The recommended dosage of Pletaal is 100 mg b.i.d. taken at least half an hour before or two hours after breakfast and dinner. A dose of 50 mg b.i.d. should be considered during coadministration of such inhibitors of CYP3A4 as ketoconazole, itraconazole, erythromycin and diltiazem, and during coadministration of such inhibitors of CYP2C19 as omeprazole.
Patients may respond as early as 2 to 4 weeks after the initiation of therapy, but treatment for up to 12 weeks may be needed before a beneficial effect is experienced.
Intermittent Claudication: Special caution should be used for patients with a history of tachyarrhythmia who are being treated for intermittent claudication. Cilostazol should be initiated by physicians experienced in the management of intermittent claudication.
The physician should reassess the patient after 3 months of treatment with a view to discontinuing cilostazol where an inadequate effect is observed or symptoms have not been improved.
Also precautions must be used for patients with unstable angina pectoris, myocardial infarction within the last 6 months, or a coronary intervention in the last 6 months who are being treated for intermittent claudication. Patients receiving treatment with cilostazol should continue with their life-style modifications (smoking cessation and exercise), and pharmacological interventions (such as lipid lowering and antiplatelet treatment) to reduce the risk of cardiovascular events.
Discontinuation of Therapy: The available data suggest that the dosage of Pletaal can be reduced or discontinued without rebound (i.e., platelet hyperaggregability).