Pletal

Pletal (cilostazol) is a prescription medication specifically designed to treat the symptoms of intermittent claudication, a condition caused by peripheral arterial disease (PAD). By inhibiting platelet aggregation and dilating blood vessels, it increases blood circulation to the legs. This action helps patients walk longer distances with significantly less pain, improving functional capacity and overall quality of life. It is a key therapeutic option for managing the debilitating symptoms associated with reduced arterial flow.

Features

• Active pharmaceutical ingredient: Cilostazol
• Available in 50 mg and 100 mg oral tablets
• Phosphodiesterase III inhibitor with dual mechanism of action
• Prescription-only medication requiring medical supervision
• Standard packaging in bottles of 60 or 100 tablets

Benefits

• Increases pain-free walking distance in patients with intermittent claudication
• Improves overall mobility and physical functioning
• Enhances quality of life by reducing lifestyle limitations
• Provides a non-surgical option for symptomatic management of PAD
• Exhibits both antiplatelet and vasodilatory effects
• Supported by extensive clinical trial data demonstrating efficacy

Common use

Pletal is indicated for the reduction of symptoms of intermittent claudication, a condition characterized by pain, cramping, or weakness in the legs during physical activity due to inadequate blood flow. It is used in patients whose symptoms are not sufficiently managed by exercise and lifestyle modifications alone. The medication does not cure peripheral arterial disease but helps manage its most disabling symptom, allowing for improved ambulation and daily activity tolerance.

Dosage and direction

The recommended dosage of Pletal is 100 mg taken orally twice daily, approximately 30 minutes before or 2 hours after breakfast and dinner. For patients who may not tolerate this dose, a reduced dosage of 50 mg twice daily may be prescribed. Treatment should be initiated under medical supervision, and dosage adjustments should only be made by a healthcare provider. The medication is intended for long-term use, and clinical response may be observed within 4-12 weeks of initiation, though full benefits may take up to 12 weeks to manifest.

Precautions

Patients should be monitored for potential cardiovascular effects, as cilostazol is a phosphodiesterase III inhibitor. Regular assessment of symptoms and walking capacity is recommended. Use with caution in patients with moderate to severe hepatic impairment or severe renal impairment. Pletal may cause tachycardia, palpitations, or arrhythmias in some patients. Ophthalmological examinations are advised periodically during treatment due to potential ocular effects. Patients should be advised that smoking cessation and walking exercise are important components of claudication treatment.

Contraindications

Pletal is contraindicated in patients with known hypersensitivity to cilostazol or any component of the formulation. It must not be used in patients with congestive heart failure of any severity, as phosphodiesterase III inhibitors have been shown to decrease survival in patients with class III-IV heart failure. Concurrent use with strong inhibitors of CYP3A4 or CYP2C19 is contraindicated due to increased cilostazol exposure. The medication is not recommended for use in patients with bleeding disorders or active pathological bleeding.

Possible side effects

Common side effects (>5% incidence) include headache, diarrhea, abnormal stools, palpitations, and dizziness. Less frequent adverse reactions (1-5%) may include peripheral edema, tachycardia, rhinitis, pharyngitis, and flatulence. Rare but serious side effects (<1%) can include thrombocytopenia, pancytopenia, agranulocytosis, ventricular tachycardia, and supraventricular tachycardia. Most side effects are mild to moderate in intensity and often diminish with continued treatment. Patients should report any persistent or severe symptoms to their healthcare provider.

Drug interaction

Pletal has significant interactions with medications that inhibit CYP3A4 (e.g., ketoconazole, itraconazole, erythromycin, diltiazem) or CYP2C19 (e.g., omeprazole), which can increase cilostazol concentrations. Concurrent use with aspirin may increase bleeding tendency. Caution is advised when co-administering with other antiplatelet agents or anticoagulants. Grapefruit juice should be avoided as it may increase serum concentrations of cilostazol. Dosage reduction may be necessary when used concomitantly with strong inhibitors of these metabolic pathways.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not take double or extra doses to make up for a missed dose. Maintaining consistent timing of administration helps maintain stable drug levels and optimal therapeutic effect.

Overdose

Symptoms of overdose may include severe headache, diarrhea, hypotension, tachycardia, and cardiac arrhythmias. There is no specific antidote for cilostazol overdose. Management should include supportive measures and symptomatic treatment. Gastric lavage may be considered if presentation is early after ingestion. Hemodialysis is not expected to be effective due to high protein binding. Cardiac monitoring is recommended in cases of significant overdose. Medical attention should be sought immediately if overdose is suspected.

Storage

Store Pletal tablets at room temperature between 15-30°C (59-86°F) in their original container. Protect from light and moisture. Keep the medication out of reach of children and pets. Do not use tablets that appear discolored or show signs of deterioration. Properly discard any unused medication after the expiration date or when treatment is discontinued, following appropriate medication disposal guidelines.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Pletal is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Individual response to treatment may vary, and not all patients will experience the same benefits. Patients should consult their healthcare provider for personalized medical advice, including proper diagnosis, treatment options, and monitoring requirements. The manufacturer’s prescribing information should be consulted for complete details.

Reviews

Clinical studies have demonstrated that Pletal significantly improves maximal walking distance and pain-free walking distance compared to placebo. In randomized controlled trials, patients treated with cilostazol 100 mg twice daily showed approximately 40-50% improvement in walking distance after 12-24 weeks of treatment. Many patients report meaningful improvement in their ability to perform daily activities and reduced limitation from claudication symptoms. Healthcare providers note that the medication is particularly valuable for patients who are not candidates for surgical intervention or who have not responded adequately to exercise therapy alone.