Cilostazol Pearl – Med List Review

We always need diagnosis and more information, but I like to analyze a medication list as an educational tool.  The med list review with some possible concerns to investigate:

  • Cilostazol 100 mg twice daily
  • Aspirin 81 mg daily
  • Propranolol 80 mg twice daily
  • Captopril 25 mg three times daily
  • Pantoprazole 40 mg daily
  • Ropinirole 0.5 mg daily
  • Alendronate 70 mg weekly

The first thing that jumps out to me is that propranolol and captopril are not used all that often for hypertension.  Captopril is an ACE Inhibitor but it really isn’t used very often as there are numerous ACE Inhibitors that don’t need to be dosed multiple times per day.  It would be interesting to know why this patient is on it versus another one?

Propranolol is kind of a jack of all trades in that it can have a bunch of different indications.  I would be looking to identify what indication it is being used for.

Remember that cilostazol is recommended to be given on an empty stomach (30 minutes before or 2 hours after meals), which can be a little bit of a challenge sometimes as it is dosed twice daily.  The day alendronate is administered it may be even more challenging 🙂

One last question I would like to investigate; With the assumption that alednronate is being used for osteoporosis, why isn’t this patient on vitamin D supplementation and/or calcium?

Based upon your experience, what else should we investigate?

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  1. gaber

    why he is not on statin

  2. Liz

    Does the patient have a h/o congestive heart failure? If so, Pletal shouldn’t be used and propranolol should be changed to metoprolol succinate, bisoprolol or carvedilol.
    Also, is pantoprazole necessary? It often gets added and never removed. Another possibility is the patient is not taking the alendronate correctly and the esophageal irritation is mistaken for GERD. This seems less likely but since you work in a long term care facility, I’d be concerned about the patient remaining upright for 30 minutes AND taking the meds with a FULL glass of water.

  3. Julia Pheifer

    Beta blocker plus ace inhibitor often given for heart failure. Prevents remodeling of heart (thickening and increasing size)

    • Eric Christianson

      good comments!

  4. Shaun

    Propranolol in not preferred in HF, preferred one is bisoprolol and that too in low dose, Patient on Ropinirole may be parkinson’s disease or restless leg syndrome, Cilostazol for intermittent claudication,

  5. Kristina

    As a pharmacy student I learn a lot from these posts, thank you, I enjoy reading them!

    • Eric Christianson

      Thanks Kristina…its kind words like that that keep me going!

      • Henry

        Thanks Eric for giving us some examples to think more about clinical as a whole. It is perfect for us as pharmacy students.

        • Eric Christianson

          Thanks Henry, enjoy doing it!


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Written By Eric Christianson

October 18, 2015

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