Comparative Evaluation of Pentoxifylline, Buflomedil, and Nifedipine in the Treatment of Intermittent Claudication of the Lower Limbs

Abstract

In the light of the current controversy surrounding the use of hemorheologic and vasodilator drugs in the treatment of peripheral arteriosclerosis, a comparative study was designed in order to evaluate the efficacy of pentoxifylline, buflomedil, and nifedipine in 45 patients with peripheral arterial disease (Fontaine stage II). The patients in this prospective randomized study were divided into three groups: 15 patients received pentoxifylline treatment (1,200 mg/day), 15 were treated with buflomedil (600 mg/day), and 15 with nifedipine (60 mg/day). Response to treatment was assessed at the start of the study and after forty-five and ninety days, by clinical examination, Doppler test, strain test, and digital occlusion plethysmography using a strain gauge ring. Pentoxifylline was significantly more effective (P < 0.05) than buflomedil and nifedipine at ninety days in improving walking performance, resting toe pressure, resting and postexercise ankle/brachial pressure ratio, and basal/postischemic toe-pulse ratio. Significant differences within groups were also noted for initial claudication, toe peak-flow time, pulse reappearance time (PRT/2), and maximum postischemic flow time, together with significant intergroup variables. In conclusion, pentoxifylline proved more effective than the other drugs tested in: 1. improving distal pressure and resting microcirculatory blood flow; 2. increasing postexercise distal flow, ratios, and pressures and enabling faster recuperation of basal pulse rates; 3. increasing initial claudication distance in the strain test within the test group and achieving a greater absolute subjective claudication distance than that obtained using the other treatments.

Clarification of serotonin‐induced effects in peripheral artery disease observed through the femoral artery response in models of diabetes and vascular occlusion: The role of calcium ions

“…This effect can be surmounted in the presence of endothelial tissue, which likely produces factors that facilitate the entrance of calcium into smooth muscle cells. This “protective” effect of the endothelium towards nifedipine's potential to influence serotonin‐induced vascular effects may explain the lack of positive findings in clinical trials in which the use nifedipine for an improvement of PAD was investigated …”

“…28 This change in intracellular calcium trafficking is not specific to smooth muscle cells but can also occur in endothelial was investigated. [30][31][32] After performing experiments with nifedipine, ouabain was incubated in an organ bath to investigate the possible role of Na + / K + ATP-ase in smooth muscle calcium ion trafficking related to serotonin action. Ouabain is an endogenous cardiotonic steroid hormone produced in the adrenal cortex, 33 and it is believed to be involved in salt sensitivity and hypertension.…”

Medical Management of Intermittent Claudication

“…A study in Spain compared the efficacy of buflomedil, verapamil, and pentoxifylline. 51 Buflomedil and verapamil did not significantly change walking performance. Pentoxifylline, on the other hand, did significantly improve walking distance.…”

Tibetan Medicine: An Effective Botanical Supplement for Peripheral Vascular Circulation

“…The efficacy data of No. 28 in PAD patients have been compared with synthetic pharmaceuticals tested in similar clinical trial designs [17][18][19][20][21][22][23][24][25][26][27]. As a parameter for the comparative evaluation, a percent of increase in maximal walking distance from various treatments has been chosen.…”

“…Based on the comparison of the maximal walking distance, No. 28 emerges as an equal or superior therapeutic modality for treating PAD versus results with the following synthetic drugs: [17][18][19][20][21][22][23][24][25][26][27].…”