From the Guidelines
Management of intermittent claudication in primary care according to NICE guidelines in the UK focuses on cardiovascular risk reduction, supervised exercise, and appropriate medication. The cornerstone of management involves lifestyle modifications including smoking cessation, which can significantly improve symptoms and reduce cardiovascular risk 1. Patients should be encouraged to participate in a supervised exercise program, ideally consisting of 2-3 sessions per week for a minimum of 3 months, with each session involving 30-60 minutes of walking exercise to the point of maximal pain tolerance.
Key Components of Management
- Antiplatelet therapy with 75mg aspirin daily or 75mg clopidogrel daily (if aspirin is contraindicated) should be prescribed to reduce cardiovascular events.
- Statin therapy, typically atorvastatin 80mg daily, is recommended to manage cholesterol levels.
- Blood pressure should be controlled to a target of <140/90 mmHg (<130/80 mmHg for patients with diabetes) using appropriate antihypertensives.
- For symptom management, naftidrofuryl oxalate 100mg three times daily can be considered if supervised exercise hasn't improved symptoms sufficiently and the patient still experiences lifestyle-limiting symptoms.
Referral to Specialists
Patients should be referred to vascular specialists if there is severe lifestyle limitation despite conservative management, rapidly progressive symptoms, suspected critical limb ischemia (rest pain, tissue loss), or if there's uncertainty about the diagnosis 1.
Importance of Supervised Exercise
Supervised exercise programs have been shown to be effective in improving functional status and quality of life, and reducing leg symptoms in patients with intermittent claudication 1. The benefits of supervised exercise are thought to be due to alterations in skeletal muscle metabolism, muscle hypertrophy, improvements in endothelial function, or altered gait, rather than the growth of new collaterals 1.
Regular Follow-Up
Regular follow-up is essential to monitor symptoms, medication adherence, and cardiovascular risk factors. This allows for timely adjustments to the management plan and ensures that patients receive optimal care.
From the FDA Drug Label
CLINICAL STUDIES: The ability of cilostazol to improve walking distance in patients with stable intermittent claudication was studied in eight large, randomized, placebo-controlled, double-blind trials of 12 to 24 weeks’ duration using dosages of 50 mg b.i.d. (n=303), 100 mg b.i. d. (n=998), and placebo (n=973). INDICATIONS AND USAGE Cilostazol tablets are indicated for the reduction of symptoms of intermittent claudication, as indicated by an increased walking distance.
The management of intermittent claudication in primary care according to the provided information is not explicitly stated. The text only discusses the efficacy of cilostazol in improving walking distance in patients with stable intermittent claudication, but does not provide guidance on the overall management of the condition in primary care, including lifestyle modifications, risk factor reduction, or other treatment options. Therefore, no conclusion can be drawn about the management of intermittent claudication in primary care according to National Institute for Health and Care Excellence (NICE) guidelines in the United Kingdom (UK) based on the provided drug labels 2 and 2.
From the Research
Management of Intermittent Claudication in Primary Care
According to the National Institute for Health and Care Excellence (NICE) guidelines in the United Kingdom (UK), the management of intermittent claudication in primary care involves:
- Supervised exercise therapy (SET) as the first-line treatment for intermittent claudication 3, 4, 5, 6
- SET programs should consist of at least two training sessions per week, each lasting over 30 minutes, during the first 3 months of a 1-year program 6
- The program should be tailored to individual patients' needs and may include a combination of exercises or only walking 6
- SET has been shown to improve walking distances, endothelial and mitochondrial function, muscle strength, and endurance, as well as overall quality of life 3, 5
Pharmacological Treatment
- Cilostazol, an antiplatelet treatment, has been shown to improve initial and absolute claudication distances in patients with intermittent claudication 7
- However, the use of cilostazol is associated with a higher risk of adverse side effects, such as headache, diarrhea, and dizziness 7