Indications: intermittent claudication in patients without rest pain and no peripheral tissue necrosis

Cautions: atrial or ventricular ectopy, atrial fibrillation, atrial flutter (contra-indicated if severe); stable coronary disease; diabetes mellitus (higher risk of intra-ocular bleeding); surgery; concomitant drugs that increase risk of bleeding (contra-indicated with concomitant use of 2 or more antiplatelets or anticoagulants)

Note: Blood disorders Patients should be advised to report any unexplained bleeding, bruising, sore throat, or fever. A blood count should be performed and the drug stopped immediately if there is suspicion of a blood dyscrrs. Patients should be advised to report any unexplained bleeding, bruising, sore throat, or fever. A blood count should be performed and the drug stopped immediately if there is suspicion of a blood dyscrasia Contra-indications: predisposition to bleeding (e.g. active peptic ulcer, haemorrhagic stroke in previous 6 months, proliferative diabetic retinopathy, poorly controlled hypertension); history of severe tachyarrhythmia; prolongation of QT interval; unstable angina; myocardial infarction in previous 6 months; coronary intervention in previous 6 months; congestive heart failure

Hepatic impairment: avoid in moderate or severe liver disease

Renal impairment: avoid if eGFR less than25 ml/minute/1.73 m2

Pregnancy: avoid—toxicity in animal studies Breast feeding: present in milk in animal studies— manufacturer advises avoid

Side Effects: diarrhoea, nausea, vomiting, dyspepsia, flatulence, abdominal pain, anorexia, tachycardia, palpitation, angina, arrhythmia, oedema, rhinitis, pharyngitis, dizziness, headache, malaise, rash, pruritus, ecchymosis; less commonly gastritis, myocardial infarction, congestive heart failure, postural hypotension, dyspnea, pneumonia, cough, insomnia, abnormal dreams, anxiety, hyperglycaemia, diabetes mellitus, anaemia, haemorrhage, myalgia; rarely increased urinary frequency, bleeding disorders, thrombocythaemia, renal impairment; also reported hypertension, pyrexia, hot flushes, thrombocytopenia, agranulocytosis, leucopenia, pancytopenia, aplastic anemia, hepatitis, conjunctivitis, tinnitus, Stevens-Johnson syndrome, toxic epidermal necrolysis.

Dose: 100 mg twice daily 30 minutes before food Note : Reduce dose to 50 mg twice daily with concomitant use of clarithromycin, erythromycin, itraconazole, or omeprazole, or with potent inhibitors of cytochrome P450 enzymes CYP3A4 or CYP2C19.