Indication:Intermittent claudication (Symptomatic treatment)
Cilostazol (Pletal): risks of cardiovascular and bleeding events-indication restricted to second-line treatment and contraindicated with some cardiovascular conditions and medicines.Furthermore, cilostazol is now contraindicated in patients with any of the following:
Unstable angina, recent myocardial infarction or coronary intervention (within 6 months)
a history of severe tachyarrhythmia
those receiving two or more other antiplatelet or anticoagulant treatments
For patients starting cilostazol, prescribers should assess benefit after 3 months of treatment, and should stop treatment if patients have not made clinically relevant improvements in walking distance. All patients who are currently receiving long-term treatment should be reassessed at a routine appointment, in light of the new advice.
MHRA Drug Safety Update April 2013
NICE CG 147 Lower limb peripheral arterial disease August 2012
Cilostazol, pentoxifylline and inositol nicotinate are not recommended for the treatment of intermittent claudication in people with peripheral arterial disease.
People currently receiving cilostazol, pentoxifylline and inositol nicotinate should have the option to continue treatment until they and their clinicians consider it appropriate to stop.
NICE technology appraisal guidance 223, Cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent claudication in people with peripheral arterial disease