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Phosphodiesterase type 3 inhibitor / antiplatelet

Cilostazol

Brand names: Pletal

Cilostazol is an oral phosphodiesterase-3 inhibitor with antiplatelet and vasodilator properties, used to improve walking distance in intermittent claudication due to peripheral arterial disease.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It inhibits phosphodiesterase-3, increasing intracellular cyclic AMP, which inhibits platelet aggregation and causes vasodilatation.

Prescribing in practice

  • It is contraindicated in heart failure of any severity, as other oral phosphodiesterase-3 inhibitors have increased mortality in heart failure.
  • NICE recommends it only as an option for claudication after lifestyle measures, and use should be reviewed if there is no benefit within a few months.
  • Caution is needed with concurrent antiplatelet or anticoagulant therapy and with strong CYP3A4 or CYP2C19 inhibitors.

Monitoring

Review symptomatic benefit after an initial treatment period and discontinue if walking distance has not improved.

Counselling the patient

  • This medicine aims to help you walk further before leg pain starts.
  • Headache, palpitations and diarrhoea can occur, especially early in treatment.
  • Report breathlessness, ankle swelling or an irregular heartbeat.

Evidence & guidelines

NICE guidance supports cilostazol as an option for intermittent claudication, based on trials showing modest improvements in pain-free walking distance.

Reference: NICE NG19 Peripheral Arterial Disease; EAU PAD Guidelines; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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