Pletal: Advanced Peripheral Artery Disease Symptom Relief
Pletal
| Product dosage: 100mg | |||
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| Product dosage: 50mg | |||
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Synonyms
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Pletal (cilostazol) is a quinolinone-derived phosphodiesterase III inhibitor specifically indicated for the reduction of symptoms of intermittent claudication, a manifestation of peripheral artery disease. This vasodilatory and antiplatelet agent works through dual mechanisms of action to improve microcirculatory blood flow and increase pain-free walking distance. It represents a cornerstone of pharmacologic management for patients whose symptoms are not adequately controlled by exercise and lifestyle modification alone. Clinical efficacy is well-established through multiple randomized controlled trials demonstrating significant functional improvement.
Features
- Active pharmaceutical ingredient: Cilostazol 50 mg or 100 mg
- Pharmacologic class: Selective phosphodiesterase type 3 (PDE3) inhibitor
- Dual mechanism: Vasodilation through cAMP elevation and antiplatelet activity
- Administration: Oral tablet taken twice daily
- Bioavailability: Approximately 90% with high protein binding
- Metabolism: Hepatic via CYP3A4 and CYP2C19 isoenzymes
- Elimination half-life: 11–13 hours with biphasic kinetics
Benefits
- Significantly increases pain-free walking distance in patients with intermittent claudication
- Improves maximal walking distance and overall functional capacity
- Reduces lower extremity ischemic symptoms including numbness and coldness
- Enhances quality of life through improved mobility and daily activity tolerance
- Provides alternative therapy for patients contraindicated for other antiplatelet regimens
- Demonstrates sustained efficacy with long-term administration
Common use
Pletal is primarily prescribed for symptomatic management of intermittent claudication secondary to peripheral artery disease. It is indicated for patients who have not achieved adequate symptom relief through supervised exercise therapy and risk factor modification. The medication is typically incorporated into comprehensive cardiovascular risk reduction programs that include smoking cessation, lipid management, and blood pressure control. Clinical use is generally reserved for patients without heart failure given its pharmacologic profile.
Dosage and direction
The recommended dosage 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, an initial dose of 50 mg twice daily may be considered. Administration with food may reduce the incidence of headache and gastrointestinal side effects. Dose adjustments are necessary in patients with hepatic impairment or those taking concomitant CYP3A4 or CYP2C19 inhibitors. Treatment response typically becomes evident within 4–12 weeks of initiation.
Precautions
Regular monitoring of cardiovascular status is recommended throughout therapy. Patients should be advised about the potential for tachycardia, palpitations, and dizziness, particularly during the initial treatment phase. Caution is advised in patients with history of atrial or ventricular tachyarrhythmias. Complete blood counts should be monitored periodically due to potential effects on platelet function. Patients undergoing surgical procedures should discuss Pletal discontinuation timing with their surgeon due to antiplatelet effects.
Contraindications
Pletal is contraindicated in patients with congestive heart failure of any severity classification. Additional contraindications include known hypersensitivity to cilostazol or any component of the formulation, active pathological bleeding such as peptic ulcer disease or intracranial hemorrhage, and severe hepatic impairment (Child-Pugh Class C). Concomitant administration with strong CYP3A4 inhibitors like ketoconazole or CYP2C19 inhibitors such as omeprazole is contraindicated.
Possible side effects
- Headache (27-34% of patients)
- Diarrhea (12-19%)
- Abnormal stools (15%)
- Palpitations (10-14%)
- Dizziness (9-12%)
- Pharyngitis (7-10%)
- Peripheral edema (7-9%)
- Tachycardia (4-7%)
- Rhinitis (6-7%)
- Nausea (6-7%)
- Dyspepsia (5-6%)
- Flatulence (4-5%)
Drug interaction
Significant interactions occur with CYP3A4 inhibitors (ketoconazole, itraconazole, erythromycin, diltiazem) and CYP2C19 inhibitors (omeprazole, fluvoxamine), requiring dose reduction or alternative therapy. Concurrent use with aspirin or other antiplatelet agents may increase bleeding risk. Caution is advised with other vasodilators due to additive hypotensive effects. Grapefruit juice may increase cilostazol concentrations and should be avoided during treatment.
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. Patients should not double the dose to make up for a missed administration. Consistent twice-daily dosing is important for maintaining therapeutic plasma concentrations. If multiple doses are missed, patients should contact their healthcare provider for guidance on resumption of therapy.
Overdose
Symptoms of overdose may include severe headache, diarrhea, hypotension, tachycardia, and cardiac arrhythmias. Management is supportive with careful monitoring of cardiovascular status and vital signs. Gastric lavage may be considered if ingestion occurred within recent hours. Hemodialysis is not expected to be effective due to high protein binding. Specific antidote is not available; treatment should focus on symptomatic management.
Storage
Store at controlled room temperature 20°C to 25°C (68°F to 77°F) with excursions permitted between 15°C and 30°C (59°F and 86°F). Keep container tightly closed and protect from moisture and light. Keep out of reach of children and pets. Do not use after expiration date printed on packaging. Properly dispose of unused medication through drug take-back programs.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions should be made in consultation with a qualified healthcare professional familiar with the patient’s complete medical history. Individual response to therapy may vary based on multiple factors including age, comorbidities, and concomitant medications. Always follow the prescribing information provided with the medication.
Reviews
Clinical studies demonstrate that 40-50% of patients achieve clinically significant improvement in walking distance with Pletal therapy. Many patients report meaningful quality of life improvements, particularly regarding ability to perform daily activities without claudication pain. Some patients discontinue therapy due to side effects, primarily headache and gastrointestinal symptoms, though these often diminish with continued use. Healthcare providers generally consider Pletal an effective option for appropriate patients with peripheral artery disease.