Cilostazol
In brief
- In our pharmacy, you can buy cilostazol without a prescription, with delivery in 9â21 days throughout the United Kingdom. Discreet and anonymous packaging.
- Cilostazol is used to relieve walking discomfort from intermittent claudication in peripheral arterial disease. It is a phosphodiesterase III inhibitor with antiplatelet and vasodilator properties, increasing intracellular cAMP in platelets and blood vessels.
- The usual dose is 100 mg taken orally twice daily, typically at least 30 minutes before breakfast and dinner.
- It is administered as a filmâcoated tablet, commonly available in 100 mg strength (also 50 mg formulations), supplied in blisters or bottles.
- The onset of effect is gradual â some patients notice improvement within weeks, but it can take up to 12 weeks to achieve full benefit.
- The treatment is intended for longâterm use until symptom improvement; if there is no benefit after about 3 months, therapy should be reassessed and may be discontinued.
- Avoid excessive alcohol while taking cilostazol, as alcohol can worsen side effects such as dizziness, tachycardia and may increase bleeding risk.
- The most common side effect is headache.
- Would you like to try cilostazol without a prescription?
Basic cilostazol information
- INN (international nonproprietary name): Cilostazol.
- Brand names available in the United Kingdom: Pletal and generic cilostazol tablets, typically 100 mg in blister packs of 56 or 112.
- ATC code: B01AC23.
- Forms and strengths: Film-coated tablets in 100 mg and 50 mg strengths, commonly supplied in blisters (10, 14, 30, 56, 60, 100).
- Manufacturers in the United Kingdom: Otsuka Pharmaceutical (Pletal) and generic manufacturers such as Accord Healthcare, Mylan, Bluefish and EG Labo.
- Registration status in the United Kingdom: MHRA authorised prescription medicine.
- OTC / Rx classification: Prescription only (Rx) in the UK.
Legal status and availability in the UK
Cilostazol is a prescription-only medicine (POM) in the UK.
In our online pharmacy, cilostazol is available without a prescription, with discreet delivery to the United Kingdom in 9â21 days.
Clinical effectiveness in the UK
Patients commonly ask whether cilostazol will increase their walking distance and how it compares to physiotherapy or revascularisation.
In patients without significant cardiac comorbidity, cilostazol can improve painâfree walking distance and quality of life.
Treatment is usually initiated by vascular specialists, with followâup in community clinics.
Tolerability limits effectiveness for some patients, with headache and palpitations leading to discontinuation in a minority.
Outcomes assessed include:
- Painâfree distance
- Maximum walking distance
- Patient global impression of change and qualityâofâlife scores
Typical regimen used in practice is 100 mg twice daily, taken at least 30 minutes before breakfast and dinner.
Indications and expanded uses
People often ask "Is this only for leg pain from peripheral arterial disease?" and whether private clinics use it differently.
- Licensed indication
- Cilostazol is licensed to improve walking discomfort from intermittent claudication due to peripheral arterial disease.
- Offâlabel use
- Occasional offâlabel use occurs in private vascular clinics for microvascular symptoms or to improve graft patency, but robust evidence is limited and NHS prescribing for nonâlicensed uses is uncommon.
MHRAâauthorised indication is prescription only and limited to symptomatic intermittent claudication.
UK GPs typically defer offâlabel decisions to vascular specialists.
- Checklist for clinicians considering offâlabel use: evidence level, patient risk profile, monitoring plan, documented informed consent.
Composition and brand landscape
Patients often recognise Pletal but may receive a generic product at the pharmacy.
Cilostazol is supplied in filmâcoated tablets, most commonly as 100 mg strength and sometimes as 50 mg tablets.
| Brand | Strength | Packaging | Manufacturer |
|---|---|---|---|
| Pletal | 100 mg | Blister 56 or 112 | Otsuka |
| Cilostazol (generic) | 100 mg, 50 mg | Blisters (various counts) | Accord Healthcare, Mylan, Bluefish, EG Labo |
| Cilostazol Accord | 100 mg | Box of 60 | Accord Healthcare |
- Labelling cues to check: tablet strength, batch number and expiry date.
Contraindications and special precautions
One of the first patient concerns is, "Can this affect my heart?" which is why screening is essential.
Absolute contraindications are firmly established and must be checked before prescribing.
- Congestive heart failure (any grade) â absolute contraindication.
- Known hypersensitivity to cilostazol or excipients.
- Severe hepatic impairment â contraindicated.
- Severe renal impairment â contraindicated.
- Active bleeding such as peptic ulcer or intracranial haemorrhage.
- Pregnancy â contraindicated.
Relative cautions include history of arrhythmias, ischaemic heart disease and uncontrolled hypertension.
- Severity categories
- Mild hepatic impairment: caution and review.
- Moderate/severe hepatic impairment: contraindicated due to accumulation risk.
- Renal impairment: mild/moderate use with caution; severe impairment contraindicated.
Patient advice: do not drive if you feel dizzy or experience palpitations, limit alcohol when starting therapy and report any new cardiac symptoms immediately.
Pharmacists should check comorbidities using the NHS Summary Care Record and report suspected adverse reactions via the MHRA Yellow Card scheme.
Dosage guidelines
Patients typically ask "How should I take it and what happens if I miss a dose?" which should be covered at dispensing.
Standard adult dosing is 100 mg orally twice daily, taken at least 30 minutes before breakfast and dinner.
| Group | Recommended dose | Adjustments |
|---|---|---|
| Adults | 100 mg twice daily, â„30 minutes before meals | Standard regimen |
| Elderly | 100 mg twice daily | No routine initial adjustment; use caution with comorbidities |
| Hepatic Impairment | Not recommended in moderate/severe | Contraindicated in moderate/severe hepatic impairment |
| Renal Impairment | Use with caution in mild/moderate | Contraindicated in severe renal impairment |
Missed dose advice: take the missed dose as soon as remembered unless it is near the time of the next dose, and do not double up doses.
Overdose advice: seek immediate medical attention for symptoms such as tachycardia, hypotension or arrhythmia.
Pharmacists should document dosing instructions in NHS electronic records and counsel patients on timing relative to meals to optimise absorption and reduce GI side effects.
Interactions overview
Many patients want to know whether cilostazol is safe with statins, antibiotics or blood thinners.
Cilostazol is metabolised via CYP pathways, and strong CYP3A4 and CYP2C19 inhibitors or inducers can affect exposure.
Concomitant therapy with multiple antiplatelet agents or anticoagulants increases bleeding risk and requires close monitoring.
- Avoid or monitor closely with strong CYP3A4 inhibitors (for example some azole antifungals and certain macrolide antibiotics).
- Exercise caution with CYP2C19 inhibitors which may increase cilostazol levels.
- Concurrent antiplatelet or anticoagulant therapy increases bleeding risk.
- Avoid excessive alcohol when starting treatment as it may worsen side effects.
| Highârisk drug class | Practical action |
|---|---|
| Strong CYP3A4 Inhibitors (certain azoles, some macrolides) | Reduce dose to 50 mg twice daily or consider alternative therapy. |
| Anticoagulants / Multiple Antiplatelets | Assess bleeding risk and monitor closely if combined. |
| CYP2C19 Inhibitors | Reduce dose to 50 mg twice daily and monitor. |
Pharmacists should flag interactions at dispensing and record counselling in the NHS system.
Comparable medicines and prescribing preferences
Patients often ask why one medicine is chosen over another, especially between cilostazol, pentoxifylline and antiplatelets.
| Medicine | Indication | Mechanism | Efficacy for walking distance | Key risks |
|---|---|---|---|---|
| Cilostazol | Intermittent claudication | PDEâIII inhibitor; antiplatelet and vasodilator | Often superior to pentoxifylline for walking distance | Palpitations, tachycardia; contraindicated in heart failure |
| Pentoxifylline | Intermittent claudication | Haemorheologic agent improving blood flow | More modest benefit vs cilostazol | GI side effects; different safety profile |
| Clopidogrel (antiplatelet) | Secondary prevention of cardiovascular events | ADP receptor blocker | Not primarily for walking distance | Bleeding risk when combined with other agents |
NICE guidance (TA223) recommends naftidrofuryl oxalate rather than cilostazol or pentoxifylline for intermittent claudication, so cilostazol is mainly used on specialist advice when there are no cardiac contraindications; antiplatelets remain central for secondary prevention.
Shared decisionâmaking in NHS vascular clinics typically weighs walking benefit against the risk of palpitations and other side effects, with GPs referring to vascular teams when cardiac concerns exist.
Frequently asked questions
-
How quickly will cilostazol help my walking?
Many patients notice improvement within a few weeks but full benefit often appears by about 12 weeks.
-
Will it affect my heart?
Cilostazol can cause palpitations and mild tachycardia and is absolutely contraindicated in congestive heart failure; report chest pain or severe palpitations immediately.
-
Can I take it with my blood thinner?
Tell your prescriber if you are on an anticoagulant or multiple antiplatelets because combined use raises bleeding risk and requires monitoring.
-
What if I miss a dose?
Take the missed dose as soon as you remember unless it is close to the next scheduled dose, and do not double doses.
When to seek urgent care: seek urgent care for chest pain, sudden severe palpitations or signs of bleeding such as passing blood or unexpected bruising.
For urgent nonâlifeâthreatening queries patients are advised to contact NHS 111 and report adverse effects via the MHRA Yellow Card with help from their pharmacist.
Guidelines for proper use
Clinicians and pharmacists should start by explaining that cilostazol can improve walking distance but carries known cardiac risks.
Baseline assessment must include a clear history of heart failure, hepatic and renal function and a full medicines review.
Standard advice is 100 mg twice daily, taken at least 30 minutes before breakfast and dinner, and to stop treatment if serious cardiac symptoms occur.
- Pharmacist counselling checklist: confirm dose and timing, review contraindications, explain common side effects (headache, palpitations, diarrhoea), check interactions and arrange followâup.
- Documentation: record counselling in the NHS Summary Care Record or local pharmacy electronic records.
- Provide patient leaflets in printed or electronic form and advise on Yellow Card reporting for adverse events.
| Monitoring point | What to check |
|---|---|
| Baseline | History of heart failure, hepatic/renal function, current medicines |
| 4 Weeks | Tolerance, early side effects, adherence |
| 12 Weeks | Clinical benefit assessment; continue only if benefit observed |
Clinicians should document informed consent for offâlabel use and ensure followâup appointments are arranged through NHS clinics or patient portals.
Delivery across the United Kingdom
| City | Region | Delivery Time |
|---|---|---|
| London | Greater London | 9â21 days |
| Birmingham | West Midlands | 9â21 days |
| Glasgow | Scotland | 9â21 days |
| Manchester | Greater Manchester | 9â21 days |
| Leeds | West Yorkshire | 9â21 days |
| Edinburgh | Scotland | 9â21 days |
| Bristol | South West | 9â21 days |
| Newcastle Upon Tyne | North East | 9â21 days |
| Sheffield | South Yorkshire | 9â21 days |
| Cardiff | Wales | 9â21 days |
| Belfast | Northern Ireland | 9â21 days |
| Norwich | East of England | 9â21 days |
| Plymouth | South West | 9â21 days |
| StokeâonâTrent | Staffordshire | 9â21 days |
