# Peripheral Arterial Disease - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: Cilostazol 100 mg tablets SmPC sections 4.2-4.4 (eMC product 2609) · ESC Guidelines on Diagnosis and Treatment of Peripheral Arterial Diseases 2017 · UK eMC Atorvastatin 10 mg Film-coated Tablets SmPC section 4.2 Posology and method of administration (eMC product 13672) · eMC SmPC, Tritace 10mg Tablets (Sanofi), section 4.1 and 4.2 - Verified date: 2026-08 ## Verified against - Cilostazol 100 mg tablets SmPC sections 4.2-4.4 (eMC product 2609) - ESC Guidelines on Diagnosis and Treatment of Peripheral Arterial Diseases 2017 - UK eMC Atorvastatin 10 mg Film-coated Tablets SmPC section 4.2 Posology and method of administration (eMC product 13672) - eMC SmPC, Tritace 10mg Tablets (Sanofi), section 4.1 and 4.2 - Peripheral Arterial Disease - disease-level clinical article (peripheral-arterial-disease-clinical.txt) - Egyptian National Drug Formulary - Cardiovascular ## Treatment metadata - Acetylsalicylic acid — 75 mg — oral.solid - Atorvastatin — 40 mg — oral.solid - Referral & safety-netting (no drug therapy) - Clopidogrel — 75 mg — oral.solid - Cilostazol — 100 mg — oral.solid - Ramipril — 10 mg — oral.solid ## Complete treatment card ```text PERIPHERAL ARTERIAL DISEASE Sources: Cilostazol 100 mg tablets SmPC sections 4.2-4.4 (eMC product 2609) · ESC Guidelines on Diagnosis and Treatment of Peripheral Arterial Diseases 2017 · UK eMC Atorvastatin 10 mg Film-coated Tablets SmPC section 4.2 Posology and method of administration (eMC product 13672) · eMC SmPC, Tritace 10mg Tablets (Sanofi), section 4.1 and 4.2 Review status: REVIEWED against Cilostazol 100 mg tablets SmPC sections 4.2-4.4 (eMC product 2609), ESC Guidelines on Diagnosis and Treatment of Peripheral Arterial Diseases 2017, UK eMC Atorvastatin 10 mg Film-coated Tablets SmPC section 4.2 Posology and method of administration (eMC product 13672), eMC SmPC, Tritace 10mg Tablets (Sanofi), section 4.1 and 4.2, Peripheral Arterial Disease - disease-level clinical article (peripheral-arterial-disease-clinical.txt), Egyptian National Drug Formulary - Cardiovascular (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Buttock or thigh claudication suggests aortoiliac disease, while calf claudication points to femoropopliteal disease [claudication] - Foot or toe pain at rest that eases when the leg is hung down over the bed suggests critical limb ischemia [ischaemia] - Erectile dysfunction can be an early sign of the same underlying atherosclerotic process [erectile dysfunction] - Collateral vessels can keep milder disease symptom-free despite reduced arterial flow SIGNS - what you find (2) - Absent pulses, slow capillary refill, mottled skin, and a cool or cyanotic limb are exam findings of PAD [cold peripheries] - Wet or dry gangrene and black, dead-looking toes indicate advanced critical limb ischemia [gangrene · ischaemia] TESTS (6) - An ankle-brachial index of 0.90 or less defines PAD; below 0.50 signals severe disease or critical limb ischemia - An ABI above 1.40 suggests falsely stiff, calcified vessels, and a toe-brachial index below 0.70 is used instead - If resting ABI is normal but symptoms persist, a 20% or greater fall after exercise confirms exertional ischemia - A duplex PSV ratio over 2.0 indicates at least 50% stenosis, and over 4.0 indicates at least 75% stenosis - A monophasic Doppler waveform, instead of the normal triphasic pattern, indicates significant stenosis - Digital subtraction angiography remains the gold standard vascular imaging test IF NOT THIS - what else fits (3) - Neuropathic pain and musculoskeletal pain are also considered on the differential for exertional leg pain - Deep vein thrombosis and chronic venous disease are also on the differential for leg symptoms - Raynaud phenomenon and thromboangiitis obliterans are additional differentials to consider Source StatPearls "Peripheral Arterial Disease" - disease-level clinical article Status traced to the source above !! MULTI-DRUG REGIMEN - all 2 drugs are given TOGETHER. Not a choice between them. !! the regimen: Acetylsalicylic acid + Atorvastatin Rx: Antiplatelet | Lipid lowering | Main treatment ANTIPLATELET - choose one 1. ACETYLSALICYLIC ACID [1 of 2 - GIVE ALL TOGETHER] Adult 75-100 mg once daily - long-term Peds Not indicated for pediatric peripheral vascular disease Choice The article names aspirin first among the antiplatelet options; clopidogrel is the alternative. Source ESC Guidelines on Diagnosis and Treatment of Peripheral Arterial Diseases 2017 Why Aspirin is an antiplatelet agent used in peripheral arterial disease to lower the risk of cardiovascular events such as myocardial infarction and stroke, reflecting the systemic atherosclerotic burden that PAD represents. Caution There is a gastrointestinal bleeding risk; co-prescribe a PPI if GI risk is high. Avoid in active peptic ulcer disease. Egypt AGGREX 75MG 60 TABS. RAMEDA 33.00 EGP (0.55/unit) ASPOCID 75MG 20 TAB. CID 22.00 EGP (1.10/unit) ASPOCID 75MG 30 TAB. CID 33.00 EGP (1.10/unit) ASPIRIN-CHEMIPHARM 75 MG 30 CHEW.TABS. CHEMIPHARM 12.00 EGP RIVO 75 MG 30 CHEW. TABS. ARAB DRUG COM... 21.00 EGP ASPOCID PAEDIATRIC 75MG 30 CHEW. TABS. CID 35.00 EGP EZACARD 75 MG 30 E.C. TABS. MULTI-APEX 51.00 EGP 2. CLOPIDOGREL [1st line] Adult 75 mg once daily Peds No paediatric dose is stated in the sources held for this drug. Source Egyptian National Drug Formulary - Cardiovascular Why First-line antiplatelet agent recommended as an alternative to aspirin to lower the risk of myocardial infarction, stroke, and vascular death in peripheral arterial disease. Caution Active pathological bleeding (eg, peptic ulcer, intracranial hemorrhage). Egypt BLOTAGRIL 75MG 30 F.C. TABS. MEDIZEN PHARM... 33.00 EGP (1.10/unit) ITOLAVIX 75 MG 30 F.C. TABS. SIGMA > INTER... 54.00 EGP (1.80/unit) BORGAVIX 75MG 30 F.C. TABLETS BORG 66.00 EGP (2.20/unit) SIGAGREL 75MG 10 F.C. TAB. SIGMA 30.00 EGP (3.00/unit) CLOPACIRC 75 MG 30 F.C.TABS. COPAD PHARMA 117.00 EGP (3.90/unit) THROMBO 75MG 30 F.C.TAB. EIPICO 123.00 EGP (4.10/unit) PLATENOR 75MG 30 TAB. HI-PHARM > EG... 150.00 EGP (5.00/unit) PLAVIX 75 MG 28 F.C.TABS. SANOFI WINTHR... 311.00 EGP (11.11/unit) LIPID LOWERING 3. ATORVASTATIN [2 of 2 - GIVE ALL TOGETHER] Adult 40-80 mg once daily (or high-intensity statin therapy to achieve target LDL cholesterol reduction) - long-term Peds Specialist lipid clinic management required for pediatric familial hypercholesterolemia Source UK eMC Atorvastatin 10 mg Film-coated Tablets SmPC section 4.2 Posology and method of administration (eMC product 13672) Why Atorvastatin is a statin that lowers LDL cholesterol and helps stabilize atherosclerotic plaque; high-intensity statin therapy is recommended for patients with peripheral arterial disease to reduce cardiovascular risk. Caution Monitor hepatic transaminases and muscle symptoms. Contraindicated in active liver disease and pregnancy. Egypt ECATROVA 40 MG 21 F.C. TABS. GLOBAL NAPI P... 66.00 EGP (3.14/unit) SIGMALIP 40MG 10 F.C.TAB. SIGMA 32.40 EGP (3.24/unit) LIPICOLE 40MG 10 F.C.TAB. PHAROPHARMA 35.00 EGP (3.50/unit) ORGOVASTIN 40MG 14 F.C.TAB. ORGANOPHARMA ... 55.00 EGP (3.93/unit) TORVAST 40MG 7 F.C.TAB. EGYPHAR 38.00 EGP (5.43/unit) ATOR 40 MG 10 F.C.TABS. EIPICO 106.00 EGP (10.60/unit) LIPITOR 40 MG 7 TABS. PFIZER > VIAT... 113.00 EGP (16.14/unit) ATORSTAT 40MG 14 BISCORED TABS. DELTA PHARMA 76.00 EGP MAIN TREATMENT - choose one, plus any add-on marked below 4. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Peripheral Arterial Disease - disease-level clinical article (peripheral-arterial- disease-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Chronic limb-threatening ischemia (rest pain or tissue loss/nonhealing wounds) is the most severe form of PAD and carries a high risk of limb loss and death. RED FLAG - Refer for revascularisation (endovascular or surgical) when claudication is lifestyle-limiting and refractory to medical therapy, or when chronic limb-threatening ischaemia is present. RED FLAG - Acute limb ischemia (from in-situ thrombosis or embolism) as an emergency presentation in patients with underlying PAD is not flagged 5. CILOSTAZOL [2nd line] Adult 100 mg twice daily taken 30 minutes before breakfast and dinner x 3 months initial trial; discontinue if no improvement in walking distance, otherwise long-term under periodic review Peds Not indicated in children Source Cilostazol 100 mg tablets SmPC sections 4.2-4.4 (eMC product 2609) Why Phosphodiesterase-3 inhibitor indicated solely for symptomatic improvement of walking distance in lifestyle-limiting claudication; does not replace mandatory antiplatelet and high-intensity statin secondary prevention. Caution CONTRAINDICATED in congestive heart failure of any severity. Common side effects include headache, diarrhea, and palpitations. Reduce dose to 50 mg BID if co-administered with strong CYP3A4 or CYP2C19 inhibitors. Congestive heart failure rules it out completely, as does any history of ventricular tachycardia, ventricular fibrillation or multifocal ventricular ectopics. Also out: any bleeding tendency, active peptic ulcer, a haemorrhagic stroke within six months, an infarct or coronary intervention within six months, unstable angina, or two or more other antiplatelets and anticoagulants already running. Reassess at three months. If the walking distance has not improved, stop it rather than continue. Egypt CILOMEPATAL 100MG 20 TAB. MEPACO 30.00 EGP (1.50/unit) INFARCA 100 MG 30 F.C.TAB. DEBEIKY > ZAD 54.00 EGP (1.80/unit) STAZOLA 100MG 20 TAB. CHEMIPHARM 36.00 EGP (1.80/unit) SERCPROVE 100 MG 20 TAB. UNIPHARMA CO.... 48.00 EGP (2.40/unit) CLAUDOL 100 MG 30 TAB. DELTA PHARMA ... 90.00 EGP (3.00/unit) CILOSORT 100 MG 30 TAB. MULTICARE > P... 93.00 EGP (3.10/unit) PLETAAL 100 MG 20 TAB. OTSUKA 160.00 EGP (8.00/unit) CILOBIOGEN 100MG 10 SCORED TABS. INTERNATIONAL... 13.20 EGP 6. RAMIPRIL [add-on - not a substitute] Adult 2.5 mg once daily initially, titrated over 3-4 weeks to a target maintenance dose of 10 mg once daily - Long-term Peds Safety and efficacy in children have not been established and the SmPC makes no posology recommendation. Source eMC SmPC, Tritace 10mg Tablets (Sanofi), section 4.1 and 4.2 Why 29 live products. The SmPC carries an explicit cardiovascular-prevention indication - 'reduction of cardiovascular morbidity and mortality in patients with manifest atherothrombotic cardiovascular disease (history of coronary heart disease or stroke, or peripheral vascular disease)'. Every patient in this condition qualifies, and it is the one vascular-protection component the row is missing. Caution This reduces future cardiovascular events; it does not improve claudication distance - the cilostazol and exercise therapy do that. CONTRAINDICATED in pregnancy and in any previous angioedema on an ACE inhibitor or ARB. Contraindicated with sacubitril/valsartan and in bilateral renal artery stenosis - which is more likely in a patient who already has peripheral arterial disease, so check renal function carefully. Check creatinine and potassium 1-2 weeks after starting and after each increase; a creatinine rise of up to 30% is acceptable, more than that means stopping and investigating. Dry cough affects up to 1 in 10 - switch to an ARB rather than adding a cough suppressant. Do not combine with an ARB or aliskiren. Withhold during any dehydrating illness (vomiting, diarrhoea, heat) - sick-day rules. Egypt RECARDOPRIL 10MG 10 TABS. PHARCO 19.20 EGP (1.92/unit) RAMPITENSIVE 10MG 10 TAB. AMOUN 20.00 EGP (2.00/unit) RIGHT-ACE 10 MG 30 TAB. ADWIA 66.00 EGP (2.20/unit) RAMIPRIL 10 MG 7 CAPS. PHAROPHARMA 17.40 EGP (2.49/unit) RAMPECARDIN 10 MG 7 TABS EIPICO 24.00 EGP (3.43/unit) TRITACE PROTECT 10 MG 20 TAB. SANOFI 132.00 EGP (6.60/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)