동맥혈관질환에서 파행[절뚝거림], 실로스타졸, Claudication due to PAD, cilostazol

실로스타졸은 혈소판 응집을 억제하는 phosphodiesterase inhibitor이며 파행 환자에서 걷는 거리를 개선시키지만 작용 기전은 알려지지 않은 direct arterial vasodilator입니다. 치료 이득은 치료 시작 4주 이후에 보고되었습니다. 복용은 식사 전 30분 전 또는 식후 2시간 후에 하며 그 이유는 높은 지방 식사가 흡수를 현저히 증가시키기 때문입니다. 딜티아젬과 오메프라졸, 포도쥬스와 같은 일부 약제, 음식은 동반 섭취시 실로스타졸의 혈청 농도를 증가시킬 수 있습니다. 실로스타졸은 추가적 출혈 시간 증가 없이 아스피린 또는 클로피도그렐과 함께 안전하게 복용할 수 있습니다.

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Cilostazol — Cilostazol is a phosphodiesterase inhibitor that suppresses platelet aggregation and is a direct arterial vasodilator, but its mechanism of action for improving walking distance in patients with claudication is not known. Benefits to therapy are noted as early as four weeks after the initiation of therapy. Cilostazol (100 mg twice daily) should be taken a half hour before or two hours after eating, because high-fat meals markedly increase absorption. Several drugs such as diltiazem and omeprazole, as well as grapefruit juice, can increase serum concentrations of cilostazol if taken concurrently. Cilostazol may be taken safely with aspirin and/or clopidogrel without an additional increase in bleeding time. Side effects for cilostazol noted in clinical studies included headache, loose and soft stools, diarrhea, dizziness, and palpitations. Nonsustained ventricular tachycardia has been reported. Because other oral phosphodiesterase inhibitors used for inotropic therapy have caused increased mortality in patients with advanced heart failure, cilostazol is contraindicated in heart failure of any severity.

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The efficacy of cilostazol has been demonstrated in several meta-analyses. In one of these, 2702 patients with stable moderate-to-severe claudication who received cilostazol (100 mg cilostazol twice daily for 12 to 24 weeks) were compared with placebo. Significantly greater increases in maximal walking distances (MWDs) and pain-free walking distances (PFWDs) were seen in patients treated with cilostazol (MWD: 67 versus 50 percent increase from baseline, PFWD: 40 versus 22 percent). In a later systematic review that compared cilostazol with naftidrofuryl and pentoxifylline, cilostazol appeared to be slightly less effective than naftidrofuryl but more effective than pentoxifylline.

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REF. UpToDate 2019.09.22

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