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Am Fam Physician. 2022;105(4):366-367

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Clinical Question

Is cilostazol (Pletal) therapy safe and effective for improving walking distance in patients with intermittent claudication due to peripheral artery disease (PAD)?

Evidence-Based Answer

Cilostazol improves initial and absolute walking distances in patients with intermittent claudication secondary to PAD and appears to be equivalent in effect to pentoxifylline (Trental). Adverse effects of cilostazol include headache, diarrhea, dizziness, and palpitations.1 (Strength of Recommendation: A, meta-analysis with consistent results.)

Practice Pointers

PAD affects up to 12% of people 55 to 69 years of age and 20% of people older than 70 years.1 A sensation of heaviness and fatigue in the leg muscles, known as vascular claudication, is present in 60% of patients with PAD.2,3 Intermittent claudication secondary to PAD is an indicator of increased systemic atherosclerosis. Compared with age-matched controls, patients who experience intermittent claudication have a higher risk of amputation and cardiovascular mortality over five years.4

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These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at

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