english.prescrire.org > Spotlight > Archives : 2009 > Intermittent claudication: smoking cessation, regular physical exercise and an antiplatelet drug

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Intermittent claudication: smoking cessation, regular physical exercise and an antiplatelet drug

Smoking cessation and physical exercise, especially walking, and taking antiplatelet drugs are the priority measures for intermittent claudication.

Intermittent claudication consists of an irregular gait (limping) accompanied by pain, cramps, stiffness and painful numbness. More often than not, intermittent claudication is the sign of a generalised vascular affection (atheromatosis), for which smoking cessation, regular physical exercise and taking an antiplatelet drug are the appropriate treatment.

Cilostazol, which is about to be commercialised for this indication, is a vasodilatator which has been on the market for 20 years in various countries. This class of medicines is extensive, but these drugs have an uncertain and at best modest effect on the symptoms, and offer no prevention against complications.

Compared with the placebo, cilostazol enables patients to walk only 50 metres further, 30 metres without pain. It causes sometimes severe adverse effects, in particular cardiovascular toxicity and haemorrhagic disorders. Worrying evidence suggests an increased risk of mortality. It interacts with numerous drugs and with food. It is better to avoid it and keep to tried and tested measures: smoking cessation and regular physical exercise.

©Prescrire January 2009

Source: "Cilostazol (Pletal°). Claudication intermittente : trop peu d'efficacité, trop de risques" Rev Prescrire 2008; 28 (302) 886-890.

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