Cilostazol Use in Patients with Diastolic Dysfunction

Contraindications and Precautions

• The American College of Cardiology states that cilostazol is contraindicated in patients with congestive heart failure of any severity, but not in those with grade II diastolic dysfunction alone 1
• The FDA black-box warning for cilostazol is based on increased mortality seen with other phosphodiesterase III inhibitors in heart failure patients, emphasizing the need to assess for clinical heart failure symptoms and signs before initiating cilostazol 1

Patient Selection and Monitoring

• The American College of Cardiology recommends assessing patient tolerance to cilostazol at 2-4 weeks after initiation and evaluating clinical benefit within 3-6 months to determine if long-term therapy is appropriate 1
• Approximately 20% of patients discontinue cilostazol within 3 months due to adverse effects, highlighting the importance of close monitoring 1
• Patients with diastolic dysfunction who develop clinical heart failure symptoms while on cilostazol should have the medication discontinued immediately 1

Clinical Decision-Making

• The American College of Cardiology guidelines acknowledge limited evidence in patients with heart failure with preserved ejection fraction, but the contraindication for cilostazol applies to "heart failure of any severity" due to concern for a class effect 1
• Cilostazol may be used in patients with grade II diastolic dysfunction without clinical heart failure, but careful patient selection and monitoring are essential given the drug's cardiovascular effects 1