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Peripheral vasodilator Pregnancy: There is no evidence of the safety of Hexopal in human pregnancy nor is there any evidence from animal work that it is free from hazard. The use of Hexopal in pregnancy should therefore be avoided unless there is no safer alternative. (SPC 4.6)

Inositol nicotinate

Brand names: Hexopal

Inositol nicotinate is a peripheral vasodilator that has been used in the management of peripheral vascular disease such as intermittent claudication and Raynaud's phenomenon.

Adult dose

Dose: Symptomatic relief of severe intermittent claudication and Raynaud's phenomenon: 3 g daily (two Hexopal Forte 750 mg tablets twice daily); the dose may be increased up to 4 g daily if necessary
Route: Oral
Frequency: Twice daily (two 750 mg tablets per dose = 3 g daily)
Max: Up to 4 g daily if necessary (SPC: 'may be increased up to 4g daily')
Product: UK SPC via MHRA Products - HEXOPAL FORTE 750MG TABLETS, INOSITOL NICOTINATE 750MG TABLETS BP (PL068310148), Genus Pharmaceuticals Limited. SPC 2: 'Each tablet contains Inositol Nicotinate BP 750 mg.' SPC 4.1 verbatim: 'Hexopal is indicated for the symptomatic relief of severe intermittent claudication and Raynauds phenomenon.' Indication, route and population match. SPC 4.2 verbatim: 'Adults: The usual dose is 3g daily (two Hexopal Forte Tablets twice daily). The dose of Hexopal may be increased up to 4g daily if necessary. Oral administration.' The SPC does not state how the 4 g daily dose is to be divided into 750 mg tablets. The SPC gives an adult dose only - no paediatric dose, no renal or hepatic adjustment and no elderly-specific dose is printed. SPC 4.4: 'This product should be used with caution in the presence of cerebrovascular insufficiency or unstable angina.'

Dose adjustments

Renal

No renal dose adjustment is printed in the SPC.

Hepatic

No hepatic dose adjustment is printed in the SPC.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via MHRA Products — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Recent myocardial infarction (SPC 4.3)
  • Acute phase of a cerebrovascular accident (SPC 4.3)
  • Hypersensitivity to the active ingredient (SPC 4.3)

Side effects

  • Nicotinic acid can cause myalgia; the risk of myalgia due to lipid-lowering agents, especially statins, can be increased (SPC 4.8)
  • Uncommon: flushing, dizziness, headache, nausea, vomiting, syncope, paraesthesia, rash, oedema and postural hypotension (SPC 4.8)

Interactions

  • Warfarin: the risk of bleeding can be increased when taken concomitantly (SPC 4.5)
  • Lipid-lowering agents, especially statins: risk of myalgia can be increased (SPC 4.8)

Monitoring

  • Use with caution in cerebrovascular insufficiency or unstable angina (SPC 4.4)
  • Bleeding in patients taking warfarin (SPC 4.5)
  • Myalgia, particularly with concurrent lipid-lowering agents (SPC 4.8)

Clinical monograph

How it works

It is metabolised to release nicotinic acid (niacin), producing peripheral vasodilatation.

Prescribing in practice

  • Vasodilators are not a substitute for risk-factor modification and structured exercise in peripheral arterial disease, and clinical benefit is limited.
  • Avoid in patients with recent myocardial infarction or where vasodilatation could be harmful.
  • Use with caution in patients prone to hypotension or flushing.

Monitoring

Monitor for symptomatic benefit and vasodilatory adverse effects, reviewing the need to continue treatment.

Counselling the patient

  • Flushing and a feeling of warmth may occur.
  • Continue to exercise regularly and address smoking and other vascular risk factors.
  • Report if symptoms do not improve so treatment can be reviewed.

Evidence & guidelines

Evidence for peripheral vasodilators in claudication is weak, and NICE emphasises exercise and risk-factor management as the mainstay of treatment.

Reference: Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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