Vasodilators - Peripheral

Peripheral vasodilators are medicines that are used to treat conditions that affect blood vessels in outer (peripheral) parts of the body such as the arms and legs. For example, peripheral arterial disease and Raynaud's phenomenon. They ease the symptoms of these conditions by dilating the blood vessels, preventing them from becoming narrower (constricting). These medicines are usually only prescribed after self-help measures have been tried and symptoms do not improve.

What are peripheral vasodilators?

. Sometimes, if you cannot tolerate the side-effects of nifedipine, your doctor may consider prescribing a different calcium-channel blocker such as nicardipine, amlodipine, or felodipine. These medicines are not licensed to treat Raynaud's disease. Rarely, naftidrofuryl or inositol nicotinate may also be prescribed by some doctors to treat Raynaud's phenomenon.

When are peripheral vasodilators usually prescribed?

If your have intermittent claudication, a vasodilator is usually only prescribed if self-help measures such as exercise have not improved your symptoms and you do not wish to be considered for surgery. However, they do not work in all cases. Therefore, there is no point in continuing with these medicines if you do not notice an improvement in symptoms within a few weeks. If your symptoms do not improve, your doctor will usually advise you to stop treatment. If symptoms improve, you can continue with treatment. Your doctor will usually review your treatment regularly to ensure that it is still being of benefit.

If you have Raynaud's disease, nifedipine is usually only prescribed after self-help measures (such as keeping the whole body warm, including the hands and feet, and stopping smoking) have been tried and your symptoms have not improved. Usually a short course of nifedipine is prescribed to begin with. This is in order to see if nifedipine will work for you.

How should I take peripheral vasodilators?

How you take nifedipine will depend upon the pattern of your symptoms and how well your symptoms improve with treatment. Some people take nifedipine regularly, each day, to prevent symptoms. Some people take nifedipine just during the winter, or just during cold weather spells. Most people start off with a low dose. If necessary, the dose may be increased. Nifedipine is available as a short-acting preparation and this is usually taken up to three times a day. It is also available as a long-acting preparation which is taken once a day.

All the other vasodilators are taken every day. Depending on the medicine that has been prescribed, this can vary between 2-4 times each day. For example, cilostazol is usually taken twice a day and moxisylyte four times a day.

What are the possible side-effects?

Most people who take peripheral vasodilators have no side-effects or only minor ones. It is not possible in this leaflet to list all the possible side-effects for these medicines. However, see below for a list of the most common side-effects. For more detailed information, see the leaflet that comes with the medicine packet.

Nifedipine - because nifedipine relaxes and widens arteries, some people develop flushing and headache. These tend to ease over a few days if you continue to take the tablets. Mild ankle swelling is also quite common and constipation is quite a common side-effect. You can often deal with constipation by increasing the amount of fibre that you eat, and increasing the amount of water and other fluids that you drink. Other side-effects are uncommon and include: feeling sick, palpitations, tiredness, dizziness, and rashes. Serious side-effects are rare.

Naftidrofuryl - the most commonly reported side-effects are feeling sick, skin rash, stomach pains, and diarrhoea. On rare occasions, some people taking naftidrofuryl have developed a liver disorder. If you notice any yellowing of your skin or the whites of your eyes, speak with your doctor straightaway.

Cilostazol - the most common side-effects include headache, and diarrhoea. Less common side-effects include dizziness, weakness, feeling or being sick, indigestion, tummy (abdominal) pain, fast heartbeat, chest pain, runny nose, bruising, swollen ankles or feet, skin rash and itching.

Inositol nicotinate - side-effects are thought to be uncommon, but may include flushing, dizziness, headache, nausea, vomiting, fainting, and rash.

Moxisylyte - the most common side-effects include mild nausea, diarrhoea, vertigo, headache, facial flushing and rash which may be encountered. On rare occasions, some people taking moxisylyte have developed a liver disorder. If you notice any yellowing of your skin or the whites of your eyes, speak with your doctor straightaway.

Pentoxifylline - the most common side-effects include nausea, vomiting, and dizziness which may occur. Uncommonly, some people experience fast or irregular heartbeat.

Other considerations

If you are taking nifedipine, do not drink grapefruit juice. This can interact with the medicine and alter its effect.

Can I buy peripheral vasodilators?

No - you cannot buy oral peripheral vasodilators; you need a prescription to obtain these medicines.

Who cannot take peripheral vasodilators?

Most people are able to take a peripheral vasodilator; however, in some cases these medicines are best avoided.

Nifedipine should not be given if you have severe damage to the heart muscle (cardiogenic shock), a valve in the heart that does not open fully (advanced aortic stenosis), within one month of a heart attack, or if you have acute attacks of angina.

Naftidrofuryl should not be given to people with a history of kidney stones.

Cilostazol should not be given to people with severe kidney or liver problems, heart failure, heart rhythm problems, uncontrolled high blood pressure, a stomach ulcer, surgery in the previous three months or a stroke in the previous six months.

Inositol nicotinate should not be given to people who have suffered a recent heart attack (myocardial infarction) or stroke.

Moxisylyte - is safe to use in most people.

Pentoxifylline should not be given to people who have had a stroke, extensive back of the eye (retinal) bleeding, a heart attack, and heart rhythm problems.

For more detailed information, see the leaflet that comes with the medicine packet.

How to use the Yellow Card Scheme

If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme. You can do this online at the following web address: www.mhra.gov.uk/yellowcard.

The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that medicines may have caused. If you wish to report a side-effect, you will need to provide basic information about:

  • The side-effect.
  • The name of the medicine which you think caused it.
  • Information about the person who had the side-effect.
  • Your contact details as the reporter of the side-effect.

It is helpful if you have your medication - and/or the leaflet that came with it - with you while you fill out the report.