2.6.4 Peripheral vasodilators and related drugs

There is currently insufficient evidence to recommend the routine use of peripheral vasodilators.
See NICE CG147 on Lower Limb Peripheral Arterial Disease and ESC Guideline for the management of peripheral arterial and aortic diseases.
The use of vasodilators may increase blood flow at rest, but the few controlled studies carried out have shown little improvement in walking distance or sustained increase in muscle flow during exercise.
Symptoms in patients with intermittent claudication are often improved through the use of treatments and lifestyle interventions to reduce cardiovascular risk. First line advice is to exercise and stop smoking. Those remaining symptomatic may be considered for treatment with naftidrofuryl and assessed for improvement after 3 to 6 months (discontinue if no symptomatic benefit).
First-line management of Raynaud’s phenomenon includes avoiding exposure to cold and stopping smoking. A calcium channel blocker such as nifedipine m/r [off-label] may be useful for reducing the frequency and severity of vasospastic attacks.
Patients suffering intermittent claudication or Raynaud’s phenomenon should be specifically advised to exercise and stop smoking.

The MHRA Drug Safety Update December 2014 detailed the risk of cardiovascular and bleeding events linked to cilostazol (Pletal^®). Cilostazol is restricted to second line treatment under the guidance of a secondary care specialist and is contraindicated with some cardiovascular conditions and medicines.