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Precautions
Pletal is contraindicated in patients with congestive heart failure of any severity.

Pletal is contraindicated in patients with haemostatic disorders or active pathologic bleeding, such as bleeding peptic ulcer and intracranial bleeding. Pletal inhibits platelet aggregation in a reversible manner.

Pletal is contraindicated in patients with known or suspected hypersensitivity to any of its components.
In rare cases thrombocytopenia or leucopenia progressing to argranulocytosisi has happen when cilostazol was not discontinued.
There is limited information with respect to safety and efficacy when cilostazol and clopidogrel are used for peripheral arterial disease.
It is advised that patients check additive effect on bleeding times during concomitant administration with cilostazol and clopidogrel. Caution is advised for checking bleeding time during coadministration.

Precaution should be taken if patient has hepatic impairment. Special caution is advised when Pletal is used in patients with severe renal impairment.

Patients on dialysis have not been studied.

Since there are no adequate and well-controlled studies in pregnant women extreme caution should be used if you are pregnant or thinking about becoming pregnant while on this medication, it is advised that you speak with your doctor.

The safety has not been established on pediatric use of this medication.

In Geriatric use, there is no overall difference in terms of safety between younger and older subjects, however greater sensitivity in some older individuals cannot be ruled out.

Drug Interactions
The following drugs interact with Pletal: "blood thinners" (e.g., heparin, warfarin), other "anti-platelet" drugs (e.g., clopidogrel, dipyridamole, ticlopidine), drugs affecting the removal of cilostazol from your system (CYP 3A4 and 2C19 substrates, inhibitors and inducers such as azole antifungals, macrolide antibiotics, diltiazem, nefazodone, SSRI antidepressants, cimetidine, rifamycins, St John's wort, certain anti-seizure medications, esomeprazole, omeprazole).

Check all prescription and nonprescription medicine labels, if they contain any of the following they may interact negatively:
Nonsteroidal anti-inflammatory drugs or NSAIDs such as ibuprofen, naproxen, or aspirin) which can increase the risk of bleeding/anti-platelet effect when used with cilostazol. Low-dose aspirin (usually 81-325 milligrams per day) as prescribed by your doctor for specific medical reasons such as heart attack or stroke prevention should be continued. Please speak to your doctor before you discontinue any medication you are already on.

Adverse/Side Effects
Call your doctor at once if you have any of these serious side effects: severe headache; bloody urine, painful urination; fever, chills, body aches, flu symptoms; chest pain; feeling short of breath, even with mild exertion; or swelling of your ankles or feet.
Less serious side effects may include: fast or pounding heartbeats; diarrhea, vomiting; weakness, dizziness; leg cramps; numbness or tingling; joint pain; or cough, runny or stuffy nose.
Other unlikely but potential side effects include: neck rigidity, pelvic pain, retroperitoneal hemorrhage, arterial fibrillation, arterial flutter, cerebral infarct, congestive heart failure, heart arrest, hemorrhage, hypotension, myocardial infarction, myocardial ischemia, nodal arrhythmia, postural hypotension, supraventricular tachycardia, suncope, varicose vein, vasodilation, ventricular extrasystoles, ventricular tachycardia, anorexia, cholelithiasis, colitis, duodenal ulcer, duodenitis, esophageal hemorrhage, esophagitis, increased GGT, gastritis, gastroenteritis, gum hemorrhage, hmatemesis, melena, peptic ulcer, periodontal abscess, rectal hemorrhage, stomach ulcer, tongue edema, diabetes mellitus, anemia, ecchymosis, iron deficiency anemia, polycythemia, purpura. increased creatinine, gout, hyperlipemia, hyperuricemia, arthralgia, bone pain, bursitis, anxiety, insomnia, neuralgia, asthma, epistaxis, hemoptysis, pneumonia, sinusitis, dry skin, furunculosis, skin hypertrophy, urticaria, amblyopia, blindness, conjunctivitis, diplopia, ear pain, eye haemorrhage, retinal haemorrhage, tinnitus, albuminuria, cystitis, urinary frequency, vaginal haemorrhage, vaginitis. agranulocytosis, aplastic anemia, granulocytopenia, thrombocytopenia, leukopenia, bleeding tendency, torsades de pointes, QTc prolongation, gastrointestinal haemorrhage, pain, chest pain, hot flushes, hepatic dysfunction/abnormal liver function tests, jaundice, extradural haematoma, subdural haematoma, blood glucose increased, blood uric acid increased, platelet count decreased, white blood cell count decreased, increase in BUN (blood urea increased), blood pressure increase, intracranial hemorrhage, cerebral hemorrhage, cerebrovascular accident, pulmonary hemorrhage, interstitial pneumonia, hemorrhage subcutaneous, pruritus, skin eruptions including Stevens-Johnson syndrome, skin drug eruption (dermatitis medicamentosa) and subacute thrombosis. If experiencing an adverse reaction to this medication discontinue use and contact a health professional.

Overdose
The signs and symptoms of acute overdose are: severe headache, diarrhea, hypotension, tachycardia, and possibly cardiac arrhythmias.
In case of overdose immediately contact your local emergency room or poison control.

Storage Instructions
Store Pletal tablets at 25°C (77°F); excursions permitted to 15-30°C (59-86°F) 

 

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