informational purposes only and does not constitute medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay in seeking it because of something you have read here. The information provided is based on the drug’s prescribing information but may not be exhaustive.

Reviews

“After three months on Pletal, my walking distance to the mailbox has more than doubled. The initial headaches were bothersome but subsided after the first few weeks. It has given me a part of my life back.” - John D., 68 “As a cardiologist, I find Pletal to be a valuable tool for motivated patients with claudication. The key is setting realistic expectations—it’s for symptom improvement, not a cure. It works best when combined with a structured walking program.” - Dr. Eleanor R. “The twice-daily timing around meals is a bit of a hassle to remember, but the improvement in my leg cramps is undeniable. I can now enjoy short walks with my grandchildren, which is priceless.” - Margaret T., 71 “Clinical trial data consistently shows a statistically significant improvement in both initial and absolute claudication distance compared to placebo. It remains a first-line pharmacologic option for appropriate patients without cardiac contraindications.” - Clinical Pharmacist Review