Phosphodiesterase-3 Inhibitor (Antiplatelet/Vasodilator)
Pregnancy: C
Cilostazol
Brand names: Pletal
Adult dose
Dose: 100 mg twice daily
Route: oral
Frequency: twice daily
Max: 200 mg/day
Take 30 min before or 2h after meals; avoid grapefruit juice; contraindicated in heart failure (all grades)
Paediatric dose
Route:
Not licensed in children
Dose adjustments
Renal
No dose adjustment required; avoid if eGFR <25 ml/min
Hepatic
Avoid in moderate-severe hepatic impairment
Clinical pearls
- Licensed for intermittent claudication — 40–60% improvement in walking distance
- Must avoid in heart failure — milrinone-class effect; class III antiarrhythmic-like properties
- CASTLE trial supports use; benefit seen within 4–12 weeks — assess response at 3 months
Contraindications
- Heart failure (any class)
- Haemorrhage
- Severe hepatic impairment
- eGFR <25 ml/min
- Pregnancy
Side effects
- Headache
- Diarrhoea
- Palpitations
- Peripheral oedema
- Tachycardia
- Chest pain
Interactions
- CYP3A4/2C19 inhibitors (omeprazole, diltiazem — increase levels; reduce to 50 mg BD)
- Antiplatelets (increased bleeding)
Monitoring
- Walking distance assessment at 3 months
- Heart rate
- Signs of arrhythmia
Reference: BNFc; BNF 86; NICE NG97 PAD guidelines; CASTLE trial. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- DAPT Score · Coronary Artery Disease
- ARC-HBR Criteria for High Bleeding Risk in PCI · Coronary Artery Disease
- PRECISE-DAPT Score for Bleeding on DAPT · Coronary Artery Disease
- DAPT Score for Dual Antiplatelet Therapy Duration · Antiplatelet Therapy
- SMART Risk Score for Recurrent CVD · Cardiovascular Risk
- DAPT Decision Tool (Ticagrelor vs Clopidogrel) · Antiplatelet Therapy