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5-HT2 Receptor Antagonist — Peripheral Arterial Disease (Intermittent Claudication) Pregnancy: Avoid — insufficient safety data

Naftidrofuryl Oxalate

Brand names: Praxilene

Adult dose

Dose: 200 mg 3 times daily with meals
Route: Oral
Frequency: 3 times daily
Max: 600 mg/day
Take with food and at least half a glass of fluid (reduces risk of oesophageal and renal oxalate calculi). Continue for minimum 3 months to assess efficacy. NICE recommends naftidrofuryl as first-line pharmacological therapy for intermittent claudication when supervised exercise has not led to satisfactory improvement.

Paediatric dose

Route:
Seek specialist opinion — not licensed in paediatrics

Dose adjustments

Renal

Use with caution in renal impairment — oxalate metabolite may precipitate in kidneys; ensure adequate fluid intake

Hepatic

Use with caution in hepatic impairment

Clinical pearls

  • NICE TA223 (2011): naftidrofuryl recommended as first-line pharmacological option for intermittent claudication — superior to placebo in improving pain-free walking distance and quality of life; preferred over cilostazol and pentoxifylline based on cost-effectiveness
  • Mechanism: 5-HT2 receptor antagonism in vascular smooth muscle and platelets — reduces platelet aggregation and vasospasm; also increases erythrocyte flexibility (rheological effect)
  • Must be taken with adequate fluid — oxalate metabolite forms calculi in concentrated urine or oesophagus if tablet retained
  • Supervised exercise programme remains first-line non-pharmacological treatment — naftidrofuryl added if exercise alone insufficient
  • Duration trial: at least 3 months required before assessing response; continue if clinically beneficial

Contraindications

  • Hypersensitivity to naftidrofuryl
  • Oxalate renal calculi history (relative)

Side effects

  • Nausea and GI upset (take with food)
  • Hepatitis (rare)
  • Oesophageal calculi (if taken without adequate fluid)
  • Renal oxalate calculi (rare)

Interactions

  • No significant pharmacokinetic interactions documented

Monitoring

  • Walking distance (pain-free and maximum)
  • Renal function and urinalysis (oxalate)
  • LFTs (rare hepatotoxicity)
  • Fluid intake advice at each review

Reference: BNFc; BNF 90; NICE TA223 (Naftidrofuryl for PAD); Cochrane Review: Oral Vasodilators for PAD; ESVS PAD Guidelines 2017. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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