Peripheral artery disease

Atherosclerotic disease of limb arteries, predominantly lower extremities. Presents with intermittent claudication, rest pain on progression, and trophic changes.

ICD-10 I73.92 drugs

Also known as: PAD, Peripheral vascular disease, PVD

Drugs used for this condition

AClopidogrelFirst line · Antiplatelet agents – P2Y12 receptor inhibitorsIn peripheral artery disease, clopidogrel is the preferred antiplatelet agent. Subgroup analyses from CAPRIE showed a particularly pronounced advantage over aspirin in this population. Dose is 75 mg daily.

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

FTolperisoneNot recommended · Centrally acting muscle relaxantFor decades tolperisone was prescribed in obliterative vascular disease: intermittent claudication, diabetic angiopathy, thromboangiitis obliterans, Raynaud's disease. The logic was to relieve vascular spasm. In the 2012 review the EMA judged the data for these indications limited and unconvincing and removed the vascular indications from European labels, leaving only post-stroke spasticity in adults. Work on peripheral artery disease runs differently: stopping smoking, structured walking, control of blood pressure, lipids and glucose, an antiplatelet drug, and revascularisation in critical ischaemia. A muscle relaxant answers none of that, while the risk of hypersensitivity reactions stays. If tolperisone has been suggested for circulation, consider seeking a second opinion.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit