Drugs used in peripheral artery disease

(PAD), intermittent claudication & enhancers

of local blood circulation

Agents used in anemias & hematopoietic

growth factors
Dr. Tibor Zelles
SU, Dept. Pharmacology and Pharmacotherapy
 Mechanism of action:
1.) vasodilatation (-R inhibition),
2.) rheology (blood viscosity ),
3.) influencing blood cells (red blood cell flexibility , platelet aggregation )

Therapeutic indications:
- local increase of blood flow in the skin (ulcus, gangrene, Raynaud disease)
- local increase of the blood flow of striated muscle (intermittent claudication)
- increase of the cerebral blood flow (prevention of acute brain ischemia
following vasoconstriction in subarachnoidal bleeding)
1). Nicergolin (ergot alkaloid)
M of Action (MA): -R inhibition, platelet aggregation , brain DA metabolism
IND: disturbances in blood supply of the brain, dementia, ischemic stroke rehabilitation.

2). Cinnarizine, flunarizine

MA: VGCCI (in smooth muscle), platelet. aggr. , red blood cell flexibility ; H antag.
IND: peripheral vasoconstriction, Mnire disease, profilactic in migraine.

3). Vinpocetin
MA: brain perfusion & metabolism
IND: disturbances in blood supply of the brain, memory problems

4). Pentoxifylline (dimethylxanthine)

MA: blood viscosity , red blood cell flexibility , platelet. aggr.
IND: arteriosclerotic & diabetic circulation problems in the periphery, eye, ear and brain.
5). Nikotinic acid & its ester derivatives
MA: triglyceride level , vasodilatation
IND: arteriosclerotic circulation problems, vasospasm.

6). Bencyclan
MA: vasodilatation, red blood cell flexibility , platelet. aggr. , visceral spasmolytic
IND: peripheral (eg. Raynaud disease) & brain vascular disorders; visceral spasm.

7). Naftidrofuryl
MA: enhancer of peripheral circulation w/ complex mechanism of action
IND: peripheral circulation disorders, eg. Raynaud disease
Drugs used in venous and capillary circulation disorders

Increase of venous tone: dihydroergotoxin, rutoside.

Improve of capillary circulation disorders:

Ginkgo biloba extracts
Calcium dobesilate blood vessel wall permeability
For DM retinopath and for angiopathies.
Agents used in cytopenias
 Iron deficiency - microcytic anemia

p.o. iron preparations (3-6 months):

- ferrous sulfate
- ferrous fumarate
- ferrous gluconate

p.e. iron preparations (in case of serious malabsorption or bleeding):

- sodium ferric gluconate comples
- iron dextrane
- iron sucrose complex
Homocysteine-S-methyltransferase
Homocysteine S-methyltransferase
 B12 (cobalamin) deficiency
megaloblastic anemia (pernicious anemia)

Hydroxocobalamin (preferred more protein-bounded longer action ), Cyanocobalamin:

- i.m. almost all case are malabsorption

- p.o., intranasal spray or gel after remission achived by i.m.; when inj. refused
 Folic acid deficiency
megaloblastic anemia; congenital neural tube defects

Folacin (folic acid):

- p.o. well absorbed

- p.e. - rare
 Anemia (esp. chr. renal failure; HIV; cancer)

Epoetin alfa:

- i.v. / s.c.

- toxicity: hypertension, thrombotic complications

Darbepoetin: glycosylated; long-acting, 1x/week

Methoxy polyethylene glycol-epoetin beta: 1-2x/month

 Neutropenia

Filgrastim (recombinant human G-CSF):

- s.c., daily

- adverse effect: bone pain

Pegfilgrastim: pegylated; long-acting

Sargramostim (recombinant human GM-CSF [stimulates granulocytic-, erythroid- &

megakaryocyte progenitors])
 Thrombocytopenia (cytotoxic chemotherapy)

Oprelvekin (recombinant IL-11): for cytotoxic chemotherapy induced thrombocytopenia

- s.c. daily

Romiplostim (peptide thrombopoietin receptor agonist): for chr. immune thrombocytopenia

- s.c.

Eltrombopag (non-peptide thrombopoietin receptor agonist): for chr. immune thrombocytopenia

- p.o.