Cilostazol (Pletal)

1. Precautions

1.1. Bleeding precautions- use electric razor in place of bladed razors, use a soft toothbrush, avoid straining with bowel movements Fall precautions- clear house of tripping hazards such as rugs and wires, adequate lighting, etc. If feeling lightheaded, dizzy, or faint, sit down immediately. Avoid taking medication with grapefruit juice.

2. Interactions

2.1. Food decreases medications absorbancy. Grapefruits and grapefruit juice may increase levels of the medication in the blood. Medication interactions include: fluconazole (antifungal meds), Erythromycin, clarithromycin, Ticlopidine, Diltiazem, omeprazole, Saquinavir, ritonavir, and enoxaparin.

3. Nursing Interventions

3.1. Implement fall and bleeding precautions. Educate patient on risks of the medication and reportable side effects.

4. Client Education

4.1. Educate patient to take the medication on an empty stomach- 30 mins before or 2 hours after eating and to avoid grapefruits and its juice. Teach them about maintaining fall prevention measures in the home to prevent falls, the increased chance of bleeding and bruising, reportable/concerning side effects such as chest pain/tightness, decreased urine output, dilated neck veins, heart palpitations, swelling of the face, fingers, legs, or feet, trouble breathing and extreme fatigue.

5. Evaluation of Medication

5.1. The medication is proven to be therapeutic and effective when the patient is able to walk further distances without experiencing pain.

6. Expected Pharmacological Action

6.1. Promotes vasodilation and antiplatelet activity by inhibiting phosphodiesterase III and increasing availability in cAMP. This increases blood flow in the extremities and leads to decreased pain, especially when walking.

7. Therapeutic Use

7.1. Used to treat intermittent claudication due to peripheral vascular disease.

8. Complications

8.1. Abnormal bleeding, easy bruising, red dots on skin, changes in bowel habits, dark or tarry stool, irregular HR (palpitations, bradycardia, tachy cardia), lightheadedness/fainting, breathing issues such as wheezing.

9. Medication Administration

9.1. Available in 50mg or 100mg oral tablets. To be taken with water 30 minutes before meals or 2 hours after eating. Usually prescribed to be taken BID. Avoid grapefruit juice.

10. Contraindications

10.1. Contraindicated in patients with heart failure, ischemic heart disease, liver, kidney, and heart diseae.