Pletal: Restore Mobility with Improved Blood Flow to the Legs
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Synonyms
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Pletal (cilostazol) is a prescription medication specifically formulated to alleviate the symptoms of intermittent claudication, a condition characterized by pain, cramping, or weakness in the legs during physical activity due to reduced blood flow. As a phosphodiesterase III inhibitor, it functions through a dual mechanism of action, promoting vasodilation and inhibiting platelet aggregation. This targeted approach directly addresses the underlying circulatory insufficiency in peripheral arteries, offering a pharmacological solution to increase pain-free walking distance. It is intended for use as part of a comprehensive management plan that includes supervised exercise and lifestyle modifications.
Features
- Active Pharmaceutical Ingredient: Cilostazol.
- Pharmacological Class: Selective phosphodiesterase type 3 (PDE3) inhibitor.
- Dual Mechanism of Action: Vasodilation of vascular smooth muscle and inhibition of platelet aggregation.
- Standard Tablet Strengths: 50 mg and 100 mg.
- Standard Dosing Regimen: Twice daily administration, taken at least 30 minutes before or 2 hours after breakfast and dinner.
- Prescription Status: Available by prescription only following a confirmed diagnosis.
Benefits
- Significantly increases pain-free walking distance, allowing for greater daily activity and independence.
- Improves maximal walking distance, enhancing overall functional capacity and quality of life.
- Reduces the symptoms of intermittent claudication, such as leg pain, cramping, and weakness.
- Offers a non-surgical pharmacological option to manage the progression of peripheral arterial disease symptoms.
- The dual mechanism provides a targeted approach to improving microcirculation in the affected limbs.
Common use
Pletal is indicated for the reduction of symptoms of intermittent claudication, a manifestation of peripheral arterial disease (PAD). It is used in patients whose symptoms are not sufficiently managed by exercise and lifestyle changes alone, such as smoking cessation. The drug is not intended to cure PAD but to improve functional outcomes and symptomatology. It is not indicated for use in patients with heart failure of any severity class.
Dosage and direction
The recommended dosage of Pletal is 100 mg taken orally twice daily. It is imperative to administer the dose at least 30 minutes before or 2 hours after breakfast and dinner to minimize the impact of a high-fat meal on absorption, which can significantly increase the drug’s bioavailability. For patients who may not tolerate this dose, a reduction to 50 mg twice daily is recommended. Treatment response is often observed within 4 to 12 weeks, though the full benefit may require up to 3 months of consistent therapy. The continuation of therapy should be reevaluated if no clinical benefit is evident after this period.
Precautions
- Pletal is contraindicated in patients with congestive heart failure of any severity. A thorough cardiovascular assessment is required prior to initiation.
- Use with caution in patients with known or suspected cardiac disease, including those with severe underlying arrhythmias or ischemic heart disease.
- Careful monitoring is advised in patients with moderate or severe hepatic impairment, as the metabolism of cilostazol may be altered; dosage adjustment may be necessary.
- Similarly, patients with severe renal impairment (creatinine clearance <25 mL/min) should be closely monitored.
- Pletal inhibits platelet aggregation; caution is warranted in patients with known bleeding tendencies, active pathological bleeding, or those taking concomitant anticoagulant or antiplatelet drugs.
- Discontinuation of Pletal is recommended prior to elective surgical procedures to mitigate bleeding risk.
Contraindications
Pletal is absolutely contraindicated in the following patient populations:
- Patients with congestive heart failure of any severity.
- Patients with a known hypersensitivity to cilostazol or any of the inactive ingredients in the formulation.
Possible side effect
Pletal therapy may be associated with several adverse reactions. The most common side effects (>10% incidence) include headache and diarrhea. Other frequently reported side effects (2-10% incidence) include:
- Abnormal stools
- Palpitations
- Tachycardia (fast heart rate)
- Dizziness
- Pharyngitis
- Rhinitis
- Infection
- Peripheral edema
- Nausea
- Flatulence
- Dyspepsia
- Abdominal pain Less common but more serious side effects require immediate medical attention and may include signs of serious bleeding (unusual bruising, bleeding gums, bloody or tarry stools), cardiovascular events (chest pain, severe dizziness), or severe allergic reactions (rash, hives, itching, difficulty breathing).
Drug interaction
Pletal has the potential for significant pharmacokinetic and pharmacodynamic interactions:
- Strong CYP3A4 Inhibitors (e.g., ketoconazole, itraconazole, erythromycin, clarithromycin, ritonavir, saquinavir): Concomitant use is contraindicated due to a significant increase in cilostazol exposure.
- Strong CYP2C19 Inhibitors (e.g., omeprazole, esomeprazole, ticlopidine, fluvoxamine): Concomitant use is contraindicated due to a significant increase in cilostazol exposure.
- Grapefruit Juice: Should be avoided as it inhibits CYP3A4 and can increase serum concentrations of cilostazol.
- Other Antiplatelet Agents or Anticoagulants (e.g., clopidogrel, aspirin, warfarin, dabigatran): Concomitant use increases the risk of bleeding.
- Other Blood Pressure Medications: Additive effects on blood pressure lowering may occur.
Missed dose
If a dose of Pletal is missed, it should be taken as soon as it is remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped. Patients should never take a double dose to make up for a missed one, as this increases the risk of adverse effects.
Overdose
In the event of a suspected overdose, medical attention should be sought immediately. Symptoms of overdose are likely to be severe extensions of the drug’s known pharmacological effects, including severe headache, diarrhea, hypotension, tachycardia, and cardiac arrhythmias. Given its effects on platelet function, bleeding is also a potential concern. Management is primarily supportive and symptomatic, as there is no specific antidote. Hemodialysis is unlikely to be effective due to the high protein binding of cilostazol.
Storage
Pletal should be stored at room temperature, between 20°C to 25°C (68°F to 77°F), in its original container. It must be kept away from excess moisture, light, and heat. The medication should be kept out of reach of children and pets. Do not use medication that is past its expiration date or shows signs of physical degradation.
Disclaimer
This information is intended for educational and informational purposes only and does not constitute medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay in seeking it because of something you have read here. The information provided is not exhaustive and may not cover all possible uses, directions, precautions, interactions, or adverse effects.
Reviews
“After three months on Pletal, my walking distance to the mailbox has more than doubled. The initial headaches were bothersome but subsided after the first few weeks. This has been a life-changer for maintaining my independence.” – Robert D., 72
“My cardiologist prescribed Pletal alongside a supervised walking program. The combination has been effective. I experienced some mild palpitations initially, which were monitored but eventually settled. It requires patience but is worth it for the functional improvement.” – Margaret T., 68
“While the medication did help with the leg pain, I had to discontinue use due to persistent gastrointestinal side effects (diarrhea and nausea) that did not resolve. My doctor is now exploring alternative options for my claudication.” – James K., 65
“The twice-daily dosing schedule is strict due to the food interaction, but I’ve built it into my routine. I’ve noticed a definite and measurable improvement in how far I can walk without stopping in pain. A very effective drug when used correctly.” – Eleanor S., 70