Population pharmacodynamics of cilostazol in healthy Korean subjects

Jung, Yun Seob; Chae, Dongwoo; Park, Kyungsoo

doi:10.12793/tcp.2018.26.2.93

Cited by 2 publications

(2 citation statements)

References 23 publications

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“…Cilostazol’s pharmacokinetics do not appear to be meaningfully altered by patient age or sex, 78,79 and data from PAD patients do not suggest that race or ethnicity impacts the effectiveness of cilostazol for reducing claudication symptoms. 68,80,81 Genetic polymorphisms in hepatic P450 enzymes can affect cilostazol pharmacokinetics but not to the degree seen with platelet P2Y12 receptor inhibitors such as clopidogrel.…”

Section: Cilostazol Adverse Events Interactions and Contraindicationsmentioning

confidence: 96%

“…34,73 However, the increase in mortality with milrinone or similar drugs was relatively small (relative risk in a Cochrane Review, 1.17 [95% CI, 1.06-1.30]), 60,74,75 an analysis of the Cilostazol Safety Database did not find an increase in mortality with cilostazol in patients with heart failure, and other studies of administrative claims have likewise failed to show an association between cilostazol and mortality among patients with heart failure. 74,76,77 Cilostazol's pharmacokinetics do not appear to be meaningfully altered by patient age or sex, 78,79 and data from PAD patients do not suggest that race or ethnicity impacts the effectiveness of cilostazol for reducing claudication symptoms. 68,80,81 Genetic polymorphisms in hepatic P450 enzymes can affect cilostazol pharmacokinetics but not to the degree seen with platelet P2Y12 receptor inhibitors such as clopidogrel.…”

Section: Cilostazol Adverse Events Interactions and Contraindicationsmentioning

confidence: 99%

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Cilostazol for Secondary Stroke Prevention

Havenon

Sheth

Madsen

et al. 2021

Stroke

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Cilostazol is a PDE3 (phosphodiesterase III) inhibitor with a long track record of safety that is Food and Drug Administration and European Medicines Agency approved for the treatment of claudication in patients with peripheral arterial disease. In addition, cilostazol has been approved for secondary stroke prevention in several Asian countries based on trials that have demonstrated a reduction in stroke recurrence among patients with noncardioembolic stroke. The onset of benefit appears after 60 to 90 days of treatment, which is consistent with cilostazol’s pleiotropic effects on platelet aggregation, vascular remodeling, blood flow, and plasma lipids. Cilostazol appears safe and does not increase the risk of major bleeding when given alone or in combination with aspirin or clopidogrel. Adverse effects such as headache, gastrointestinal symptoms, and palpitations, however, contributed to a 6% increase in drug discontinuation among patients randomized to cilostazol in a large secondary stroke prevention trial (CSPS.com [Cilostazol Stroke Prevention Study for Antiplatelet Combination]). Due to limitations of prior trials, such as open-label design, premature trial termination, large loss to follow-up, lack of functional or cognitive outcome data, and exclusive enrollment in Asia, the existing trials have not led to a change in clinical practice or guidelines in Western countries. These limitations could be addressed by a double-blind placebo-controlled randomized trial conducted in a broader population. If positive, it would increase the evidence in support of long-term treatment with cilostazol for secondary prevention in the millions of patients worldwide who have experienced a noncardioembolic ischemic stroke.

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