Buy Pletal Online

Pletal (cilostazol)

BOXED WARNING

Contraindicated w/ CHF of any severity due to possible decrease in survival.

THERAPEUTIC CLASS

Phosphodiesterase 3 (PDE3) inhibitor

DEA CLASS

RX

INDICATIONS

Reduction of symptoms of intermittent claudication.

ADULT DOSAGE

Intermittent Claudication

Reduction of Symptoms: 100mg bid

D/C if symptoms have not improved after 3 months

DOSING CONSIDERATIONS

Concomitant Medications
Moderate/Strong CYP3A4 or Strong CYP2C19 Inhibitors: Consider reduction to 50mg bid

ADMINISTRATION

Oral route

Take at least 1/2 hr before or 2 hrs after breakfast and dinner

HOW SUPPLIED

Tab: 50mg, 100mg

CONTRAINDICATIONS

CHF of any severity. Hemostatic disorders or active pathologic bleeding (eg, peptic ulcer, intracranial bleeding).

WARNINGS/PRECAUTIONS

Thrombocytopenia/leukopenia progressing to agranulocytosis reported (rare) . May induce tachycardia, palpitation, tachyarrhythmia, and/or hypotension. Patients w/ history of ischemic heart disease may be at risk for angina pectoris or MI exacerbation. Special caution w/ moderate/severe hepatic and severe renal impairment (CrCl <25mL/min).

ADVERSE REACTIONS

Headache, palpitation, tachycardia, abnormal stools, diarrhea, peripheral edema, dizziness, infection, rhinitis, pharyngitis, nausea, back pain, dyspepsia, abdominal pain, increased cough.

DRUG INTERACTIONS

See Dose Modification. May increase levels and overall pharmacological activity w/ strong or moderate CYP3A4 inhibitors (eg, ketoconazole, itraconazole, erythromycin, diltiazem) and strong CYP2C19 inhibitors (eg, ticlopidine, fluconazole, omeprazole).

PREGNANCY AND LACTATION

Category C, not for use in nursing.

MECHANISM OF ACTION

Phosphodiesterase III inhibitor; not established. Suspected to inhibit phosphodiesterase activity and suppress cAMP degradation resulting in an increase of cAMP in platelets and blood vessels, leading to inhibition of platelet aggregation and vasodilation.

PHARMACOKINETICS

Distribution: Plasma protein binding (95-98%). Metabolism: Liver (extensive) via CYP450 3A4 (primary), 2C19; 3,4-dehydro-cilostazol, 4'-trans-hydroxy-cilostazol (major active metabolites). Elimination: Urine (74%), feces (20%); T1/2=11-13 hrs.

ASSESSMENT

Assess for hypersensitivity to drug, CHF, hemostatic disorders, active pathologic bleeding, history of ischemic heart disease, renal/hepatic impairment, pregnancy/nursing status, and possible drug interactions.

MONITORING

Monitor for tachycardia, palpitation, tachyarrhythmia, hypotension, and other adverse reactions. Monitor platelets and WBC counts periodically.

PATIENT COUNSELING

Advise to take at least 1/2 hr ac or 2 hrs pc. Inform that benefits of medication may not be immediate and treatment may be required for up to 12 weeks before beneficial effect is experienced.

STORAGE

25°C (77°F); excursions permitted to 15-30°C (59-86°F).

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