Advise Please

[sbk]

Pletaal or Cilostazol is an anti-platelet drug. Is this the same as blood thinning medication? My father-in-law has been prescribed Pletaal by the dr on the mainland but it is unavailable here and apparently must be ordered from Bangkok.

He does have high blood pressure and recently had to undergo surgery after his broken arm was neglected by the local hospital (he had to have a steel pin inserted after the bone had to be rebroken and reset). My understanding is that he was forced to wait at the mainland hospital for nearly a week while they brought his blood pressure down. But, as we have all learned, getting health details out of some Thai people can be difficult .

He wants to know what its for and can he substitute it with something more readily available. I suggested he talk to the Dr here on the island but not sure how Dr friendly he is feeling after the last fiasco with his arm.

[Neeranam]

I'm just an amateur haemotologist.

See a doctor

http://www.aetna.com/products/rx/data/antiplateletcpb.html

[sbk]

These were prescribed by the Dr on the mainland. He is now getting low, does not want to have to go back to the mainland just for this. He is willing to get them sent down from Bangkok but would like to know what they are for.

Seems a simple enough request, to know what drugs you are taking and what they are for.

[lopburi3]

http://www.cardiacconsultants.com/antiplat.htm

It's a blood thinner like aspirin. I suspect he should ask doctor why he needs this medication rather than the normal baby or 81mg or so aspirin that most of use use (and are cheap).

[Totster]

Hi SBK, I don't know that particular drug, but to offer an opinion on substitutes...

Generics can be used as a cheaper ( and sometimes more readily available) alternative, but often they don't have the correct effect, or need higher dosage etc.. I say this from experience with using athsma medication

The only person able to advise you on the use of a generic is a doctor, so, my advice would be to get a second opinion, or at least ask the same doctor for alternatives

I'm assuming this drug is not generic BTW, apologies if I have assumed wrong

totster

[Neeranam]

They are not the same as drugs like warfarin, which are blood thinning ones.

http://www.mayoclinic.com/health/periphera...0537/DSECTION=8

[sbk]

Ha! Getting a 70 year old Thai man to ask the Dr why he's on it! Why do you think he's asking me?

In all seriousness, seeing he is on this makes me a tad worried. I am not sure if he is supposed to be on it continuously or if it was just something he was given in order to bring his blood pressure down for the surgery. My mother is on "blood thinners" and when she had surgery they took her off the meds so her blood would clot.

He has no faith in the local doctors after the fiasco with his arm (Xray tech was not in, so the doctor felt his arm and said, "probably not broken" --he is 70 years old and it was a direct hit from a coconut on his arm--he was getting them down btw)--so getting him to talk to the local doctor is highly unlikely. I will try to talk him into going back to the mainland and talking to the doctor that originally gave him the meds.

[Totster]

I understand the faith in doctors...

Whenever members of the family go, the get all kinds of pills, I try and find out what each one is, because no one explains, no labels etc.. I find it a little scary !

totster

[sbk]

I understand the faith in doctors...

Whenever members of the family go, the get all kinds of pills, I try and find out what each one is, because no one explains, no labels etc.. I find it a little scary !

totster

No kidding! I just talked to my husband about it, and he suspects (but will ask to make sure) that the mainland doctor just gave him two packets of the pills with no further explanation.

[cathyy]

I found this online:

Abstract:

Cilostazol (CLZ) was originally developed as a selective inhibitor of cyclic nucleotide phosphodiesterase 3 (PDE3). PDE3 inhibition in platelets and vascular smooth muscle cells (VSMC) was expected to provide an antiplatelet effect and vasodilation. Recent preclinical studies have demonstrated that CLZ also possesses the ability to inhibit adenosine uptake by various cells, a property that distinguishes CLZ from other PDE3 inhibitors, such as milrinone. After extensive preclinical and clinical studies, CLZ has been shown to have unique antithrombotic and vasodilatory properties based upon these novel mechanisms of action. CLZ was approved in 1988 for the treatment of symptoms related to peripheral arterial occlusive disease in Japan (Pletaal®) and in 1999 in the U.S. and in 2001 in the U.K. (Pletal®) for the treatment of intermittent claudication symptoms. Despite its remarkable antiplatelet properties, CLZ is not generally considered an antithrombotic agent in Western countries, perhaps due to the bulk of its antithrombotic preclinical and clinical development being conducted in Japan. In this review, the unique properties of CLZ are reviewed with the focus on CLZ as a unique antiplatelet agent targeting platelets and VSMC, demonstrating synergy with endogenous mediators and showing lowered risk of bleeding risk compared to other antiplatelet drugs.

Um, in English, it means it prevents small clumps of platelets from clogging the arteries in his arms and legs. This could have been merely a post-operative precaution to prevent a clot forming in his arm and heading to points more dangerous, like his heart or lungs. It could also be to treat a persistent condition (intermittent claudication) where, for example, he gets severe leg cramps after walking a relatively short distance, due to obstructed blood flow to the muscles in his legs.

Best he see the doc for clarification on whether to continue it.

[sbk]

Hi cathyy, thanks for the english translation

well, after telling hubby he needs to find out more information, he grilled his dad on this med. He has been taking it for quite some time, he is under the impression it is for his gout, which causes him tremendous pain in his legs. Before, the drug was covered under the health care scheme, now he must pay 1800 baht for a pack of 10 pills. Even for him, this is a bit much.

I will suggest he talk to his doctor and find out if there is a cheaper alternative he can take. He goes to see the doctor for his arm the day after tomorrow, so hopefully he can get this cleared up as well.

[lopburi3]

I expect Cathyy last para is the real reason he is using it - leg cramps. Gout is joint specific rather than sore legs AFAIK (and I have gout). If he is not taking allopurnalinol to reduce uric acid I suspect he just calls it gout because many have that ailment.

[sbk]

He is taking allopurnalinol as well. He most definitely has been diagnosed with gout. Previously he had kidney stones, now gout. Too bad I can't get him to up his water intake. So, in all likelihood, this med is for leg cramps not because of some impending stroke?

[lopburi3]

Sounds as if for the leg circulation problem. I don't know if aspirin is used for that specifically but it would be worth asking doctor I would think - especially if he goes off that medication the aspirin would at least help prevent heart attacks (unless he has reasons not to use). Perhaps a simple "could I use aspirin" would be accepted by the men in white?

[sbk]

Its worth a try. 1800 baht for 10 pills = 5400 baht a month (64,800 a year!). And that's just for this particular drug.

I will get hubby to talk to him today. Thanks for the info everybody. Glad to hear it isn't for an impending heart attack!