chronic

Peripheral Arterial Disease

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 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 against6 documents

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

Verified date2026-08

Presentation reference

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

SourceStatPearls "Peripheral Arterial Disease" - disease-level clinical article

Presentation findings are traced to the source above.

Combination safety

Combination regimens

!! 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

ACETYLSALICYLIC ACID

Antiplatelet

Regimen: pad-secondary-prevention

1 of 2 - GIVE ALL TOGETHER

Strength75 mg

Formoral.solid

Adult dose and duration

75-100 mg once daily - long-term

Paediatric dose

Not indicated for pediatric peripheral vascular disease

Choice

The article names aspirin first among the antiplatelet options; clopidogrel is the alternative.

Dose 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.

Cautions

There is a gastrointestinal bleeding risk; co-prescribe a PPI if GI risk is high.
Avoid in active peptic ulcer disease.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
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 COMPANY (ADCO)	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

CLOPIDOGREL

Antiplatelet

1st line

Strength75 mg

Formoral.solid

Adult dose and duration

75 mg once daily

Paediatric dose

No paediatric dose is stated in the sources held for this drug.

Dose 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.

Cautions

Active pathological bleeding (eg, peptic ulcer, intracranial hemorrhage).

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
BLOTAGRIL 75MG 30 F.C. TABS.	MEDIZEN PHARMACEUTICAL INDUSTRIES	33.00 EGP (1.10/unit)
ITOLAVIX 75 MG 30 F.C. TABS.	SIGMA > INTERNATIONAL TRADING OFFICE	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 > EGYPHARMA-EGYPT	150.00 EGP (5.00/unit)
PLAVIX 75 MG 28 F.C.TABS.	SANOFI WINTHROP > SANOFI	311.00 EGP (11.11/unit)

LIPID LOWERING

ATORVASTATIN

Lipid lowering

Regimen: pad-secondary-prevention

2 of 2 - GIVE ALL TOGETHER

Strength40 mg

Formoral.solid

Adult dose and duration

40-80 mg once daily (or high-intensity statin therapy to achieve target LDL cholesterol reduction) - long-term

Paediatric dose

Specialist lipid clinic management required for pediatric familial hypercholesterolemia

Dose 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.

Cautions

Monitor hepatic transaminases and muscle symptoms.
Contraindicated in active liver disease and pregnancy.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
ECATROVA 40 MG 21 F.C. TABS.	GLOBAL NAPI PHARMACEUTICALS > M.N.-EGYPT	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 > ORGANO	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 > VIATRIS EGYPT	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

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose 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.

Cautions

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

CILOSTAZOL

2nd line

Strength100 mg

Formoral.solid

Adult dose and duration

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

Paediatric dose

Not indicated in children

Dose 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.

Cautions

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
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. > UNIPHARMA	48.00 EGP (2.40/unit)
CLAUDOL 100 MG 30 TAB.	DELTA PHARMA > ACTIVA THERAPEUTICS	90.00 EGP (3.00/unit)
CILOSORT 100 MG 30 TAB.	MULTICARE > PHARMACARE	93.00 EGP (3.10/unit)
PLETAAL 100 MG 20 TAB.	OTSUKA	160.00 EGP (8.00/unit)
CILOBIOGEN 100MG 10 SCORED TABS.	INTERNATIONAL DRUG AGENCY (IDI) > BIOCAPITAL PHARMA	13.20 EGP

RAMIPRIL

add-on - not a substitute

Strength10 mg

Formoral.solid

Adult dose and duration

2.5 mg once daily initially, titrated over 3-4 weeks to a target maintenance dose of 10 mg once daily - Long-term

Paediatric dose

Safety and efficacy in children have not been established and the SmPC makes no posology recommendation.

Dose 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.

Cautions

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.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
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.