Your Health

Medications for Peripheral Artery Disease (PAD)

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Medications are of some benefit in treating PAD and generally fall into two categories:

  • Medications that improve flow through narrowed arteries
  • Medications that thin the blood so that it does not clot as easily

Prescription Medications

Pentoxifylline

Antiplatelet agents

  • Clopidogrel
  • Ticlopidine
  • Dipyridamole
  • Cilostazol

Clot-busting drugs (thrombolytic drugs)

  • Recombinant tissue plasminogen activator (rt-PA, alteplase)

Anticoagulants

  • Warfarin
  • Heparin

Over-the-Counter Medications

Aspirin

Prescription Medications

Pentoxifylline

Pentoxifylline improves blood flow by lowering its thickness and making red blood cells more flexible.

Possible side effects include:

  • Indigestion
  • Nausea
  • Lightheadedness
Antiplatelet Agents

Common names include:

  • Clopidogrel
  • Ticlopidine
  • Dipyridamole
  • Cilostazol

Among the many antiplatelet agents currently available, cilostazol is the only one specifically labeled for use in the treatment of intermittent claudication. Significant improvements in walking distance have been noted with its use. Cilostazol should not be taken if you have heart failure .

Possible side effects include:

  • Headache
  • Runny nose, sore throat
  • Bowel changes
  • Increased bleeding risk
Clot-busting Drugs (Thrombolytic Drugs)

Common name: Recombinant tissue plasminogen activator (rt-PA, Alteplase)

Given by IV, this drug is only given to people in the hospital. These drugs may be used if you develop acute limb ischemia. This is a serious condition related to PAD where there is a sudden decrease in blood flow into a limb.

Of the several thrombolytic agents on the market, none is specifically FDA approved for treating peripheral vascular occlusion. These drugs work in the complex chemistry of blood clotting to dissolve the chemicals that hold blood clots together. But because there is a fine balance between blood clotting and blood thinning, thrombolysis must be very carefully controlled.

Possible side effects include:

  • Bleeding, especially in the area of stomach ulcers or recent surgical sites
  • Rare allergic reactions
  • Serious heart and lung events
Anticoagulants

Common names:

  • Heparin
  • Warfarin

Anticoagulants may be used if you develop acute limb ischemia. This is a serious condition related to PAD where there is a sudden decrease in blood flow into a limb. If this occurs, the doctor may give you an injection of heparin in the hospital. Once at home, an oral anticoagulant, such as warfarin, may be used.

These drugs work immediately to prevent blood from clotting, rather than dissolving a clot after it has formed. If you are at high risk of another blood clot, these medications may be needed.

Possible side effects include:

  • Bleeding
  • Allergic reactions
  • Too few platelets— thrombocytopenia

Over-the-Counter Medications

Aspirin

Aspirin is often used for circulatory diseases due to its safety, low cost, and proven effect at reducing heart attacks and other occlusive vascular diseases. Various doses may be prescribed by your physician. Lower doses are less likely to cause the gastrointestinal disturbances or bleeding ulcers common with higher doses.

Possible side effects include:

  • Indigestion
  • Peptic ulcers
  • Increased bleeding tendency
When to Contact Your Doctor
  • New or worsening symptoms
  • Medication side effects
  • Foot wounds that do not heal
  • Foot infections
Special Considerations

Whenever you are taking a prescription medication, take the following precautions:

  • Take them as directed—not more, not less, not at a different time.
  • Do not stop taking them without consulting your doctor.
  • Don’t share them with anyone else.
  • Know what effects and side effects to expect, and report them to your doctor.
  • If you are taking more than one drug, even if it is over-the-counter, be sure to check with a physician or pharmacist about drug interactions.
  • Plan ahead for refills so you don’t run out.

Revision Information

  • American Family Physician. Peripheral vascular disease: diagnosis and treatment. Am Fam Physician. 2006;73(11):1971-1976.

  • Hills AJ, Shalhoub J, et al. Peripheral arterial disease. Br J Hosp Med (Lond). 2009;70(10):560-565.

  • How is peripheral arterial disease treated? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/pad/treatment.html. Updated June 2, 2014. Accessed June 23, 2014.

  • Peripheral arterial disease (PAD) of lower extremities. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 13, 2014. Accessed June 23, 2014.

  • Prevention and treatment of PAD. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/More/PeripheralArteryDisease/Prevention-and-Treatment-of-PAD%5FUCM%5F301308%5FArticle.jsp. Updated February 26, 2014. Accessed June 23, 2014.

  • 11/18/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed.: Rooke TW, Hirsch AT, Misra S, et al. 2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;124(18):2020-2045.