Intermittent claudication, treatment

The PDE3 inhibitor, cilostazol, has been used as an antithrombotic agent and is currently being used in patients being treated for intermittent claudication. Cilostazol is also used for the prevention of restenosis after treatments such as angioplasty. Another PDE3 selective inhibitor, milrinone, has been used in the treatment of congestive heart failure. Milrinone also has been shown to increase the conductance of the CFTR transporter in vitro. 

PI (adenosine) receptors were explored as therapeutic targets before P2 receptors. Adenosine was identified early and is in current use to treat supraventricular tachycardia. A2a receptor antagonists are being investigated for the treatment of Parkinson s disease and patents have been lodged for the application of PI receptor subtype agonists and antagonists for myocardial ischaemia and reperfusion injury, cerebral ischaemia, stroke, intermittent claudication and renal insufficiency. 

A systematic literature review showed ten controlled studies of ginkgo for treatment of intermittent claudication (Ernst 1996). Many studies... 

Ernst E. (1996). [Ginkgo biloba in treatment of intermittent claudication. A systematic research based on controlled studies in the literature]. Fortschr Med. 114(8) 85-87. 

Isoxsuprine has been used to arrest premature labor, where it is given in a loading dose of 0.2-1 mg/min for 10 minutes and then reduced to 0.1-0.3 mg/min [40, 41], It has been also used in the treatment of cerebral and peripheral vascular diseases [42], intermittent claudication [43], and obliterative arterial diseases [44]. 

Unlabeled Uses Prevention of postoperative deep vein thrombosis (DVT), protection of aortocoronary bypass grafts, reduction of graft loss after renal transplant, treatment of intermittent claudication, sickle cell disease, subarachnoid hemorrhage, diabetic microangiopathy, ischemic heart disease... 

Pittler MH, Ernst E. Ginkgo biloba extract for the treatment of intermittent claudication. A meta-analysis. Am J Med 2000 108 276-281. 

TREATMENT OF PERIPHERAL ARTERY DISEASE AND INTERMITTENT CLAUDICATION... 

Methylxanthines decrease blood viscosity and may improve blood flow under certain conditions. The mechanism of this action is not well defined, but the effect is exploited in the treatment of intermittent claudication with pentoxifylline, a dimethylxanthine agent. However, no evidence suggests that this therapy is superior to exercise conditioning. 

Treatment of patients with intermittent claudication on the basis of chronic occlusive arterial disease... 

Intermittent claudication decreases exercise capacity and overall functional capacity, Impaired walking ability is coupled with the inability to perform activities of daily living and results in a decrease in overall quality of life (60). Pharmacologic and nonpharmacologic measures aimed in improving mobility and consequently the quality of life is important treatment goals for patients with PAD,... 

Girolami B, Bemardi E, Prins MH, etal. Treatment of intermittent claudication with physical training, smoking cessation, pentoxifylline, or nafronyl a meta-analysis. Arch Intern Med 1999 ... 

Dawson DL, Cutler BS, Meissner MH, et al, Cilostazol has beneficial effects in treatment of intermittent claudication results from a multicenter, randomized, prospective, doubleblind trial, Circulation 1998 98 678-686,... 

Beebe HG, Dawson DL, Cutler BS, et al, A new pharmacological treatment for intermittent claudication results of a randomized, multicenter trial, Arch Intern Med 1999 159 2041-2050. 

Jacoby D, Mohler ER III. Drug treatment of intermittent claudication. Drugs 2004 64(15) 1657-1670. 

Mobler ER III, Hiatt WR, OlinJW, etal. Treatment of intermittent claudication with beraprost sodium, an orally active prostaglandin 12 analogue a double-blinded, randomized,... 

These elfects on cerebrovascular events and on intermittent claudication suggest that simvastatin and other elfective lipid-lowering treatments may have a general antiatherosclerotic elfect not limited to the coronary bed. Definitive evidence on the elfects of statin therapy in stroke prevention and peripheral vessel disease is likely to be provided by the Heart Protection Study (MRC/BHF Heart Protection Study Collaborative Group, 1999). As noted above, this UK study has randomized over 20,000 patients aged up to 80 to simvastatin 40 mg or placebo, and the 5-year treatment period is scheduled for completion in 2001. Among these patients are 3288 patients with a history of cerebrovascular disease. Because of its size and the broad array of patient types randomized, this study should also provide reliable evidence of the elfect of simvastatin on coronary morbidity and mortality in women, elderly patients, patients with low levels of LDL and HDL cholesterol, patients with peripheral vascular disease, and diabetic patients with or without coronary disease (MRC/BHF Heart Protection Study Collaborative Group, 1999). 

Comp PC. Treatment of intermittent claudication in peripheral arterial disease. Recent clinical experience with cilostazol. Today s Ther Trends 1999 17 99-112. 

Cariski AT. Cilostazol a novel treatment option in intermittent claudication. Int J Clin Pract Suppl 2001 (119) 11-18. 

EDTA treatment of intermittent claudication—a doubleblind, placebo-controlled study. J Intern Med 1992 231(3) 261-7. 

Extracts from the leaves of G. biloba are marketed in some countries for the treatment of cerebral dysfunction and of intermittent claudication. In a review it was concluded that seven out of eight controlled trials of good quality showed positive effects of G. biloba compared with placebo on the following symptoms memory difficulties, dizziness, tinnitus, headache, and emotional instability with anxiety (3). For intermittent claudication, the evidence for efficacy was judged unconvincing. 

Cameron HA, Waller PC, Ramsay LE. Drug treatment of intermittent claudication a critical analysis of the methods... 

Piribedil is a piperazine derivative, a dopamine receptor agonist, which has been mainly used for the treatment of depression and Parkinson s disease. It has also been recommended for the treatment of patients with intermittent claudication, without convincing evidence. 

More than 5 million (estimated range 4 to 7 million) adults age 40 years or more have PAD and 95% of individuals with PAD have at least one cardiovascular risk factor the majority of patients have multiple risk factors for CVD. Based on the PAD Awareness, Risk, and Treatment New Resources for Survival (PARTNERS) program, the prevalence of PAD in primary care practices is high, yet physician awareness of the PAD diagnosis is relatively low. In this cross-sectional study, PAD was detected in 29% of 6979 patients and 83% of the patients were aware of their diagnosis but only 49% of their patients physicians were aware. The reason for this observation is that patient self-report of symptoms and the use of questionnaires to detect PAD are not sufficiently sensitive and specific to reproducibly diagnosis PAD and the cardinal symptom of PAD, intermittent claudication, is present in the minority of patients (1 to 27%). A simple ABI measurement wiU identify a large number of patients with previously... 

---