Pletal (cilostazol) is a selective phosphodiesterase III inhibitor indicated for the reduction of symptoms of intermittent claudication, a condition characterized by pain and cramping in the legs due to inadequate blood flow. As a vasodilator and antiplatelet agent, it works by improving blood circulation to the extremities, enhancing walking distance, and reducing ischemic symptoms. This prescription medication is intended for patients who have not achieved adequate symptom relief through exercise and lifestyle modifications alone. Clinical studies demonstrate its efficacy in improving pain-free walking distance and overall quality of life in affected individuals.

Features

• Active ingredient: cilostazol 50 mg or 100 mg
• Selective phosphodiesterase type III (PDE3) inhibitor
• Dual mechanism: vasodilation and antiplatelet aggregation
• Oral administration, twice daily dosing
• Available in film-coated tablet form
• Prescription-only medication

Benefits

• Significantly increases pain-free walking distance in patients with intermittent claudication
• Improves maximal walking distance and overall physical functioning
• Reduces symptoms of leg pain, numbness, and cramping during activity
• Enhances quality of life by enabling greater mobility and daily activity participation
• Provides antiplatelet effects that may help prevent thrombosis
• Offers symptomatic improvement without invasive procedures

Common use

Pletal is primarily prescribed for the symptomatic treatment of intermittent claudication, a manifestation of peripheral arterial disease. It is used in patients who experience exercise-induced cramping, pain, or fatigue in the legs due to reduced blood flow. The medication is typically recommended when lifestyle modifications—including smoking cessation, exercise training, and lipid management—have proven insufficient. It may be used as part of a comprehensive management strategy that includes risk factor modification and supervised exercise therapy.

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 be made based on individual tolerance and response. The medication should be taken consistently at the same times each day to maintain stable plasma concentrations. Clinical response may not be immediate, with maximum benefits typically observed after 12-24 weeks of continuous therapy.

Precautions

Patients should be carefully monitored for cardiovascular status during treatment. Pletal should be used with caution in patients with known or suspected coronary artery disease, as the drug may increase heart rate. Regular monitoring of blood pressure and heart rate is recommended. Patients with congestive heart failure of any severity should not use Pletal due to increased mortality risk in this population. Caution is advised in patients with hepatic impairment or severe renal impairment (creatinine clearance <25 mL/min). Bleeding risk should be assessed periodically, particularly in patients taking concomitant antiplatelet or anticoagulant therapy.

Contraindications

Pletal is contraindicated in patients with congestive heart failure of any severity. It should not be used in patients with known hypersensitivity to cilostazol or any component of the formulation. The medication is contraindicated in patients with active pathological bleeding, such as peptic ulcer disease or intracranial hemorrhage. Concomitant administration with strong inhibitors of CYP3A4 (such as ketoconazole, itraconazole) or CYP2C19 (such as omeprazole, esomeprazole) is contraindicated due to potential for significantly increased cilostazol exposure.

Possible side effects

Common adverse reactions include headache (27-34%), diarrhea (12-19%), abnormal stools (12-15%), palpitations (10-14%), and dizziness (9-12%). Less frequently reported side effects include tachycardia, peripheral edema, nausea, rhinitis, and pharyngitis. Serious side effects may include thrombocytopenia, leukopenia, agranulocytosis, pancytopenia, and bleeding complications. Cardiovascular effects including angina pectoris, myocardial infarction, and ventricular tachycardia have been reported. Patients should report any unusual bleeding, bruising, palpitations, or severe headaches to their healthcare provider.

Drug interaction

Pletal interacts significantly with medications that inhibit CYP3A4 and CYP2C19 enzymes, potentially increasing cilostazol concentrations. Concomitant use with aspirin may increase bleeding risk. Caution is advised when co-administering with other antiplatelet agents, anticoagulants, or thrombolytics. Drugs that affect heart rate or rhythm may have additive effects with Pletal. Grapefruit juice may increase cilostazol exposure and should be avoided. Omeprazole, erythromycin, diltiazem, and ketoconazole are among medications that require careful consideration and potential dosage adjustment when used with Pletal.

Missed dose

If a dose of Pletal 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 a double dose to make up for a missed one. Maintaining consistent dosing is important for therapeutic effect, but occasional missed doses are unlikely to significantly impact overall treatment efficacy. Patients should establish routines to minimize missed doses and discuss any pattern of missed medications with their healthcare provider.

Overdose

Symptoms of Pletal overdose may include severe headache, diarrhea, hypotension, tachycardia, and cardiac arrhythmias. In cases of suspected overdose, symptomatic and supportive care should be initiated immediately. Gastric lavage may be considered if ingestion was recent. Hemodialysis is unlikely to be effective due to high protein binding of cilostazol. Cardiac monitoring is recommended for patients presenting with overdose symptoms. There is no specific antidote for cilostazol overdose. Management should focus on maintaining hemodynamic stability and addressing specific symptoms as they arise.

Storage

Pletal tablets should be stored at room temperature between 15-30°C (59-86°F) in their original container. The medication should be protected from excessive moisture and light. Keep the container tightly closed and out of reach of children and pets. Do not store in bathrooms or other areas with high humidity. Discard any medication that has expired or shows signs of deterioration. Proper disposal methods should be followed according to local regulations, preferably through medication take-back programs.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Pletal is a prescription medication that should be used only under the supervision of a qualified healthcare professional. Individual response to treatment may vary, and not all patients will experience the same benefits. The safety and efficacy of Pletal have been established through clinical trials, but all medications carry potential risks. Patients should discuss their medical history, current medications, and treatment options with their healthcare provider before initiating therapy. This information is not exhaustive and should not replace professional medical guidance.

Reviews

Clinical studies demonstrate that Pletal significantly improves walking distance in patients with intermittent claudication. In randomized controlled trials, patients treated with 100 mg twice daily showed a 28-50% increase in pain-free walking distance compared to placebo. Many patients report meaningful improvements in daily activities and quality of life. Some users note the gradual onset of effect, with maximum benefits typically achieved after several months of consistent use. Healthcare providers generally consider Pletal an important option in the pharmacological management of intermittent claudication when appropriately prescribed to suitable candidates without contraindications.