page156
history of ventricular tachycardia, of ventricular
fibrillation and of multifocal ventricular ectopics,
prolongation of QT interval, congestive heart failure
Hepatic impairment
avoid in moderate or severe liver
disease
Renal impairment
avoid if eGFR less than 25 mL/
minute/1.73 m
2
Pregnancy
avoid—toxicity in
animal
studies
Breast-feeding
present in milk in
animal
studies—
manufacturer advises avoid
Side-effects
gastro-intestinal disturbances;
tachy-
cardia, palpitation,
angina,
arrhythmia, chest pain,
oedema;
rhinitis; dizziness,
headache;
asthenia;
rash,
pruritus, ecchymosis;
less commonly
gastritis,
con-
gestive heart failure, postural hypotension, dyspnoea,
pneumonia,
cough,
insomnia, abnormal dreams,
anxiety,
hyperglycaemia, diabetes mellitus,
anaemia,
haemorrhage,
myalgia,
hypersensitivity reactions
(including Stevens-Johnson syndrome and toxic epi-
dermal necrolysis in rare cases);
rarely
anorexia,
hypertension,
paresis,
increased urinary frequency,
bleeding disorders,
renal impairment,
conjunctivitis,
tinnitus,
and jaundice
Dose
. 100 mg twice daily (30 minutes before or 2 hours after
food)
Pletal
c
(Otsuka) A
Tablets
,
cilostazol 50 mg,
net price 56-tab pack =
£35.31;
100 mg,
56-tab pack = £35.31
INOSITOL NICOTINATE U
Indications
peripheral vascular disease; hyperlipid-
aemia (section 2.12)
Cautions
cerebrovascular insufficiency,
unstable
angina
Contra-indications
recent myocardial infarction,
acute phase of a cerebrovascular accident
Pregnancy
no information available—manufacturer
advises avoid unless potential benefit outweighs risk
Side-effects
nausea,
vomiting,
hypotension,
flushing,
syncope,
oedema,
headache,
dizziness,
paraesthesia,
rash
Dose
. 3 g daily in 2–3 divided doses;
max.
4 g daily
Hexopal
c
(Genus) U
Tablets
,
scored,
inositol nicotinate 500 mg,
net price
100 = £30.76
Tablets forte
,
scored,
inositol nicotinate 750 mg,
net
price 112-tab pack = £51.03
MOXISYLYTE U
(Thymoxamine)
Indications
primary Raynaud’s syndrome (short-term
treatment)
Cautions
diabetes mellitus
Contra-indications
active liver disease
Pregnancy
manufacturer advises avoid
Side-effects
nausea,
diarrhoea,
flushing,
headache,
dizziness;
hepatic reactions including cholestatic
jaundice and hepatitis reported to CSM
Dose
. Initially 40 mg 4 times daily,
increased to 80 mg 4
times daily if poor initial response; discontinue after 2
weeks if no response
Opilon
c
(Archimedes) A U
Tablets
,
yellow,
f/c,
moxisylyte 40 mg (as hydro-
chloride), net price 112-tab pack = £75.18.
Label:
21
NAFTIDROFURYL OXALATE
Indications
see under Dose
Side-effects
nausea,
epigastric pain,
rash,
hepatitis,
hepatic failure
Dose
. Peripheral vascular disease (see notes above),
100–
200 mg 3 times daily
. Cerebral vascular disease,
100 mg 3 times daily
Naftidrofuryl
(Non-proprietary) A
Capsules
,
naftidrofuryl oxalate 100 mg,
net price 84-
cap pack = £4.52.
Label:
25,
27
Praxilene
c
(Merck Serono) A
Capsules
,
pink,
naftidrofuryl oxalate 100 mg,
net
price 84-cap pack = £8.10.
Label:
25, 27
PENTOXIFYLLINE U
(Oxpentifylline)
Indications
peripheral vascular disease; venous leg
ulcers [unlicensed indication] (Appendix A8.2.5)
Cautions
hypotension,
coronary artery disease;
avoid
in acute porphyria (section 9.8.2);
interactions:
Appendix 1 (pentoxifylline)
Contra-indications
cerebral haemorrhage,
extensive
retinal haemorrhage,
acute myocardial infarction
Hepatic impairment
manufacturer advises reduce
dose in severe impairment
Renal impairment
reduce dose by 30–50% if eGFR
less than 30 mL/minute/1.73 m
2
Pregnancy
manufacturer advises avoid—no informa-
tion available
Breast-feeding
present in milk—manufacturer
advises use only if potential benefit outweighs risk
Side-effects
gastro-intestinal disturbances,
dizziness,
agitation,
sleep disturbances,
headache;
rarely flush-
ing,
tachycardia,
angina,
hypotension,
thrombocyto-
penia,
intrahepatic cholestasis,
hypersensitivity reac-
tions including rash,
pruritus and bronchospasm
Dose
. 400 mg 2–3 times daily
Trental
c
(Sanofi-Aventis) A U
Tablets
,
m/r,
pink,
s/c,
pentoxifylline 400 mg,
net
price 90-tab pack = £19.68.
Label:
21,
25
Other preparations used in peripheral
vascular disease
Rutosides (oxerutins,
Paroven
c
)
are not
vasodilators
and are not generally regarded as effective preparations
as capillary sealants or
for
the treatment
of
cramps;
side-effects
include headache,
flushing,
rashes,
mild
gastro-intestinal disturbances.
Paroven
c
(Novartis Consumer Health) U
Capsules
, yellow, oxerutins 250 mg, net price 120-cap
pack = £13.05
Dose
relief of symptoms of oedema associated with chronic
venous insufficiency,
500 mg twice daily
136
2.6.4 Peripheral vasodilators and related drugs
BNF 61
2
Cardiovascular system