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INTRODUCTION

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cilostazol (sil-os-tah-zol)

Pletal

Classification

Therapeutic: antiplatelet agents

Pharmacologic: platelet aggregation inhibitors

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Indications
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Reduction of the symptoms of intermittent claudication as measured by increased walking distance.

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Action
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Inhibits the enzyme cyclic adenosine monophosphate (cAMP) phosphodiesterase III (PDE III), which results in increased cAMP in platelets and blood vessels, producing inhibition of platelet aggregation and vasodilation. Therapeutic Effects: Reduced symptoms of intermittent claudication with improved walking distance.

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Adverse Reactions/Side Effects
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CNS: headache, dizziness. CV: palpitations, tachycardia. GI: diarrhea.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess patient's walking distance and pain-free walking time. Document any increase in walking distance and time as an indication that this drug is helping reduce intermittent claudication.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report fast heart rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

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Interventions
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  • Implement therapeutic exercises and ambulation activities to augment the effects of drug therapy and promote increased walking distance. Patients should attempt to walk as long as possible after the onset of leg pain, and progressively increase the time spent walking before stopping due to claudication.

  • Because of the risk of tachycardia and other arrhythmias, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

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Patient/Client-Related Instruction
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  • Instruct patient to report other bothersome side effects, including severe or prolonged headache or diarrhea.

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Pharmacokinetics
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Absorption: Slowly absorbed after oral administration.

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Distribution: Unknown.

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Protein Binding: 95–98% bound to plasma proteins; one active metabolite is 97.4% bound, the other is 66% bound.

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Metabolism and Excretion: Extensively metabolized by the liver, two metabolites have platelet aggregation inhibitory activity; metabolites are mostly excreted by the kidneys.

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Half-life: Cilostazol and its active metabolites—11–13 hr.

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TIME/ACTION PROFILE (symptom reduction)

ROUTE ONSET PEAK DURATION
PO 2–4 wk up to 12 wk unknown

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; CHF; OB: Potential for congenital defects, stillbirth, and low birth weight; Lactation: Potential risk to nursing infants; discontinue or bottle feed.

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Use Cautiously in: Pedi: Safety not established.

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Interactions
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