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Cilostazol, (Pletal), MedicineNet, Inc.:"PRESCRIBED FOR: Cilostazol improves walking speed and walking distance among patients with intermittent claudication. It does not cure intermittent claudication. Cilostazol has not been studied in patients with leg pain at rest, leg ulcers due to reduced flow of blood, gangrene or rapidly progressing claudication."
http://www.focusonheart.com/script/main/art.asp?articlekey=9143&track=goheart
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Cilostazol, (Pletal), U. S. Food and Drug Administration:"Cilostazol (Pletal) is a drug for the treatment of intermittent claudication. It allows people with this condition to exercise longer before developing their characteristic leg pain and to walk longer before they must stop because of the pain. Cilostazol’s mechanism of action is not clear. It is an inhibitor of phosphodiesterase III (PDE III), which causes it to be a vasodilator and inhibitor of platelet aggregation, these actions may contribute to its effect, but other drugs with those properties are not known to be useful in intermittent claudication."
http://www.fda.gov/cder/news/cilostazol/default.htm
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Cilostazol, (Pletal), Texas Health and Human Services Commission:"Cilostazol is indicated for use in the reduction of symptoms of intermittent claudication, which is determined by an increase in walking distance. The recommended dose is 100 mg twice daily, although dosages of cilostazol range from 50 mg to 300 mg daily. Cilostazol is extensively metabolized by the CYP3A4 isoenzyme and, to a lesser extent, CYP2C19. Cilostazol 50 mg twice daily should be contemplated in patients receiving concurrent therapy with medications that inhibit the CYP3A4 isoenzyme (e.g., ketoconazole, itraconazole, erythromycin, diltiazem) as well as CYP2C19 inhibitors such as omeprazole. Dosages greater than 300 mg daily will be reviewed. Duration of Therapy: There is no basis for limiting the duration of cilostazol therapy as patients may suffer from intermittent claudication, the primary symptom of peripheral arterial disease, chronically."
http://www.hhsc.state.tx.us/HCF/vdp/Criteria/cilostaz.html
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Cilostazol, (Pletal), Otsuka America Pharmaceutical, Inc.:"The mechanism of the effects of PLETAL on the symptoms of intermittent claudication is not fully understood. PLETAL and several of its metabolites are cyclic AMP (cAMP) phosphodiesterase III inhibitors (PDE III inhibitors), inhibiting phosphodiesterase activity and suppressing cAMP degradation with a resultant increase in cAMP in platelets and blood vessels, leading to inhibition of platelet aggregation and vasodilation, respectively."
http://www.pletal.com/pro/0_7.asp
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Cilostazol, (Pletal), The Department of Defense (DoD) PharmacoEconomic Center (PEC):"Another major concern of the FDA's Cardio-Renal Advisory Committee was the lack of information on use of cilostazol with clopidogrel (Plavix), an anti-platelet drug indicated for the reduction of atherosclerotic events (MI, stroke, and vascular death) in patients with atherosclerosis documented by recent stroke, recent MI, or established peripheral arterial disease. Unlike aspirin, which is effective in patients with a previous heart attack or stroke but does not appear active in patients with claudication, clopidogrel appears effective in all three groups. Because both cilostazol and clopidogrel inhibit platelet function, it is possible that combined use could lead to excessive bleeding. However, concomitant use of cilostazol with aspirin, which also inhibits platelet function, did not result in increased bleeding. Otsuka has agreed to conduct Phase 4 studies of cilostazol and clopidogrel."
http://www.pec.ha.osd.mil/Updates/9904web/9904pg4/9904pg4.htm
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Cilostazol, (Pletal), MedicineNet, Inc:"In January 1999, the U.S. Food and Drug Administration approved cilostazol (brand name: PLETAL) for the management of intermittent claudication, a condition in which pain develops in the lower legs during walking and sometimes at rest. It results from narrowing of the arteries that supply the leg muscles with blood and oxygen. Cilostazol does not cure intermittent claudication but rather reduces the pain so that patients can walk longer before developing pain. In 8 studies, the average improvement in walking distance was 28 to 100% for patients who took cilostazol as compared with -10 to 30% for patients who took a placebo ("sugar pill"). It is not completely known how cilostazol works. Its primary action is to expand the arteries going to the legs, increasing the flow of blood and oxygen to the muscles. It also reduces the ability of blood to clot. Until now, pentoxifylline (TRENTAL) was the only drug approved for the
management of intermittent claudication. TRENTAL improves blood flow by making it easier for red blood cells that carry oxygen to travel through arteries and by decreasing the stickiness (viscosity) of blood."
http://www.asiamedicinenet.com/script/main/Art.asp?li=AMN&ArticleKey=9088
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Cilostazol, (Pletal), Doctor's Guide:"ROCKVILLE, MD and PEAPACK, NJ -- October 27, 2000 -- A newly published study shows that Pletal® (cilostazol) Tablets enables people with the debilitating leg pain associated with intermittent claudication to walk nearly twice as far as patients taking either Trental® (pentoxifylline), the only other medication currently available for the condition, or placebo. The study of nearly 700 seniors is published in the November 1 issue of The American Journal of Medicine."
http://www.pslgroup.com/dg/1e879a.htm
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Cilostazol, (Pletal), RxList:"Cilostazol affects both vascular body and cardiovascular function. It produces non-homogeneous dilation of vascular beds, with greater dilation in femoral body than in vertebral, carotid or superior mesenteric arteries. Renal arteries were not responsive to the effects of cilostazol. In dogs or cynomolgous monkeys, cilostazol increased heart rate, myocardial contractile force, and coronary blood flow as well as ventricular automaticity, as would be expected for a PDE III inhibitor. Left ventricular contractility was increased at doses required to inhibit platelet aggregation. A-V conduction was accelerated. In humans, heart rate increased in a dose-proportional manner by a mean of 5.1 and 7.4 beats per minute in patients treated with 50 and 100 mg b.i.d., respectively. In 264 patients evaluated with Holter monitors, numerically more cilostazol-treated patients had increases in ventricular premature beats and non-sustained ventricular
tachycardia events than did placebo-treated patients; the increases were not dose-related."
http://www.rxlist.com/cgi/generic/cilostaz_cp.htm
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Cilostazol, (Pletal), Nurses's PDR Resource Center:"Classification: Antiplatelet drug. Action/Kinetics: Inhibits cellular phosphodiesterase (PDE), especially PDE III. Cilostazol and several metabolites inhibit cyclic AMP PDE III. Suppression of this isoenzyme causes increased levels of cyclic AMP resulting in vasodilation and inhibition of platelet aggregation. Inhibits platelet aggregation caused by thrombin, ADP, collagen, arachidonic acid, epinephrine, and shear stress. High fat meals significantly increase absorption. Significantly plasma protein bound. Extensively metabolized by the liver with two of the metabolites being active. Primarily excreted through the urine (74%) with the rest in the feces. Uses: Reduce symptoms of intermittent claudication."
http://www.nursespdr.com/members/database/ndrhtml/cilostazol.html
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