Acalabrutinib
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Drug reference
Cilostazol
Phosphodiesterase-3 inhibitor (antiplatelet/vasodilator) · Peripheral vascular disease treatment
START
100 mg PO BID, ≥30 min before or 2 h after meals
TYPICAL MAX
200 mg/day (100 mg with potent CYP3A4/2C19 inhibitors)
STOP IF
Any heart failure, significant bleeding, severe tachyarrhythmia
WATCH
Cardiac status (exclude HF before start), bleeding, response at 12 weeks (stop if no benefit)
CDSCO approvedATC B01AC23
KDIGO 2024 + manufacturer label
- ONSET
- 2h · absorption
- PEAK
- 2.4h · Cmax
- t½
- 12h · plasma t½
- DURATION
- 12h · BID interval
EXCRETION
Hepatic CYP3A4/2C19; ~74% renal metabolites
route + CYP
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
Avoid — limited data; not for a non-life-threatening indication in pregnancy
FDA category + note
Top interactionssee all 12 →
- AcalabrutinibSevereDatabaseDDInter
- AmisulprideSevereDatabaseDDInter
- AmprenavirSevereDatabaseDDInter
- ApixabanSevereDatabaseDDInter
Available in India
42 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Inhibits PDE3, raising platelet and vascular smooth-muscle cAMP → reversible antiplatelet effect, arterial vasodilation and improved walking distance in claudication; also favourable effects on triglycerides/HDL.
Indications
Intermittent claudication (peripheral arterial disease) — improve symptom-free walking distance
Dosing
- Adult
- 100 mg PO twice daily, ≥30 min before or 2 h after breakfast and dinner; 50 mg BID with strong CYP3A4/2C19 inhibitors.
- Pediatric
- Not established.
- Renal adjustment
- No specific adjustment; limited data CrCl <25 — caution.
- Hepatic adjustment
- Severe hepatic impairment: contraindicated; mild–moderate caution.
- Geriatric
- No specific adjustment; assess bleeding/cardiac risk.
- Max dose
- 200 mg/day (100 mg BID); 100 mg/day with potent CYP inhibitors
Pharmacokinetics
Onset
Symptomatic benefit over 2–12 weeks
Peak effect
Cmax ~2.4 h (delayed by high-fat meal — take fasting-spaced)
Duration
BID dosing
Half-life
~11–13 h (parent + active metabolites)
Bioavailability
Increased ~90% by high-fat food (so dose between meals)
Protein binding
~95–98%
Metabolism
Hepatic CYP3A4 and CYP2C19 (active metabolites)
Excretion
Renal (~74%) and faecal (metabolites)
Contraindications
- Heart failure of any severity (boxed — PDE3 inhibitors increase mortality in HF)
- Active bleeding (e.g. peptic ulcer, intracranial)
- Severe hepatic impairment
- Hypersensitivity to cilostazol
Side effects
Common
Headache (common, dose-limiting)Diarrhoea/abnormal stoolsPalpitations/tachycardiaDizzinessPeripheral oedema
Serious
- Increased mortality in heart failure (boxed)
- Serious bleeding
- Severe tachyarrhythmia
- Thrombocytopenia/agranulocytosis (rare)
Pregnancy & lactation
Pregnancy
Avoid — limited data; not for a non-life-threatening indication in pregnancy
Lactation
Avoid (excreted in animal milk; bleeding risk)
Drug interactions
Amisulpride
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Amprenavir
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Apixaban
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Aprepitant
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Ardeparin
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Argatroban
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Arsenic Trioxide
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Atazanavir
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Avapritinib
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Bedaquiline
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Bepridil
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Related guidelines
Cardiovascular disease prevention
ESC · Cardiology · 2021
Primary prevention of cardiovascular disease
AHA · Cardiology · 2019
GI bleeding on antiplatelet or anticoagulant therapy
CSI · Cardiology · 2020
Coeliac disease
OTHER · Gastroenterology · 2016
Inflammatory bowel disease
OTHER · Gastroenterology · 2015
Ask House about Cilostazol
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: Goodman & Gilman 14e, Harrison 22e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19