Management of Peripheral Arterial Disease with Cilostazol and Pentoxifylline
Introduction to Pharmacotherapy
- The American College of Cardiology recommends cilostazol (100 mg twice daily) as first-line pharmacotherapy for all patients with lifestyle-limiting intermittent claudication from peripheral arterial disease, provided they do not have heart failure 1, 2, 3
- Cilostazol should be offered to all patients with lifestyle-limiting intermittent claudication who have failed or are concurrently receiving supervised exercise therapy 1, 2, 3, 4
Cilostazol Therapy
- The effective dose of cilostazol is 100 mg orally twice daily, which is more effective than 50 mg twice daily 5, 6
- Cilostazol improves maximal walking distance by 40-60% after 12-24 weeks of therapy 5, 6
- Cilostazol is contraindicated in patients with heart failure of any severity due to its potential adverse cardiac effects 1, 2, 5, 6
Pentoxifylline Therapy
- Pentoxifylline should only be considered as second-line therapy when cilostazol is contraindicated or not tolerated 1, 2, 3, 4
- The recommended dose of pentoxifylline is 400 mg orally three times daily with meals 5, 6
- Pentoxifylline has limited efficacy, with marginal and not well-established clinical effectiveness 1, 2, 3, 4
Treatment Algorithm
- Supervised exercise therapy should be implemented first, with cilostazol 100 mg twice daily started simultaneously or if exercise is inadequate, unless heart failure is present 1, 2, 3
- If cilostazol is contraindicated or not tolerated, pentoxifylline 400 mg three times daily should be considered 1, 2, 3, 4
- Inadequate response after 12-24 weeks of optimal medical therapy should prompt consideration of endovascular intervention 1, 2, 5