Cilostazol

What is Cilostazol?

Cilostazol is a medication available under the brand name Pletal, as well as in generic form. It belongs to a class of drugs known as phosphodiesterase 3 (PDE3) inhibitors, which have both antiplatelet and blood vessel-widening (vasodilating) effects.

Cilostazol is approved for:

• Reducing the symptoms of intermittent claudication — leg pain, cramping, or fatigue caused by reduced blood flow to the legs due to peripheral arterial disease (PAD) — to help increase walking distance

Cilostazol is available in the following formulation:

• Oral tablets (Cilostazol 50mg, Cilostazol 100mg)

What is the Recommended Dosage of Cilostazol?

There is no single “correct” dose of cilostazol for everyone. The right dose depends on several individual factors, including:

• The severity of symptoms
• The patient’s age
• Kidney and liver function
• Other medications currently being taken, since several drugs significantly increase cilostazol levels in the body
• Overall cardiovascular health, including heart function

Available Dosage Forms

Cilostazol is available as oral tablets, generally taken twice daily on an empty stomach (at least 30 minutes before or 2 hours after meals), in strengths that allow a prescriber to tailor the dose based on tolerability and interacting medications.

Important Note on Dosing

Exact dosing instructions are not provided on this page because appropriate dosing must be determined individually, and because cilostazol has several dose-limiting drug interactions. Patients should:

• Follow the exact dose and schedule prescribed by their licensed medical specialist
• Never adjust the dose on their own
• Ask their prescriber or pharmacist if dosing instructions are unclear, especially when starting a new medication

How Cilostazol Works

Cilostazol works by blocking an enzyme called phosphodiesterase 3 (PDE3). This has two main effects: it reduces the ability of platelets (small blood cells involved in clotting) to clump together, and it helps relax and widen blood vessels, which can improve blood flow to the legs.

In simple terms: cilostazol helps improve blood flow in the legs and reduces some of the leg pain and cramping caused by peripheral arterial disease, which can allow patients to walk farther with less discomfort.

Cilostazol manages the symptoms of intermittent claudication; it does not cure the underlying peripheral arterial disease, which is caused by narrowing of the arteries due to atherosclerosis, and it works best when combined with other measures such as a structured walking program, smoking cessation, and management of other cardiovascular risk factors.

Is a Prescription Required to Buy Cilostazol Online?

Yes. Cilostazol is a prescription-only medication in the United States and most other countries.

Before starting cilostazol, patients should consult a licensed medical specialist, such as:

• A vascular specialist
• A cardiologist
• A primary care physician

Important Safety Warning

Patients should be cautious of websites offering cilostazol without a prescription. These may include:

• Counterfeit medications with incorrect, unsafe, or no active ingredient
• Products not manufactured under proper quality and safety standards

Always obtain cilostazol from a licensed pharmacy, and only after being evaluated and prescribed by a qualified healthcare provider.

Side Effects of Cilostazol

Common Side Effects

These are generally mild and may lessen over time:

• Headache (relatively common, especially when starting treatment)
• Diarrhea or loose stools
• Abnormal or rapid heartbeat sensation (palpitations)
• Dizziness
• Stomach upset or indigestion

Serious Side Effects

Although uncommon, seek immediate medical attention if any of the following occur:

• Signs of heart failure, such as sudden shortness of breath, swelling in the legs or abdomen, or rapid weight gain
• Chest pain or a fast, irregular heartbeat
• Unusual bleeding or bruising
• Signs of an allergic reaction, such as swelling of the face, lips, tongue, or throat, hives, or difficulty breathing

This list is not exhaustive. Patients experiencing any unusual or concerning symptoms should contact their prescriber promptly.

Drug Interactions

Cilostazol can interact with a range of substances. Patients should tell their prescriber about all medications and products they use, including:

• Strong CYP3A4 inhibitors (such as certain antifungals like ketoconazole, or certain antibiotics like erythromycin), which can significantly raise cilostazol levels and typically require a reduced dose
• CYP2C19 inhibitors (such as omeprazole or fluconazole), which can also raise cilostazol levels and may require a reduced dose
• Other antiplatelet medications or blood thinners, such as aspirin or clopidogrel, since combined use may increase bleeding risk
• Grapefruit juice, which may increase cilostazol levels if consumed regularly in large amounts
• Over-the-counter (OTC) medications, including certain heartburn medications
• Supplements and herbal products, particularly those affecting bleeding or interacting with liver enzymes

Patients should provide their licensed medical specialist and pharmacist with a complete and current list of all prescription drugs, OTC medications, vitamins, and herbal supplements before starting cilostazol.

Safety & Important Considerations

• Heart failure: Cilostazol and related medications in its class have been associated with reduced survival in patients with significant heart failure; this medication should not be used in patients with any degree of heart failure
• Heart rhythm conditions: Caution is advised in patients with certain arrhythmias or a history of rapid heart rate
• Liver or kidney disease: May require dose adjustment or avoidance depending on severity
• Bleeding risk: Cilostazol has mild antiplatelet effects and may increase bleeding risk, particularly when combined with other antiplatelet medications
• Pregnancy and breastfeeding: Should only be used during pregnancy or breastfeeding if the potential benefit justifies the potential risk, as determined by a prescriber, since safety data in these populations is limited
• Age-related considerations: Older adults may be more sensitive to side effects such as palpitations or dizziness
• FDA boxed warning: Cilostazol carries a boxed warning stating it should not be used in patients with heart failure of any severity, based on findings from related medications showing decreased survival in this population
• Monitoring requirements: Prescribers may periodically reassess walking distance, symptom improvement, heart rate, and overall cardiovascular status

This medication should only be used for its approved purpose, as determined by a licensed prescriber.

Who This Medication Is For

Cilostazol is generally intended for:

• Adults with peripheral arterial disease who experience intermittent claudication (leg pain or cramping with walking) that limits their daily activity
• Patients who do not have heart failure or other contraindications (see Section 9)
• Patients who have been evaluated by a licensed prescriber and determined to be appropriate candidates based on their vascular and cardiac health

Use should always follow an appropriate clinical evaluation and a specialist’s recommendation. It is worth noting that improvement in walking distance typically takes several weeks to become noticeable, and full benefit may take up to 12 weeks of consistent use.

Who Should Not Take Cilostazol

Cilostazol may not be appropriate for individuals who:

• Have heart failure of any severity
• Have a known allergy to cilostazol or any ingredient in the product
• Have unstable angina, a recent heart attack, or a recent coronary procedure, without specialist guidance
• Have a history of certain serious heart rhythm disturbances
• Have active bleeding, such as a bleeding ulcer

This is not a complete list. A full medical history review by a licensed specialist is necessary to determine if cilostazol is safe and appropriate.

What to Do If You Miss a Dose

• Take the missed dose as soon as remembered, unless it is close to the time of the next scheduled dose, in which case the missed dose should generally be skipped
• Do not double up or take an extra dose to make up for a missed one
• Try to take cilostazol at the same two times each day, on an empty stomach, to maintain consistent effect
• Contact a licensed medical specialist if there is any uncertainty about the dosing schedule

Related medications to Cilostazol

Other approaches sometimes used for managing intermittent claudication and peripheral arterial disease include:

• Pentoxifylline, another medication used to improve blood flow symptoms in PAD
• Supervised exercise (walking) programs, often used alongside or instead of medication
• Antiplatelet medications such as aspirin or clopidogrel, primarily for overall cardiovascular risk reduction rather than symptom relief
• In more severe cases, procedures to open or bypass blocked arteries

Switching between treatments should only be done in consultation with a licensed medical specialist, who can weigh factors such as symptom severity, heart function, and overall cardiovascular risk.

Storage Instructions

• Store at room temperature, generally between 68°F and 77°F (20°C to 25°C), unless otherwise directed on the packaging
• Keep away from excess heat, moisture, and direct light
• Store in the original packaging or container until ready to use
• Keep out of reach of children and pets
• Dispose of expired or unused medication according to local guidelines or pharmacist instructions

Disclaimer:

This page is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Patients must consult a licensed vascular specialist, cardiologist, or other relevant medical specialist before starting, changing, or stopping treatment with cilostazol. Treatment decisions must be based on a full clinical evaluation by a qualified specialist.