Nurses Compass
Drug Guide
Cilostazol
Classification
Therapeutic: Antiplatelet Agent and Vasodilator
Pharmacological: Phosphodiesterase III Inhibitor
FDA Approved Indications
- Intermittent Claudication due to Peripheral Arterial Disease
Mechanism of Action
Cilostazol inhibits phosphodiesterase III, leading to increased levels of cyclic AMP, which causes vasodilation and inhibits platelet aggregation, improving blood flow in peripheral arteries.
Dosage and Administration
Adult: 100 mg twice daily, 30 minutes before or 2 hours after meals
Pediatric: Not approved for pediatric use
Geriatric: Use with caution; adjust dose based on tolerability and risk factors
Renal Impairment: Adjust dose based on severity of impairment; typically, use with caution and monitor closely
Hepatic Impairment: Use with caution; no specific dose adjustment established
Pharmacokinetics
Absorption: Well absorbed orally
Distribution: Widely distributed, crossing the placenta and into breast milk
Metabolism: Extensively metabolized in the liver via CYP3A4 and CYP2C19
Excretion: Primarily in urine as metabolites, small amount as unchanged drug in feces
Half Life: 11-13 hours
Contraindications
- Heart failure of NYHA Class III or IV
- Active bleeding or bleeding disorder
Precautions
- Use cautiously in patients at risk for bleeding, with hepatic impairment, or with a history of syncope
Adverse Reactions - Common
- Headache (Common)
- Diarrhea (Common)
- Dizziness (Common)
- Tachycardia (Common)
Adverse Reactions - Serious
- Bleeding (Rare)
- Thrombocytopenia (Rare)
- Arrhythmias (Rare)
Drug-Drug Interactions
- Concurrent use with other antiplatelet agents or anticoagulants increases bleeding risk.
Drug-Food Interactions
- No significant food interactions reported.
Drug-Herb Interactions
- Potential increased bleeding with garlic, ginseng, ginkgo.
Nursing Implications
Assessment: Monitor for signs of bleeding, cardiovascular status, and blood pressure.
Diagnoses:
- Risk for bleeding
- Ineffective tissue perfusion
Implementation: Administer as prescribed, educate patient on bleeding precautions, monitor liver function.
Evaluation: Assess for reduced claudication symptoms, monitor for adverse effects and signs of bleeding.
Patient/Family Teaching
- Take medication exactly as prescribed.
- Report signs of bleeding (bruising, bleeding gums, blood in stool).
- Inform about possible side effects like headache and dizziness.
Special Considerations
Black Box Warnings:
- Increased risk of cardiovascular events in patients with heart failure.
Genetic Factors: No specific genetic considerations noted.
Lab Test Interference: May cause false elevations in uric acid levels.
Overdose Management
Signs/Symptoms: Dizziness, tachycardia, hypotension, bleeding
Treatment: Supportive care, manage bleeding if present, activated charcoal if within an hour of ingestion, no specific antidote.
Storage and Handling
Storage: Store at room temperature, 20-25°C (68-77°F).
Stability: Stable in original container, protect from moisture and light.